Dr. Alan Feller

Here are a few immediate post op photos: http://www.fellermedicaldata.com/images/stevo/1.jpg http://www.fellermedicaldata.com/images/stevo/2.jpg http://www.fellermedical.com/images/stevo/3.jpg

Felix, The skin is what decides the success of an FUE procedure. If the skin around the target follcile is mushy (like over cooked spaghetti) then the FUE will not come out intact. If this happens in greater than 30% of the attempts the procedure must be aborted. ALL FUE doctors, and I mean EVERY SINGLE one of them suffers from this possibility no matter how they are hyped or how they advertise. It is a universal and unavoidable limitation of the FUE procedure as it is known today. Thankfully I have only had to end an FUE procedure no more than 5 times. But this low number may be because I am very picky on whom I will accept for FUE. This prescreening may be making my numbers look better than they really would be if I just attempted FUE on everyone who wanted it. Janna, Thank you. The holes in the photo were made with a .9mm Feller Punch and are fresh. If I had taken a photo even one hour later those holes would be down to about .5mm. The majority of my lunchtime procedures are in the 200 to 300 graft range. Interestingly, I have found that I have never once had to abort a lunchtime procedure. I believe this is because I am fresh and focused on a low number. Psychologically it removes alot of stress and allows me to work more successfully even on what I would call "difficult" skin. Most of my FUE cases are pretty small, but I try to book one full day of FUE per every two weeks to do larger cases like 1000-1500 FUE in one sitting. I find if I spread the cases out this way the potential "burn out" rate is decreased and the quality is maintained. I really don't recommend "brute forcing" FUEs every day, or even every other day. Janna, the offer to teach you and Dr. S FUE is always open. It must be performed as a team with atleast one tech pulling them out. If you call the office you can set up a time to watch us do a few and then jump in if we can find a volunteer. We can video the session and post it right here on HTN.

Bill, Well said. I still agree with everything you wrote. Felix, I understand your disappointment, but NO doctor can tell how well an FUE will work out PRIOR to actually attempting it. Sure, there are doctors who CLAIM to, but NONE of them will allow a knowledgable witness into the room while they perform the procedure. The reason is pretty obvious. I have asked every doctor making this claim to allow me into their OR while performing FUE and NONE have invited me. In fact, the only doctors who have given me an honest invitation to watch their FUE are: Bernstein, Rahl, Lindsey, Alexander, Gabel,Jones, and Wong(when he was experimenting with them). Is it a coincidence that NONE of these well known doctors promise to hit a target FUE count? Of course not, because telling an FUE patient that they simply might not be a candidate BEFORE hand is simply the right thing to do. If the skin allows for it, we will max the session out. If it doesn't, other options have already been explored and agreed upon. Janna, I perform 3 FUE procedures per week. Most of the time they are of the smaller "lunchtime" variety which I have a hard time calling a "case" because they're so tiny compared to my strip cases. I call them lunchtime cases because I traditionally start them around lunchtime in my office (12:30p). Here are links to an FUE case I did just yesterday afternoon. This patient had an alopectic area from forcepts delivery during his birth. It always bothered him, but he didn't want to have a strip surgery to fill the area, so he opted for FUE. We dense packed 203 FUE grafts into the left temple: http://www.fellermedicaldata.com/FUE/cl/1.jpg http://www.fellermedicaldata.com/FUE/cl/2.jpg http://www.fellermedicaldata.com/FUE/cl/3.jpg Also, Janna, there is no question that the number of FUE procedures and the number of grafts therein will increase as the doctor becomes more and more practiced. FUE is identical to learning a musical instrument. At first it seems near impossible to do (try picking up a guitar for the first time and playing the opening to "stairway to heaven". It isn't going to happen. But over time it becomes second nature. It goes from frustrating to sastifying if the practitioner keeps tenaciously trying and practicing and never giving up. Once confidence is gained that the procedure is do-able AND the doctor realizes he can actually do it, it gets easier and faster. My first FUE attempts in 2002 literally almost made me rip my own hair out. I made training myself in FUE a "self imposed residency". I must have quit and said I would never try it again a dozen times. But I was always compelled to return to the challenge time and time again. When I realized it may not be ALL me, I started to focus on the instrumentation and decided to design my own. This got us around some problems, but not all of them. FUE is a blind procedure that relies on "feel". The ONLY way to develop "the touch" is to just keep doing them. The bigger the case becomes, the more you lose your feeling of touch and the quality begins to drop off. In strip surgery I found this occurs for the average experienced tech at about the point they've already cut around 400 grafts. In FUE it is about 400-500 FUE grafts for an experienced doctor. You should encourage Dr. S to get into FUE. My door is always open to him if he's interested.

No question that the photo B put up are holes made with a punch larger than 1mm. I'd say more like a 1.2mm or greater. If a clinic doesn't disclose what size instrument they are going to use on a patient then they are not giving "informed consent" and are breaking the law. State medical boards take informed consent VERY seriously, as do the courts. IMO, if an FUE clinic doesn't disclose the instrumentation they are using because they claim it's "proprietary" just leave the office. To date there are only 2 truly proprietary custom made FUE instruments in use today. One was made by myself back in 2002, and the other by Dr. Harris. We use our respective instruments on a regular basis and never once made the public or our patients guess what diameter the cutting surfaces were. IMO any clinic claiming they won't disclose the instruments they use is not only breaking the law, but using "proprietary" technology to hide something they don't want the public to know. Simple as that. FUE should be a transparent field and all technology disclosed. Any attempt to hide the actual instrumentation being used is an evasion until proven otherwise. So far, no clinic has proven otherwise. End the hype and make all FUE doctors accountable to their patients. As far as I'm concerned, all FUE cases should be videotaped by a third party to document how well each and every FUE graft comes out. If this ever became law, 99% of the FUE practitioners out there would no longer offer this meticulous procedure.

Balody, Actually, Thana is a man of few words in person. I didn't even realize how into literature he was until I started reading his posts and saw that one photo he posted in the gallery with one of his bookcases behind him. That must have been his summer reading material. He's never cussed in person, alway a perfect gentleman. Grow well Thana. Dr. F

Thank you for bringing this to my attention Spex. John, you should not be pulling anything out of your scalp, so stop that immediately. What seems like an inconsequential hair pull to you is actually very traumatic to the follicle. Removing hairs with tweezers and inspecting them is not routine for hair transplantation and any observation you make based on the look of these hairs has no bearing on the future growth of the transplants. The areas you referred to are more than likely NOT infected. Rather, at 3 months the hairs begin to grow into the new area of skin and the skin can become IRRITATED. Infection an irritation look the same at this point, but since the surgery was preformed 3 months prior (or more) the chances of infection are virtually zero. However, if you constantly touch these area with your fingers then you can initiate an infection. Stop focusing that closely on your hair and leave it alone. It knows what to do and doesn't need help or inspection. If you are very concerned then call Marcia and make an appointment for a follow up. Dr. Feller

It was good seeing you today Than, Here are your 13 days post op photos: http://www.fellermedicaldata.com/images/thanatopsis/12.jpg http://www.fellermedicaldata.com/images/thanatopsis/13.jpg http://www.fellermedicaldata.com/images/thanatopsis/14.jpg http://www.fellermedicaldata.com/images/thanatopsis/15.jpg http://www.fellermedicaldata.com/images/thanatopsis/16.jpg http://www.fellermedicaldata.com/images/thanatopsis/17.jpg http://www.fellermedicaldata.com/images/thanatopsis/18.jpg http://www.fellermedicaldata.com/images/thanatopsis/19.jpg http://www.fellermedicaldata.com/images/thanatopsis/20.jpg http://www.fellermedicaldata.com/images/thanatopsis/21.jpg

I would like to introduce my long time associate, mentor, and friend Dr. William Lindsey of Reston, Virginia. Dr. Lindsey has teamed up with me in a joint practice located in Reston, Virginia which he will operate as the managing partner and sole surgeon. Dr. Lindsey is a doubly board certified surgeon in Facial Plastic Surgery and Otolaryngology and has been practicing folluclar unit transplantation for 10 years. Dr. Lindsey was the first doctor to perform FUE in Virginia as well as the first to perform dense pack megasessions on a regular basis. His specialty are dense packed hairlines, plug repair, and scar repair. Dr. Lindsey has been working in my office in Great Neck regularly for the past 8 years learning our techniques of patient evaluation, dense pack megasessions as well as FUE. Likewise, I have been working in his office for the past 8 years learning plastic surgery techniques that he's applied to hair transplant surgery. His specialties are dense packed hairlines, plug repair, and scar repair. Most importantly, Dr. Lindsey's staff of technicians were trained by me and my technicians and are all qualified experts in microscopic disection of strip grafts and FUE grafts. Most of you don't know Dr. Lindsey because he spends little time on the internet, but now that I have introduced him to the boards he will be showcasing his work here as well as posting and answering questions. We have accumulated photos and video of Dr. Lindsey's work over the years and will be presenting them here and on other boards. I think you will all find that he is a top notch surgeon and a pure professional through and through. Dr. Lindsey's website will be overhauled in the next few weeks to provide far more information, photos, and videos of his patients and his work. To make an appointment to see Dr. Lindsey please call (number removed) (link removed) Dr. Feller

Balody wrote: "i certainly hope he had been drinking cos i didnt understand a word he wrote,he,ll be in surgery today but goodluck anyway than!" Balody, sometimes you crack me up! Thanatopsis you were a great patient. I know it's hard to sit still like you did all day, but I beleive you will agree it was well worth it in just a few months. Popping is when a graft or grafts pop out of the recipient site it was placed into usually due to the placement of another graft nearby. Incidence of popping will increase in skin that has been previous scarred by surgery or trauma. It will also increase in skin that has had alot of lumps, bumps, and "black and blue" marks in the past usually from sports trauma and horse play. Popping will also increase in patients who are anti-coagulated from medicines, heavy running before surgery, aspirin, vitamins, and alcohol. While a person who is somewhat anti-coagulated may bleed a bit more during surgery, thankfully I've never had to cancel a case because of it. The length of time a case may take toward completion may increase, but we have thankfully always been able to get the job done thanks to some countering techniques and teamwork.

By and large, cherry picking grafts using FUE is a myth. The simple truth is that when you target a follicular unit you really have no idea what's under the skin and what you are going to wind up with. Even if you do target what you think is a one hair graft, it may really be a two or even three hair graft with the other hairs in the sleeping phase. Or, you may target what you think is a 3 hair follicular unit, but in reality is a two hair FU with an extra hair coming from a neighboring follicular unit. Another problem with multi hair FUE targeting is that not all the follicles may come with the group when it's targeted because of the size of the punch and the splay of the follicles under the skin. I will agree, though, that the use of a larger punch will increase the chances of getting all the follicles when targeting multi-hair FUs. If, however, the punch exceeds 1mm in diameter, then in my opinion you are no longer performing FUE, but rather the old style plug work. Some patients cannot tolerate the thought of a strip procedure, so for these people we WILL use larger punches as longs as the ACKNOWLEDGE that they understand that it will leave depigmented and sometimes raised dots within the donor area. But again, this is NOT true FUE.

Thank you Richie, My best to you and yours. Careful on those motorcyles. Dr. F

Stop touching it! Your fingers are full of grease and bacteria. Grow well, Dr F

I second the recommendation for Dr Gabel to be admitted into the Coalition. He is an exceptional doctor and human being. I've operated side by side with him over the years and can say without reservation he is one of the very finest surgeons I've had the opportunity to work with. I hope to welcome him aboard the Coalition. Dr. Feller

Dhugh, It's been a while since I've seen you on here. I remember your case. It is an excellent example that demonstrates how all HT doctors and clnics are NOT alike. I posted a side by side comparison of what was done on you by another HT doctor and a similar patient I did at the same time. This is the difference between old style mini/micro graft work and dense pack TRUE follicular unit transplantation: http://www.fellermedicaldata.com/images/dhugh/1.jpg Best of luck Dhugh.

John, I don't know density off hand, but I rarely drop below 40-50 per sq cm on average. Hairlines are typically even higher. Dr F

Balody, You are dead on. I couldn't have summerized it better. If you click on the links in the first page you will see I put his before photos next to his recent 7 month after photos. The first few are with his hair wet in the after photos, the last one or two are with the hair dry. Excellent photography and he kept the angles almost exactly the same from before to after. I opted not to remove the plugs because, as Bill noted, it would have caused even more trouble. Plugs that size don't get removed without a fight, and he would have been left with yet even MORE scar. To me, the right thing to do was to fill in the gaps between the plugs on the hairline and behind. This would build the "foundation" that he needed. IF this does not satisfy him then, as noted by Bill, he would do one more round just in front with pure singles in a super dense pack. Had I started out by doing the front it would not have helped because of the space behind. H2 has been through the ringer and I don't blame him if his patience has worn thin. I'd feel the same way if I had 5 prior surgeries with his amount of hair and didn't reach my goal. The problem is there was no real continuity of care from procedure to procedure AND the techniques used on him were ancient. He's lucky he looked as good as he did. What saved him was that nice silky hair he has. Had he had a course thicker hair he would have been in some real trouble. It's been a long dark tunnel for him, but rays of daylight are beginnig to shine through and he should be able to put this all behind him.

Immediate post op photos of Hair2stay. Any hair in his old plugs were shaved to the skin with a straight razor. All visible hair on the hairline are solely transplants: http://www.fellermedicaldata.com/images/hair2stay/8.jpg http://www.fellermedicaldata.com/images/hair2stay/9.jpg http://www.fellermedicaldata.com/images/hair2stay/10.jpg http://www.fellermedicaldata.com/images/hair2stay/11.jpg

You had no surgery on your left side? There is a wall of scar tissue running right through it. Give me a call at the office tomorrow after 11:30am or I'll call you and we'll get on the same page. Typing takes too long and I'm not catching your concerns clearly.

Here some intra op photos of your procedure

John M, Your TOTAL graft count was 3,281 Your break down was as follows: 1,312 single FUs 1,969 double/triple FUs Distribution was approx: Most single hair FUs on hairline and temples All doubles/triples just behind hairline to the top. The very back of the transplant were the remaining singles. Nice blog. Grow well, Dr. F

PGP Don't put your fist through the screen. I agree with you. The number one reason for large scars, in terms of case numbers, IS the practitioner. No question in my mind. Why? Because most physicians don't want to make longer incisions so that the strip can be thinner. It is extra work and effort in terms of cutting and dealing with bleeding issues. You also have to be much more careful. But a person doesn't have to have E-D syndrome to be prone to stretching.They just have to have a lower collagen content. This was demonstrated, ironically, by Rassman and Bernstein when they studied potential candidates for FUE procedures and catagorized them by collagen content. Not all big scars are stretch scars. Some, like the first video below, are nothing more than apparent malpractice. This patient visited me for repair of his HT and I was stunned by the size of his scar. Clearly it wasn't a stretching situation, but rather a necrotic one. What probably happened was that this patient's first doctor negligently took TWO strips, one above the other, during the SAME procedure. As a result, IMO, the tension on the wound and the devascularization of the island of hair bearing skin inbetween resulted in necrosis or death of the skin. Thankfully, the scalp is VERY hardy and he was very healthy so the body produced a new layer of skin to cover the huge wound. You will also notice in the video that as his scar proceeds toward the right part of his donor area it dips down toward his ear like a frown. That is a SURE sign that the doctor was inexperienced and negligent in my opinion because this area near the ear is thin, tight, and prone to future hairloss. Had this doctor simply extended the incision above the ear and toward the upper temple on both sides he would have obtained MORE than enough grafts. Predictably, this patient had virtually NO growth from his botched procedure. By the way, if you think it was done ten or fifteen years ago think again. He had that surgery LESS than one year ago in the UK. And he is NOT alone. VIDEO: Unacceptable donor scar VIDEO: Proper scar of a patient I performed 3,000 grafts on only 10 days earlier. This video was shot 1 minute after I removed his staples

Yes, I see what you mean. It can be read that way. My bad. I would NOT have tried to place more grafts in your recipient area (whether it would have been easy or not) because of the scarring from the prior plugs. Keep growing and thickening and if you get the chance I'd like to see the growth for myself after the New Year if you find yourself in town. Grow well. Dr. F

The combover is an excellent way to cover skin that you otherwise couldn't due to limited resources like poor donor area or sub par prior work. When a patinet comes in with more bald scalp than can usually be covered with the available donor area I will "polarize" the patients by placing a higher density of grafts to one side to create a "part" and angle the grafts in such a way that he will comb the hair over the balder areas in distant areas of the scalp. Click the links for a patient I did a few years ago that exemplifies this approach perfectly. We did only one procedure on him: http://www.fellermedicaldata.com/images/fm/5.jpg http://www.fellermedicaldata.com/images/fm/1.jpg http://www.fellermedicaldata.com/images/fm/2.jpg http://www.fellermedicaldata.com/images/fm/3.jpg http://www.fellermedicaldata.com/images/fm/4.jpg

Hair2stay, I understand your furstration and I know how difficult it is to wait for your hair to grow. I don't minimize how much you are bothered as your post makes it pretty clear, but perhaps I can make you feel a bit better by simply putting together a few of the photos you put up side by side. For those out there who don't know much about your case, hair2stay had 5 surgeries prior to visiting me for repair work. His donor area was pretty well tapped out and was loaded down with scar tissue. Fortunately, he still had some good hair on the sides of his scalp which gave us enough to produce 1500 follicular units. It would have been nice to have more, but this is what he had to work with. Most of his old work was of the plug variety and while the cosmetic result from afar was actually pretty impressive, his hair had the classic "corn row" look when the hair was pulled back. He also had a ridge of scarring from confluence of scar right on and behind the hairline. From the photos I think you are doing quite well. I see that you are concerned about the gap of scar between the first row of plugs and the second, but like I said on the day of your procedure, that's probably the last area that will grow. I never rely solely on scar tissue to execute a repair when I don't have to and that's why I cut down your first row of plugs on the hairline and filled in as many gaps as I could there because that was the most important area to fill if you were going to pull your hair back. As the other posters wrote, you are only at 7 months and still have a way to go, especially because you had so much surgery prior to visiting me. Click the links to view some side by side photos that may help to make you feel a bit better. Stay in touch, and remember, you can always call the office and voice ANY concerns about your growth and perhaps I have something to tell you that may make the wait a little easier. http://www.fellermedicaldata.com/images/hair2stay/beforeafter1.jpg http://www.fellermedicaldata.com/images/hair2stay/beforeafter2.jpg http://www.fellermedicaldata.com/images/hair2stay/beforeafter3.jpg http://www.fellermedicaldata.com/images/hair2stay/beforeafter4.jpg http://www.fellermedicaldata.com/images/hair2stay/beforeafter5.jpg http://www.fellermedicaldata.com/images/hair2stay/beforeafter6.jpg

Bill wrote: "Clearly the cosmetic appearance of this patient's hair has improved significantly and clearly this is a difficult case. The pictures in natural lighting however, reveal that he is not as far along as the indoor pictures lead our members and guests to believe." Bill, usually we agree, but here you are mistaken. You cannot tell how far along a transplant patient is when his hair has been buzz cut. EVER. He didn't look "not as far along" in the outside photo because the lighting was more "true", but simply because his hair was short. Had that same photo been taken inside it would have made little difference. The only reason the photo I showed of him looked superior to the one he took outside was because I took it over a month LATER and his hair was correspondingly LONGER. Because of this the necessary HT "layering effect" started to kick in and he looked better. If we went outside to take the picture he would have looked the same way, maybe even BETTER. Before coming to us, BHUK had no hope of hiding those plugs.I say plugs and not minigrafts because even though they were small, skin was punched out to put them in. He also had scarring that extended well past the borders of his plugs and he had confluence of scar that made the skin look like a sheet of scar tissue. If we just removed the plugs he would of had strange patches of white skin with hard texture throughout the front of his scalp that would always call attention to itself. Because of this he had to continue forward and cover all the work with more hair. The plan worked and he was happy, that's why he went to the expense and trouble of traveling from England to America for a second time.