Dr. Alan Feller

Yesterday I had the pleasure of performing surgery on a regular viewer of this site. He may be a poster, but I didn't ask. He certainly seems very knowledgeable so I wouldn't be surprised. During our surgery we were discussing how to ensure quality in a hair transplant. It occurred to me that one simple way would be to take photos of the surgery while it was being done and then posting it immediately for the world to see BEFORE the final results. Perhaps if everyone did this, the quality of the work would increase across the board. This patient had 1500 grafts packed into the front third of the scalp.

I agree Gary. While this patient healed very well, it doesn't necessarily follow that the next guy will also. My approach on this volunteer was to keep the FUE as shallow as possible. I will do at least ten more patients before I try to extract a substantial amount.

From what you wrote it seems like you are pretty near the limit for another strip. You might want to start thinking about an FUE case that may or may not include some body hair. Have you been reading about this option?

Steven, You are basically talking about FUE. Give me a call 516-487-3797 Dr Feller

As many of you know I have been experimenting with volunteers to gathter as much data as possible for FUE procedures. In my meeting with Dr. Campbell in NYC she cautioned the use of FUE in areas other than the head due to excessive scarring in the form of "raised white bumps". I took this concern to heart and appreciated her willingness to share this observation. Since Dr Campbell claimed there was a way around this problem I immediately set myself to the task of identifying the actual problem and then solving it. Below are the before and after photos of the back of a patient I performed a few FUEs on. The after photo was taken less than a week post op. I see some irritation of two sites that was probably the result of scratching, but nothing drastic. Perhaps the increased scarring that Dr Campbell was talking about is on the way, but so far, so good. I will post follow ups over the next 6 months.

As many of you know I have been experimenting with volunteers to gathter as much data as possible for FUE procedures. In my meeting with Dr. Campbell in NYC she cautioned the use of FUE in areas other than the head due to excessive scarring in the form of "raised white bumps". I took this concern to heart and appreciated her willingness to share this observation. Since Dr Campbell claimed there was a way around this problem I immediately set myself to the task of identifying the actual problem and then solving it. Below are the before and after photos of the back of a patient I performed a few FUEs on. The after photo was taken less than a week post op. I see some irritation of two sites that was probably the result of scratching, but nothing drastic. Perhaps the increased scarring that Dr Campbell was talking about is on the way, but so far, so good. I will post follow ups over the next 6 months.

Ramble, I rarely charge more than $5,000 for surgeries up to 1800+ grafts. Call my offic for a consultation. Dr. Feller Feller Medical, PC Great Neck, NY 1-800-HAIRS-2-U 1-515-487-3797

This work looks fine to me. Good staggered hairline construction from what I can see in the photo. Dr. Feller

I wouldn't cancel a hair transplant just because a patient has dandruff. What you are describing sounds different. If you are having a reaction to the Rogaine you definitely want to stop using it. The fact that you have a surgery coming up is even more of a reason. You don't want an inflammed and irritated scalp prior to your procedure as this would be much more of a negative than the Rogaine would be a positive. I don't know that Rogaine will prevent shock fall out. There was a lecture during the last ISHRS meeting that showed that Rogaine was beneficial to the grafts after surgery, but I don't think there was any mention of it's ability to protect the native hair from shock. Dr. Feller

Sorry about the email bmt07, I'm changing my servers and updating some software. I made the mistake of doing this around the Thanksgiving Holiday so everything is slowed down. You might also note that all the links I've put on this site are down as well. I should have everything back on line by the middle of next week so keep sending to info@fellermedical.com. I'm also creating another domain on a dedicated server that will be open to ALL doctors so they can post their photographs without e-mailing. Everyone likes pictures, right? Enjoy the holiday (if you are in the US), and remember...calories don't stick on Thanksgiving, it's a medical fact Dr. Feller

If you had a Follicular Unit transplant, you have nothing to worry about after 12 days. Nothing really to worry about after 3 days if you are just talking about shower water pressure. Relax, you didn't hurt your grafts so stop being so timid. If you had an FU transplant those scabs should have been off a long time ago. Scrub them off with the pads of your fingertips in your next few showers and have done with it. You will probably see tiny crusts with hairs in them, don't worry about it as these are not the grafts. In another week you should look more or less like you did before surgery. Grow well and heal well. Dr. Feller

One more thing Harrylemon, Do you mean to say that you had over 5,300 grafts implanted in one day? If I read you right, you had approx 2300 FU from the strip, but that they were subdivided down in a 1:2 ratio. Is that correct? I've never heard of this. Dr. Feller

In a case such as yours where there may be an insufficent number of one haired grafts the cutting down of multi hair grafts to single hair grafts becomes a necessity. To date I have had one patient out of over 2000 where I have found this to be the case. Understand that of all the subjective opinions in HTs, the ROUTINE breaking up of follicular families is an issue that is no longer debated. Dr. Feller

Harrylemon, Thanks for your contribution. I am a bit confused, however. You said that you had a little over 2300 grafts in the first paragraph, and then had 5-6 thousand GRAFTS, in the second. Did you mean HAIRS? Also, I doubt that of all the doctors out there Dr Shapiro is cutting 2 hair follicular grafts down to single hair grafts. This clearly is NOT follicular Unit transplantation. The power of his microscopes is a non-sequitar in this issue. You probably have a minimum of 20% naturally occuring single hair FUs in your donor and that is where i suspect those one hair sprouts originated. If Dr. S is cutting down FUs to micrografts that is a revelation for this board. Dr. Feller

Valid point of view Wizard. Look higher up on the thread and view the "mock up" of the results of a second surgery. Tell me what you think. Any better? Dr. Feller

WW Thought you might like to see a picture of a patient I did in 1994 who made the exact same request you did. Notice the poor yield and the "haze" effect. Fewer than half grew. It was the dismal results of this guy that made me really want to find the problem. It didn't take much for me to realize that breaking up follicular families was a mistake, even though EVERYONE was doing it. I never did another micro/mini case since this guy. Since then I always kept the follicular families together... Now they are called follicular units Dr. Feller

Hello Noreaster, good to hear from you. Yes, the big difference between this guy and the first guy is the positon of his temple hair. Also, look at how much higher the temple hair rises onto the head compared to the first guy. At his age, I don't think there is a lot of side recession in store for him. The other big difference is the overall density. I would say he was transplanted at an average of 25 grafts per cm sq. I admit he looks great in the picture, but in real life he is rather thin. We already scheduled him for surgery number two this December as per our original plan. Interesting that you guys prefer this guy. I wouldn't. Perhaps it is because we are looking at photographs. I think the best thing to do is have an open house for you guys and ask a few patients (particularly these two) to attend. I would really like your real world opinions. One of the reasons I read this board so closely is to get the opinion of the average patient. It is invaluable when it comes to strategy. In the end I know who I work for...I work for you! So keep the comments coming. Don't worry, I can take it. If a surgery is physically possible by the laws of man and nature I can do it. Let's keep working together so I can discover what the best way is. Thanks to everybody Dr. Feller

WW What you are proposing is the the old mini/micrograft scheme. The whole idea behind modern FU HTs is to keep the hairs together as they exist in the back of the scalp. The LAST thing you would want to do is, say, cut a four haired FU into two 2-haired micrografts. Very bad! Dr. Feller

HairHair, Nice formula. I'll bring it up at the next meeting. Could be a Nobel prize in it for you. Dr. Feller

pdm68 Perhaps you would have perferred the look of the patient below? In his case I spread 1400 grafts over the front 2/3 of the scalp. I believe this is the strategy you are after, but you must understand that this guy is quite a bit thinner than the first guy. Dr. Feller

Arfy, First off, RELAX! I'm not trying to "spin" your words. I beleive it was noreaster who has posted time and time agan that you can never really attain a high density after transplantation. Now you, someone who knows a thing or two about density, chimes in and says that my work is too dense. I just couldn't resist bringing up the dicotomy. I am not attacking you personally when I tell you that your assesment of the hairline is wrong, nor is it subjective. Let me explain. The lowest border of a hairline is not set by me, but rather by how far forward the temple hair is. The futher forward the temple hair, the lower I can place the hairline. The further back the temple, the higher the hairline and the deeper the recession. When you look at this patient's amount of side hair recession, I have no choice but to place the hairline where I did. Had I raised the hairline any more than I did, he would look like he had a mohawk. If I dropped it, he would have a scant looking hairline that intersectd the temple hair at a wrong angle and that would look unnatural. There are, of course, more variables but I think you get my point. Perhaps because he is a work in progess many of you can't see past the unfinshed area. I mocked one up on photoshop to give you all an idea of how he will look in another seven months. Perhaps it will help ANY BETTER LOOKING? Dr. Feller

WW Your request would be a difficult order to fill using the standard strip method. To get that many grafts you would need a sizable strip. Unfortunately, only about 20% of the yeild would be single haired grafts. What would we do with the rest of the grafts? You may want to have Follicular Unit Extraction performed (FUE) in which case I could target a much higher percentage of single hairs. Somewhere on the the order of 90%. Aside from this, I would always recommend a generous amount of 2 hair grafts on the hairline, along with the singles. Without them, you wind up with what I call the "haze effect". That is, you see the hair, but it doesn't really provide good coverage. The look is a bit strange, especially if you don't have good hair behind it to optically back it up. I will post a thread on this in the future. Dr Feller

Wizard, All the grafts took. While I admit that I don't count every graft, I didn't see any obvious spaces in the pattern. Also, he is obviously thicker than patients I've performed say 1200 grafts on. In Phase 2, as you call it, I will indeed begin to drop the density in favor of area. Why not? He will probably continute to comb the front hair into the back anyway, so when he does the hair will combine to form a very nice look (which was the plan from day one). I used to perform surgery by going into the same areas a second time, but have learned that the best chances for success are as few passes as possible. NW When you write 1/2 and 1/2 I assume you mean half in the first 2/3 of scalp and then the other half in the same 2/3 of scalp between the first grafts. This method is just not as reliable. Complications include increased bleeding time, increased surgery time, increased scarring, decrease graft survival and more. I'm not against beefing up an area that is a bit thin after the first round, but a second session into an area that has say 1000 grafts is simply not the best way. Get most in in one sitting and have done with it. Arfy, You are the first person in the history of hair transplantation to tell me I actually transplanted an area TOO DENSE! THANKS! When you say this guy looks "unbalanced" I will assume you are referring to his hair I agree! If he told me he was only going to have one surgery I would have spread the grafts out over a larger area. I do disagree with you that his pattern, when finished, would not be natural however. It will be as natural as any guy who just lost his hair to that point. Case in point, former VP Al Gore. He is quite thick in the front and top and totally empty in the crown. To waste hairs in the crown of a Norwood 6 of his age would be a mistake in my opinion. This has been commented on time and time again on this site. Your assesment of his hairline is also off. His is a very, very conservative hairline the height of which is dictated by the recession of his temple hair (among other things). Some of your comments may be subjective, but the hairline one is objectively wrong. Sorry. Also, the density of his frontal hairline is LOWER than that of the hair behind it. This was done to ensure a soft hairline. Look at the closeup photo and you should see this. This guy is very happy. Perhaps better than this, his wife is happy! I will post the results of round 2 after six months. Dr. Feller

OK guys. Here is a patient on whom I did over 35 grafts per cm sq in the first third of the head. He easily has 2 more surgeries in him. In fact he will be going for surgery number 2 in December to fill in the 4 inch area just behind where I filled in in surgery number 1. Would you prefer a different strategy? Give me your honest opinions. Dr Feller Dr. Feller

Yes Monty, welcome to the world of surgery where there are as many valid viewpoints as there are opinions. My patients shampoo their grafts the very next day. Going into the ocean WILL soften the scabs, and this is exactly what you want. The act of swimming is not going to hurt the grafts. Also, the normal increase in BP due to exercise will not affect the grafts either. Understand that a scab in a hair transplant is NOT completely the same as one you might get after a simple cut. Most of a HT scab is comprised of the very tip of the graft that sticks out of the scalp, not just healing skin. The goal is to have this bit fall off so that the skin may re-incorporate the graft in a mannor that is flush to the skin. I suspect the very few doctors who insist on a week before shampooing are either still using bulkier minigrafts, or have changed to FUs but never revised their postop instructions. Dr. Feller