Dr. Alan Feller

Ben, You are not even half way grown out yet. There is alot more on the way in ALL areas of the recipient site. If you want to lower your hairline you certainly can, but wait until this session grows out first. You will probably be surprised how much lower your hairline actually will be once the hairs are given a chance to mature. Grow well. Dr. Feller

I have asked the doctor in question many many times to clarify and support grandiose statements he's been making on the internet for years and have never gotten an answer. Not the least of these questions is: what are the specific differences between FIT and FUE? Not once, not a single time, has a detailed answer been offered. You do not need to risk a lawsuit to expose a person like this doctor. All you need to do is simply respond to statements he himself makes publicly with a few simple straight forward questions. If he evades the question like a politician then you know instantly that he has a credibility problem and you move on. Truth is, he is a very capable and ambitous doctor. The will, the ability, and the experience are all there. Believe me, it's no easy task to perform FUE on any kind of a regular basis, but he seems to overshadow his accomplishments and potential with a massive ego and a bad attitude. A shame really.

Congratulations Pat. Heal well and grow well. By having another HT you increase the credibility of this field in general. Grow fast! Dr. Feller

I agree that this is thin for six months, but I wouldn't be too concerned quite yet. Some patients take longer to grow, others need almost no time at all. It depends on the patient. Sipa, if you are concerned, come on into the office so I can have a look for myself. While there isn't much I can do at this point to speed up your growth, it may make you feel better to have this reassurance. If you have the time you are welcome to come to the office for photos on a monthly basis which we can post together until you are grown out so that others in the online community may learn from your experience.

Here are recent photos of Jim A. with wet hair: Dr. Feller

He's actually very similar to another patient I had who had similar characteristics on the hairline before I repaired him. His case may be found on my website: Hairline repair with FUE Dr. Feller

Here are some photos of yesterdays FUE procedrue on Big 1:

Yes B spot, I agree. Forget all the static of who did what and when. The bottom line is that the results from all the high profile clinics who offer bht have been by and large poor. A few good patients here and there, but NOT nearly enough to justify this unethical procedure. The truth is we, as HT doctors, need to start over again with body hair. It is becoming obvious that FUE is not the method to successfuly obtain them. But I wouldn't throw the baby out with the bathwater yet. If body hair is in fact physiologically compatible with the scalp, then we need to find a way of removing them without damaging them, which is where I think the problem is. Again, FUE is clearly a dead end in this regard.

I agree, it doesn't look like a big deal to me from those photos. I wonder how big the punch was, it certainly must have exceeded 1.2 mm in diamter. Perhaps this is the way to go. How did he grow out?

Scientist, I don't know about the luckyman fiasco. Could you post a link for me? What did he do? DR F

What he is referring to is my suggestion that if body hair is to continue, it probably should NOT be done with FUE, but rather with larger areas of skin removed intact. Perhaps not as a strip, but large punches may be the answer, say 5mm diameter. One thing is for sure, if this method is utilized and the results are STILL pitiful, then it proves that bodyhair IN GENERAL is simply not a practical HT option.

I couldn't agree more with Pat. In fact, I've already done what he suggets from 2002 to 2004 and have found that bht is just not worth it to patients. That's why I never charged a dime for it. It truly urks me that there are doctors out there still offering this procedure. One very high profile doctor performed massive bht on a patient who came to me after NONE of the bht grew. I have video of me and my staff literally squeezing out the dead but unabsorbed follicles from his scalp. I will post this on this thread when I can figure out how. BHT as it is performed today should be dropped. Instead, perhaps, larger areas of skin containing bodyhair should be removed to decrease stress on the graft. Of course there would be far more scarring, but I have found some patients have no problem with it. I think this is the direction bht should go, if anywhere, and I might dive back into the experiment if I can find the time and enthusiasm. One thing is for sure, to me, current FUE technology for body hair is a dead end. Other doctors who offer this should either prove me wrong, or stop charging patients for this inconsistent and poor procedure.

Shockloss is not from transectioning surrounding native hair. Transections may cause folliclular injury directly, depending on what level the graft was cut at, but it is not shockloss Shockloss is a secondary physilogoical phenomenon caused by a combination of several insults including cutting too many tiny arterioles and veinules as well as localized swelling causing enough compression to compromise the blood supply and directly injure the hair root.It is largely unpredictable even when proper HT techniques are utilized. Thankfully, shocklost hairs tend to regrow fully in time.

Body Hair Transplantation is an unethical offering and should only be performed on those who know that it's success/failure rate has been actively hidden by those clinics performing it. I have asked the most high profile clinics who offer bht to produce the results of just 15% of the number of bht patients they've done. To date, over 2 years later, there has been nothing but silence. A few photos here and there, but nothing approaching a consistent result. I notified my state's (New York) office of medical conduct to be aware that offering this procedure to the public, especially as an alternative to standard scalp to scalp transplantation, should be considered fraudulent and misleading to patients. Shortly after notifying a high profile clinic that I had done this, that clinic stopped offering bht in New York State. There are very few doctors who've performed bht and therefore there are very few who can comment on it's efficacy from experience. I have performed them, for free and on an experimental basis since 2002, and have found this procedure to fail most of the time. The yields are very low and the caliber of the hair are very thin. Not to mention that those few hairs that do grow tend to maintain that classic body hair or pubic hair "kink". Not something I would want on my head. Dr. Feller

Once again the problem of language blurs the dialog. Ugly, 1. When you refer to "splitting up the graft" you must define what you mean. In my clinic we do not divide up grafts-ever. We don't just look at a 4 hair grouping and say, hmmmm, I think we'll cut that in half, because at this point it is NOT yet a "graft", it is just an area of strip that is in the process of dissection. Don't confuse a "close grouping" of follicles with a "graft". Sure, there are some patients with follicles so close to each other that you simply can't split them any further down than 3 or 4 hair grafts, but they are quite rare. 2. The smaller the incision the less scar you will produce, so there are no "excess scaring" issues when planting many smaller follicular units. In fact, it is beneficial to have the smaller units because their ability to transport nutrients and wastes across the graft (to and from the surrounding dermis) is ENHANCED compared to the larger 3-4 graft variety. 3. You should never be squeezing grafts into slits. If you are, the slit is simply too small.

Gorpy you are correct in your analogy, and that method is the standard by which most transplants have been performed for the last 7 to 10 years. But it is time to move up to the next level of refinement, and this includes a greater number of overall grafts that are spaced a lesser distance apart. Bushy, I appreciate your view and agree that it is correct, however your analogy refers to 5-6 hair grafts which is not the point of this debate. The debate, at it's core, is: Is it better to divide a 4 hair graft down to 2 2-hair grafts and then go to the trouble to pack them tighter and in greater numbers. I don't want to confuse the issue any further with talk of 5-6 hair grafts since NONE of the participants in this discussion would ever advocate the use of such monster grafts (with the usual physiolgical exceptions of nordic hair or extremely curly hair, etc...). That said, Bushy, your point is dead on with respect to the work differential between clinics. A clinic that fails to subdivide appropriately will still get paid the same as those who go to the trouble to do so. And even though both are using "follicular units" they are very different surgeries. Dr. Feller

Again, the conversation gets muddled because those involved are not speaking the same language. "Mimicking nature" doesn't necessarily mean COPYING nature as gorpy suggested. It means doing something else with what's available to achieve a result that looks as close to nature as possible. Gorpy, if you were transplanting 50,000 hairs from the donor to the recipient area, then I would say that you were COPYING nature by utilizing the actual groupings as they already exist. However, since we are moving only about 6,000 hairs (in an ultra-megasession) you can no longer attempt to COPY nature because there are so few building blocks to work with. Moving 4 hair follicular units into the recipeint area as such will not be the most efficient distribution of those hairs because you will necessarily have to leave more space between the grafts than you would if a skilled technician could divide that grouping into, say, 2 2-hair groupings. In nature, the over-abundance of hair in the recipient area ensures that the eye will not pick up the bare spaces between the follicular units. As a result, multi-hair units of 3 or more will not appear "stalky". If, however, you removed 80% of the surrounding hairs as may occur during the normal balding process, these "naturally" occuring follicular groupings would indeed begin to stand out and look "unnatural". Fortunately for nature, these hairs begin to miniturize when that level of hair loss is achieved so the "natural look" is somewhat preserved. Hair Transplantation does not benefit from this compensation in hair shaft diameter and so thick groupings of 4 hairs can appear to be unnaturally "standing off" the scalp if there aren't enough hairs between and in front of the 4 hair groupings to prevent the eye from seeing the hair/skin interface. When you have 4 hairs coming out of one slit the slit itself must be larger and the spacing between the grafts must be greater. But when you are dealing with, say, 2 2-hair grafts, the slits can be smaller and about HALF the distance apart. This means the SPACING between grafts will be smaller and less obvious to the eye. Combine this with lateral slit method that allows the hair to almost hug the surface of the scalp and you have a powerful combination of techniques that truly "mimics" nature. Copying nature does not mean you will have the best result. For example, nature's idea of a "shelter" is a cave. Caves were the first human homes.But as we become more technologically advanced we didn't pile rocks and boulders of various sizes on top of each other to create an artificial cave-like structure did we? No, we analyzed the physics of the situation along with the available material and came up with a refind construction method that resulted in shelters that were far BETTER than nature. Would anyone really want a home that looked like a cave just because it mimicked nature? Not in this case. If we had 50,000 hairs available to transplant, then I would agree that we should stick to nature's method. But since we don't, more refined methods are needed to achieve our goal. There are, of course, many other variable that must be factored in when performing HT and deciding how to divide grafts such as hair caliber and density, but overall I believe the best and most consistent results to date have been through ultra mega sessions of between 1 and 3 grafts per grouping. Dr. Feller

If final results are the most important goal, and I beleive they should be, then the case for ultra-megasessions can not be overstated. Until I met Dr. Hasson in 2002, I felt a case should only max out at about 2,000 grafts per sitting. I beleived this because my instrumentation and protocols only allowed 2,000 at a time. The public dialog among HT docs also supported this view. To go any further would have definitely caused necrosis, poor yields, wide scars, and other bad things due to the limitations of THAT TECHNOLOGY. However, after speaking with Hasson in 2002 for ten minutes I learned that there were more refined ways of doing HTs. Lateral slits, custom blades, and extra tumesence were just a few of the "secrets" he generously shared with me. When I tried them I was amazed at the difference in results. Sure, it takes a bit of getting used to, and you do have to increase the size of your staff. But the results are well worth it, and this debate should not lose site of this as I beleive it has. Anyone can de-construct a procedure as Jana, Limmer, and others have to find fault or praise, but the problem doesn't begin there. There is no established terminology in the HT field. For crying outloud we still can't nail down what "vertex" and "crown" actually refer to. Go to several different doctors and you will get at least two versions of each. Without basic terminology, how can we have an intelligent debate? Take the word "follicular unit". What does that really mean? In one office it may mean 3 grafts, in another it may mean 2. It is a useless terminology, as is most of the HT dictionary. My experience to date, after adopting hassons techniques, is even if you divide down what might be termed a "3 hair follicular unit" into 3 single follicles, they will grow with the same yield as if you didn't split them in the first place. This is not a "rip off" or a "cheat" to the patient since it takes considerably more work and skill to do this. And it is far more worth it IF, and only IF, the doctor and staff can pack those grafts close enough to make it worthwhile. I would rather have three hairs evenly but tightly spaced on my scalp coming out of their own single point of origin than three hairs coming out of one slit any day of the week. With that said this does not mean I am a proponent of cutting all grafts down to singles. But, a clinic dedicated to ultra refinement should be able to go the extra step to have an overwhelming majority of 1 and 2 hair grafts over the 3 to 4 hair variety, and then be able to plant them tightly and uniformely. In the end, the only indisputable terminology is the "hair", and I agree with Pat that this should be counted and disclosed along with the amount of donor area removed. Until we move the debate onto this standard there will never be a conversation where the participants are speaking the same language. Dr. Feller

Bal, I think the best course of action would be to revise the scar you believe is the worst. We would completely remove it and then do a two layer closure (inside absorbable suture, outside staples).Then I would take what ever small number of grafts that comes with it and place it into the front hairline. Then you would go back to the UK and start the trial. By the way, you don't need to come to me to have the first revision done, you can have just about any cosmetic surgeon in the UK do it. You are certainly welcome to come out to New York, but you can save a trip by doing it locally. Dr. Feller

Bal, I think your best option is to follow the method of scar revision that I outlined in my private email to you which originated as a suggestion from Dr. Hasson in Vancouver. You should indeed do a standard scar revision using STAPLES, and then every two weeks every other staple should be removed and then replaced 2 weeks later. This cycling should go on for 4-6 months and then the scar watched. IF it works, then it should be repeated on the other scars. During the last surgery some hairbaring skin should be removed with the scar and transplanted to the front to thicken it up if it is necessary by then. I recommend that you find a local UK doctor who is capable of doing this. Have him contact me and we can coordinate this trial. If it works, it may be the answer for many other patients who have especially flexible scalp skin as you do. You do not have to wait. All you need to do is find the right doctor and go for it. I think it is the best and most reasonable chance you have to SIGNIFICANTLY minimize that scarring from your prior surgeries. Regards, Dr Feller

Paris, One has nothing to do with the other. Tricho is not the panacea it is being made out to be. Yes, it is an improvement, but it is not scarless surgery. Tricho will minimize a scar's appearance IF, and only IF the scar is about 1-3mm. If the scar stretches beyond this, then tricho is uselss. That said, tricho should be performed on ALL strip patients to improve the chance of an undetectable scar. If you need more than 400 or so grafts, then you should go for a strip and not FUE. Dr Feller

I cannot agree enough that flaps should be avoided. I've seen many patients with this procedure and have yet to see one that looks natural FROM ALL ANGLES. That is to say, a few I've seen looked fantastic from the front view. But ONLY the front view. As soon as they were viewed in profile or from the back it became extremely obvious that something was not quite right. Most of these patients have fairly wide scars in the donor area (particularly over the ears) which were very difficult to cover. Another problem is that IF the flap is successful, the density differential between the front and the sides is so disproportionate that it looks strange. I think this flap procedure,scalp reductions, and plugs, should be banned from medicine for good. But, until a law is passed, there will still be those who do it. Unfortunate.

M.M. was in his early 40s when he first came to visit us. He was only missing hair in the first third of his scalp. This baldness was only accentuated by the fact that he still had fairly thick hair on the rest of the scalp. We dense packed the bald area with over 3,000 follicular units in one visit using a ONE PASS, LATERAL SLIT technique. We documented his results at 3 month intervals up to the present 9 months. We will post the 12 and 15 month photos as his growth continues to progress.

I believe Finallyfree was correct in his first post, up until the bht part. BHT, while Do-able, has not yet proved to be viable on a practical basis. Even if DR. A's photo is genuine, this would only represent one patient out of how many? That is not enough to offer to the general public for profit, in my opinion. That said, there is sufficient evidence to justify further experimentation with bht and invent new ways to remove those precious hairs succesfully with a succes rate of, say, 80+ percent. Dr. Feller

Reverse, Just call the office and Tracy will give you the names of patients you can meet with. If you give us the date and time you are available, just come to the office and we'll have a few megasession patients for you to see. Dr. Feller