Dr. Alan Feller

LT, I don't remember you specifically, but I usually tell all patients in your situation more or less the same thing, so I want to reiterate what I probably said to you on here so you and other viewers know exactly where I stand on situations like yours. After poor hair transplant surgery most patients metaphorically find themeselves in the middle of a tunnel. The question then becomes, do you continue toward the end of the tunnel, or do you turn around and try to head back to the beginning? Those who are willing to give HT one more chance will forge ahead toward the end of the tunnel by doing a proper mega-session or two. The internet is full of posters who took this route successfully "to get out". There are, however, very few people who can turn around and run back to where they began. That is, HT surgery is not really reversable. Sometimes, if there were very few grafts used, the patient can get laser removal of hair and look almost untouched. But, this is not the case for most transplants. Then there is the donor scar issue. Many patients want to make the donor scar disappear as if it were never there. That almost NEVER happens. All strip surgery leave noticable donor scars if the hair is cut short enough. Even if FUE is packed in to the scar AND it grows with a high yield, the scar will still be visible, albeit harder to detect. FUE into scar should NOT be seen as a method to reverse the fact that there is, indeed, a donor scar present. One cannot "back out of the tunnel" using FUE into scar. Likewise, revising scar with "trichophylic closure" will also not "reverse" the presence of scar. Both of these methods MAY reduce the visibility or obviousness of the scar, but they will not cure it. LT, I'm not saying that you are of this mindset, but I have encountered it in many patient's who've had particularly objectionable work in the past and wish to "erase that past".Unfortunately it doesn't work that way and these patients may find they have run down an endless rabbit hole in search of a doctor or technique that doesn't really exist.

All hair transplant practices talk a good game. Almost all claim to be "the best" or "pioneering". However, I find a very precious few actually post thier RESULTS on a regular and ongoing basis. All the very worst clinics in the world PRIOR to internet exposure tauted their "experience", "credenitals", and "training". And these clinics produced some of the most pitiful results in the history of the hair transplant industry. These clinics, in fact, had a strangle hold on the field until independent clinics with a drive to excel broke their monopoly through consistent use of the internet. Consistent posting of patient results along with full transparency is the modern measure of an HT clinics worth. That's the whole purpose of this site and ones like it. Credentials and training are necessary to obtain licensure and a basic level of competence, but thanks to the internet they are no longer enough. NOW, doctors have a positive duty to participate on forums such as this one to demonstrate the level and CONSISTENCY of their skills. MOST HT clinics shutter at this reality and shy away. Why do you think this is?

My guess is that even a great FUE session won't make much of a dent. Believe it or not, probably the best thing to do is to punch out 3mm plugs from the donor area then refine them under the microscope to minigrafts and then implant into the alopectic area of the donor and the top. This patient needs VOLUME. Thankfully he has very curly hair which will cover the plug donor sites AND provide him with the serious volume he needs. Ironically, if his surrounding hair were thinner, then FUE might be useful, but the contrast in density would make FUE pointless, not to mention very expensive. Dr. Bernstein is probably the world leader in punching out old plug work so he is the number one main for this job as this experience will serve him well in performing the old syle plug work this patient needs. This would be a VERY RARE approach, but probably the best one: My approach would be to punch out as many plugs as possible from the donor area with as much space between them as possible. Then I would suture or staple each wound closed. That will minimize the visible scarring. Then refine the grafts (on purpose) only down to minigrafts, NOT FUs. Then implant in both areas. That gets around the non-stretch skin problem AND allows for maximum yield. Sometimes you have to look to old techniques to get around rare problems. Dr. Bernstein would probably be the best in the world for this approach in my opinion. His results should then be posted on the web for all to see.

I'm going to move to the new thread that Bill started, but I want to mention here and now that white dotting, or what some doctors wrongly call "depigmenting" most certainly CAN happen with punches smaller than 1mm in diameter. It's just that the CHANCES for obvious white dotting is DECREASED with the decreasing diameters. FUE is NOT a scar-free surgery. It produces MORE scar tissue by an order of 10 BUT, the scarring is more distributed and therefore harder to detect.

Without a doubt, IMO, the very best tools for an experienced FUE practitioner are the .8mm and .9mm diameter punches followed by further refinement of grafts under high power microscope. A novice FUE doctor may need to start with a 1mm punch, but after some practice they will find that a 1mm punch is no longer needed. You should start a new thread on this topic. Be interesting to see which FUE docs chime in. I've found that most don't want to discuss what size punches they use. Shine some light on this topic Bill. Dr. Feller

NG2B No, this hair doesn't thin to the point where it dies like MPB. I don't have any stats on it, but it is surely less than 5% incidence. Yes, additional hair is expected to thin as well. That's why you have to implant ALOT of it to get a good cosmetic effect. It must also be packed tightly. This may very well put the brakes on any plan to fill greater areas of scalp like the scalp later on because of the obvious limitations of a finite donor area. If this happened to clubhead he would still be well covered, just thinner. I don't get your last point.

I must admit that I can barely understand the story because of the missing names, but I DO understand the part where he was NOT told what punch sizes were to be used for his surgery. This is absolutely a crimson red flag, and Martinet did the right thing in backing off. Buying an FUE transplant without a written gaurantee as to the range of punch sizes is like buying a car without knowing what size engine is under the hood. When a clinic REFUSES to SHOW you the punches during surgery or REFUSES to allow you to videotape the procedure (should you want to), then you should RUN RUN RUN. There is no excuse for this behavior on the part of ANY clinic and until proven otherwise is an indicator that they are hiding the fact that they may be using larger punches than they may have led you to believe. We allow observers and cameras into the FUE suite IF the patient wants it with no problem. Most visitors only stay for a few minutes or shoot just enough footage to see how it's done and then get bored and leave. There's nothing to it IF you have nothing to hide. I have challenged EVERY high profile FUE megasession clinic to allow me to come in and observe their work and take pictures which I would then post on this site and others. NOT one clinic would allow it. NOT ONE! Now what does that tell you? I stand by my statement that ANY FUE surgery wherein the doctor uses any punch 1mm or larger is NOT FUE surgery, but just a baby version of the obsolete plug method. Until there are agreed upon standards and terminology in the FUE subspecialty of hair transplantaton, these clinics will keep using larger tools than necessary and the patients will have NO recourse. Bravo to Martinet. By being armed with knowledge he avoided a potential nightmare. The sheer arrogance of a clinic to demand him to sign a consent form without disclosing the tool sizes is disgusting and ILLEGAL. This gives us all a bad name in the HT industry. This is why you must do your research. ALL doctors claim they are the best or among the best. How do you know which are telling the truth? Go on sites like HTN and plug the name of the clinics you've visited into the search feature. If little or nothing good comes up then you know to keep searching for different doctors.

Spex put up Dai Vernon's portrait that I mentioned in my previous post. That is how he looks today Below are photos of how he looked when I first met him:

Make NO mistake about it. A person can lose some of his transplants over the years. It's not common, but it DOES happen. What can happen in a few patients is that the caliber of the transplanted hairs can actually thin noticably within 3 years of the transplant. I have no idea why this happens, but it is a definite phenomenon in few patients. The way to counter this graft thinning is simply to implant more grafts in the area. This happened to a patient of mine who used to post quite frequently. I performed two surgeries on him that gave him a thick tuft of hair in the front and top of the head. Then, about 2.5 years later he visited the office because of noticable thinning in the recipient area. We did one more transplant and that did the trick. He has no problem since. He posted a professional portrait of himself and signed off the internet to go on with his life. Making sure your transplant surgery is done right is just ONE aspect contributing to the final result. YOUR personal physiology plays just as important a role. The body does many seemingly qwirky and weird things and we are FAR from having all the answers. Fortunately, the overwhelming majority of patients have "average" physiologies that allow for significant cosmetic improvment after surgery. Dr. Feller Great Neck, NY

Dr. Ashfaq Ahamd (obviously a phoney alias), I see from viewing your past posts that you are an all talk and show nothing kind of guy. I've read your snide and negative comments on posts of other doctors as well so it's good to see you are an equal opportunity harasser, not just my own personal annoyance. Here's a quarter, go and offer your useless "surgical" advice to someone who cares. Dr. Feller

Navraj, While poor growth is a possibliltiy in all patients, it is too early to determine if you are such a patient at this stage. The further back on the scalp hair transplants are placed, the longer it takes for them to wake up and grow. As the other posters have written, give it more time and see how things wake up. Six months may seem like a long time to us, but to transplanted hair it isn't much time at all. Please keep us updated and either post more recipient area photos here online, or email them to info@fellermedical.com so I can gauge your progress for myself. Grow Well, Dr. F

"Public accountability of doctors" is the key phrase that describes the best way to gauge an HT doctor's abililities. Other things like academic testing also help, but only after a general and consistent consensus of "good" or "acceptable" has been establihed by the public. In the past this was, for the most part, impossbile and the "public" had to rely on the learned opinion of other doctors for valid referrals. But this is, as Pat already mentioned, the police policing the police-a clear conflict of interest that we've all had to live with. Now, however, the internet has made it very easy to publish patient results and for the public to have access to updated information on a REGULAR BASIS. If a doctor and his patients aren't publishing their results, then there is clearly something wrong. If a doctor isn't ENCOURAGING his paitents to post their results, then again, there is clearly something wrong. No matter how much information is published online about a general surgeon or internist, the layman will never be able to form an accurate picture because they lack the training and experience necessary to gauge these doctors abilities. However, ANY layperson can look at a cosmetic result of an HT doctor and ACCURATELY gauge success or failure. After all, the purpose of cosmetic surgery is to satisfy the COMMON eye as well as the professional eye. So in this rare instance, surgery may be more accurately judged by the public rather than professional collegues. Sites like HTN allow the common person to judge, whereas ABHRS ONLY allows the SELF-APPOINTED "professional" to judge. If the ABHRS had a forum in which it's member doctors were compelled to post photos and take criticism from the public and other collegues, then I would apply to take the "test" immediately and hopefully join. But such is not case, and until it is, what's the point of joining?

The ABHRS will have a shadow cast over it as long as it: 1.Deceptively uses the word "board" when the word "club" would be more appropriate. 2. It's members get caught falsely advertising their "board certification" as a recognized credential, which it is not. 3. Allows membership of doctors who consistenly produce poor or mediocre work. 4. Allows member who CLAIM to perform follicular unit transplants when in reality they do mini/micrografting. 5. Imply that their members are "elite" because they take a test that has little or nothing to do with hands on techniques. 6. Use a static evaluation system of a few cases per year as representative of a doctors work. Even the very worst HT doctors can produce 5 good photos of cases per year. The main problem with the ABHRS is the mentality that all one need do is pass a test to be considered "elite". That's laugable, but thats exactly what many of it's members claim. If the ABHRS wants to really impress the public with their "desire" to strive for excellence in hair transplantation, then they should post five cases per month on the internet for the world to see. THAT is the ultimate "certification" and one, unfortunately, that MANY ABHRS members shudder at. Most of the very best results of HT posted on the internet today were produced by non-ABHRS doctors. The percentage of ABHRS doctors and their patients who post their results online is also incredbily low. Why is this? The ABHRS should drop the word board from it's name and initiate a policy of posting 5 cases per MONTH on the internet. Then and only then can the public really trust the ability of their members doctors. Wait a moment, this has already been done by the Coalition and IAHRS. And while these two organizations may not be perfect, they are a whole lot more reliable than the sanctioning of a club whose criteria are a "test" and some photos every now and then.

B- HUGE improvement! You must be quite happy. Excellent work. Grow well. Dr. F

I have noticed a literal epidemic of patients visiting our office who've had mediocre to poor quality HT work in the RECENT past. Almost all of these people had one thing in the common: the clinics they picked did NOT perform dense pack surgery on them. What is even more sinister is that several clinics CLAIMED to have performed dense pack surgery when clearly they did not. Those who did not perform dense pack procedures claimed they were justified because the ultimate growth yield would be far lower due to damage to the blood supply. Will this false justification EVER go away? For those patients and doctors who still don't get it, it is OK to dense pack grafts IF, and only IF, small blades, GENUINE microscopic and ultra-refind methods are used CONSISTENTLY. Here is an example of an ultra dense pack only 4 months after surgery. For now forget about the incredible rate of speed with which this patient started growing, and focus on the area. In the before photo you can see a triangle was drawn around the perimeter of BALD skin in what I call a temple triangle. Use his large birth mark as a reference point. Then look at the bottom photo and see how dense this same area is only 4 month later after 70 grafts per cm sq were implanted into that area. Use the birth mark as a reference to compare to the before photo to confirm that this hairy area are actually grafts. When you look for an HT doctor PLEASE make sure they are advocates of DENSE PACKING. I will post "hairjet" case in few days with all photos, but I felt it would be very educational for newbies and veterans alike to see this result as a testiment to the NECESSITY of dense packing. Dr. Feller http://www.fellermedicaldata.com/images/hairjet/1.jpg

I have noticed a literal epidemic of patients visiting our office who've had mediocre to poor quality HT work in the RECENT past. Almost all of these people had one thing in the common: the clinics they picked did NOT perform dense pack surgery on them. What is even more sinister is that several clinics CLAIMED to have performed dense pack surgery when clearly they did not. Those who did not perform dense pack procedures claimed they were justified because the ultimate growth yield would be far lower due to damage to the blood supply. Will this false justification EVER go away? For those patients and doctors who still don't get it, it is OK to dense pack grafts IF, and only IF, small blades, GENUINE microscopic and ultra-refind methods are used CONSISTENTLY. Here is an example of an ultra dense pack only 4 months after surgery. For now forget about the incredible rate of speed with which this patient started growing, and focus on the area. In the before photo you can see a triangle was drawn around the perimeter of BALD skin in what I call a temple triangle. Use his large birth mark as a reference point. Then look at the bottom photo and see how dense this same area is only 4 month later after 70 grafts per cm sq were implanted into that area. Use the birth mark as a reference to compare to the before photo to confirm that this hairy area are actually grafts. When you look for an HT doctor PLEASE make sure they are advocates of DENSE PACKING. I will post "hairjet" case in few days with all photos, but I felt it would be very educational for newbies and veterans alike to see this result as a testiment to the NECESSITY of dense packing. Dr. Feller http://www.fellermedicaldata.com/images/hairjet/1.jpg

JR, Because there is no agreed upon terminology for FUE procedures it is difficult to have a conversation about it because key words mean different things to different people. Right now FUE is NOT a scientific discipline. It is art, and as art it is difficult to describe accurately. Unfortunately it is the lack of agreed upon definitions that allows ten different clinics to SOUND like they are offering ten different forms of FUE, when in fact they are mostly the same. That said I will move on to your questions the way I read them: NO it's not impossible to get fantastic numbers of FUE on certain patients. Dr. Jones and DHI were performing 2,000+ surgeries in a "day" as far back as 2003. But you are confusing terms: "Yield" refers strictly to successfully GROWING grafts. Obviously this can only be determined months after the procedure. "Extraction" is not the same as "graft". Sometimes you will get out a single follicle. Other times you may pull out 2 complete follicular unit. How do you count them? In the former you could equate one extraction with one graft. In the latter you coud equate one extraction with TWO grafts. Confusing, eh? Other confusing terms are "day" and "procedure". If a patient is worked on for 16 hours during a 24 hour "day" and does this twice, then there is plenty of time to remove literally thousands of grafts. This is what I've called "the brute force" method and has already been used by many fue clinics with little success and even less consistency of success. Right behind the etherial term "day" is "procedure". Some clinics will (wrongfully) claim that if a patient visits the operating room 3 or 4 days in a row that the patient had undergone just "one" procedure. I personally find this to be purposefully and wilfully misleading not only to the patient, but to the potential patients who might read the description of 3 days of surgery as ONE procedure. Trust me, if insurance companies were paying for the HT, these clinics would certainly NOT be calling 3 days of work just ONE procedure. REMOVING thousands of grafts over a 48 hour period using several teams is not impossible. Like I said, it has been done for years. The question is how well will all these grafts grow? What is the true "yield"? To date I have seen virtually no evidence that FUE megasessions can be counted on for CONSISTENT success when compared to strip. OF COURSE there will be successes, but how many patients in total were operated on to produce a few showcase patients? You as the general public will never know unless the clinic you are considering is fully transparent. How do you find out if a clinic is transparent? Simple, find out if the doctor and his technique have been peer reviewed. Then ask to watch a procedure and if you can bring a video camera. It doesn't get much more transparent then that. "Trauma" is another confusing term when applied to FUE, but yes, a larger area of skin will be traumatized and forced to reorganize itself after an FUE "insult". When you tally up the total surface of area of skin affected by the two procedures, FUE will total 10 times as much "trauma" as a comparable sized strip surgery. While this is not so much of a problem at the time of the FUE, it becomes a considerable issue only a few months after the fact because the skin will tend to harden due to the deposition of scar tissue around each hole. When these rings of scar tissue fan out, they ultimately coalese together to form a "sheet of scaring". Further FUE in skin like this is very difficult and the number of successful attempts drops. In other words, the fewer times you have to cut the skin, the better. This axiom serves the whole of the surgical field, not just FUE. It's also common sense. I agree that it is best to "strip" out a patient before moving to FUE. JR, I believe if something can be imagined, it can be done. So removing and re-implanting even 7,000 FUE grafts is possible. But in order to do so with consistent yields approaching strip requires a new paradigm and a hardy leap in technology. Again, this is possible, but I have seen no evidence of such a leap in technology nor consistency of FUE results. It WILL happen, and I for one hope it does soon. But for now I will remain skeptical about megasession FUEs and trust that smart and motivated people will keep working out the problems to bring FUE to the point where it can actually replace strip as the mainstream of hair transplantation. If I were to have another hair transplant tomorrow, you can safely bet the house that I would choose STRIP over FUE. But ten years from now...who knows? Dr. Feller

The "doctor compare" issue has raised it's head again. It's not suprising since we are all in competition in the final analysis. But we can't let this get the best of us. This thread is already getting a bit heated and that is the last thing any of need. It is also completely unnecessary in my opinion and misses the point. The issue isn't which DOCTOR is the best; the issue is which WORK is the best and most consistent. The former is very subjective, the latter is much closer to objective. Once you view doctors through this lens the need to compare doctors or worry about bias among doctors and reps diminshes considerably. Newbies can look at photos of results and immediate post op work and intuatively know which work is best when compared to average or below average work. From there they can track backwards and see which doctors they THINK are the best for THEM. All docs and reps should just keep posting their work and encouraging their patients to do the same. Nothing but nothing cuts through the noise of information and hype than consistently produced results. It IS a bit of an effort, but one that is well worth it to the clinic, the rep, and most of all the patients. Dr. Feller

JD, After looking at your photos IMO you MUST get a super dense pack on the hairline or you WILL be disappointed. This is because you have pretty good hair on the top. If your front isn't thick to the point of "puffy" your transplant WILL be very noticable. This asian patient I included in the link below went to a doctor who could not handle a large donor harvest and dense pack. Look at his before photos. The haze of hair you see are the transplant. They are NOT cut, that's how they look grown out. By dense packing him tightly with ALOT of grafts we were able to return him to well balanced head of hair No matter who you go to (Asian, Anglo, or Martian) If you don't see photos like this guy I did, then run. Because Asian hair is so low in density in the donor area you NEED someone who can remove a large amount of donor and then pack it tight into the recipient area http://www.hairrestorationnetwork.com/eve/showthread.php?t=154571 Best of luck, Dr. Feller Great Neck, NY http://www.fellermedical.com

Both products are equally useless, but atleast you paid less for yours.

Petesman, Any photos to share? I think if anyone is going to praise laser combs for regrowing hair they are obligated to show clear and credible photos. To date not a SINGLE user has provided any evidence that the "magical lasers" actually worked on them. Not a single one. But this is understandable considering they are following the example of the hairmax laser company who THEMSELVES have faild to show clear and credible photos. Shlock medicine and junk science still sell in America.

Laser combs are such a marginal "treatment" for hairloss that I'm surprised objections to it have gained so much traction on the internet. Perhaps it is the cost of these "devices" that makes it stand out against the backdrop of other magic potions purported and advertised to grow hair. The plain facts are that lasers cannot grow hair, nor has anyone provided a mechanism for such a miraculous claim once you get past the hype. Laser combs rely solely on junk science, supposed user tesitmonials, complicit reporters who are looking for a feel-good story but never ask to see actual before/after results of any cosmetic significance,shills, and salesmen. The truth is the truth and it doesn't matter who says it or how it's said. To date there are exactly NO credible before/after photos of patients who have benefited from the use of laser combs. So why would anyone buy one? If those on this thread are going to make claims that their laser comb works when nobody elses has, you don't have to explain why it works, but you are obligated to post your photos. Don't reject your common sense.

Thana, I would rather you NOT regularly rub any brush or comb over your transplant areas, so if you must use the laster comb, keep it away from the transplants. Not because of the laser, that won't do anything (include making hair grow), but because of the plastic teeth.

Sure B, of course your invited.

The problem is still physiological, however, when you are performing a small FUE session of say only 200 plus grafts, you can harvest from all over the head to find the most conducive areas. However, in a large FUE surgery you run out of room real fast. The problems with FUE increase exponentially as you increase the number of attempts. So a 1,000 graft FUE surgery isn't just twice as difficult as a 500 graft FUE but rather 4 times as difficult. The smaller the procedure, the more room you have to pick the best areas to harvest. That's why the novice should just focus on performing many smaller FUE procedures rather than going for 300 and up. Janna, I look forward to you and Dr. S. visiting when you find the time.