Dr. Alan Feller

Thin immature hairs or hairs produced from injured follicles do not develop enough thickness in caliber to created deep enough pits to pick up the oil. So no, if you drag different types of hair through oil they will not all pick up oil equally because they don't have the absorbing ability that healthy hairs do. That is, hairs produced from healthy follicles. I don't know about hairs that grow back thicker and darker. Thicker and darker than they were in the donor area?

Yes, the amount of tissue surrounding the graft DOES affect the quality of the graft. A single hair graft devoid of virtually all surrounding tissue is a poor quality graft no matter which method is used. However, the super thin graft produced using FUE is a far inferior graft compared to the super thin graft produced using FUT. A damaged graft will first and foremost simply not grow. Or, it may grow, but produce a hair with a thinner shaft. Or the hair may become kinky and thin, which means it will become incapable of picking up scalp oils giving it a dry or frizzy appearance.

It's interesting that you call it the "dreaded" debate. Yes, I mean to say that single hair grafts from FUE procedures are not as good quality as those from FUT. The reason is trauma. By being single follicular grafts they do not have as much tissue around them to protect them during the traumatic extraction process. Even if they appear intact they are mostly damaged when compared to their FUT counterparts which experience no such trauma at all. There you go.

No need to consult me. Just wanted to give my opinion based on the photos. Best of luck on your plan and your HT.

I agree with Dr. Feriduni's assessment and plan. You are clearly miniaturizing, not just in the hairline but in the top as well. This is no doubt why you are anxious to get it done now. I would have to agree with you. Starting on the hairline you have, and no lower, looks about right to me based on the angles of the photos. Thickening up the front will give you a more solid frame and you can comb those hairs backward to give a "puff" effect and make the top look thicker as well. CAUTION though, the FUE procedure does not typically produce high quality and yield of single hair grafts, and you are going to need a lot of them to beef up your hairline without looking stalky. I f you are dead set on doing it as an FUE just be prepared to do another pass sometime up the road, then you should be fine. But again I want to say caution because it looks like your other hair is miniaturizing as well UNLESS that top photo you put up has the hair wet. In that case, nothing to worry about yet. But if that hair is dry, then there is massive miniaturization going on and you may want to start planning for that now. Best of luck to you Dr. Feller Feller and Bloxham Hair Transplants Great Neck, NY

3000 grafts one year later. FUT procedure. Note the thin scar that is difficult to see even with very short hair. All the skin and hair below and above the scar are in perfect shape ready to be used in the future if desired. Notice thick growth from just one procedure.

Absolutely true, and I have no doubt this happens from time to time. But I have also had patients whose donor area was exactly the same 20 months after surgery, thick as ever, but the grafts that came from there were beginning to miniaturize in the donor area AFTER having been obviously thicker. It's as if there was full and normal growth, and then a retreat from this optimal state to a lesser state as evidenced by the thinner hair shafts. Thankfully, another round of hair transplants did the trick, but those new grafts went through the same process even though they were from a different part of the donor area. Thicker at first, and then thinner. So we overcame miniaturization with numbers. Thankfully this is very rare and has a solution. Best, Dr. Feller

You are correct to be nervous about using FUE for removing old grafts. It is not the right procedure for your repair. It is unreliable as the grafts tend to be brittle and break during the extraction processes. But you may not have to go that route yet. If you're hairline is not inappropriate in terms of shape or being too low you may just want to thicken around the old grafts. This may give you a more natural look, and a thicker result, which is no doubt why you went in the first place. Plenty of doctors on this site do this kind of work. Of course Dr. Bloxham and I do it. Here's a recent video example: But as I wrote, there are many doctors on this site who do this routinely. Check a few out. If you are dead set against another procedure, then have the old grafts removed properly using a slightly bigger punch than would be used for FUE. This will minimize breakage and the resulting ingrown hair cysts by insuring the grafts are removed intact. Dr. Bernstein does this fairly regularly in NYC; and so does Dr. Lindsey in Virginia (Lindsey is my partner so perhaps a bit of bias there but I think he's great with these very detailed facial plastic reconstructions, but so is Bernstein). You may want to check them out. Perhaps you can post some photos. That is always helpful. Dr. Feller Feller and Bloxham Hair Transplant Great Neck, NY

What you are describing sounds like graft miniturization. In strip surgery it is rare. Maybe one in 500 patients. In FUE cases it appears to be much higher and is usually to a greater degree. When a transplant is performed, FUE or FUT, grafts are removed from the donor area and placed into the recipient area. The body's healing system is then activated and new blood vessels are created to nourish and sustain those grafts. The new grafts and the new vascular system are, in a sense, balanced. That is, the graft gets the blood supply it needs and no more; and the new blood supply gives the graft the vascular supply it wants and no more. In most patients this "arrangement" becomes stable and the hair will return to its normal growth cycle and produce a hair every bit as thick as it used to be when it was in the donor area. However, In some patients, the process of healing and metabolic homeostasis is NOT complete before the second year. Not stable. Something happens, although we don't know exactly what, where the graft just decides to stop producing a thick hair shaft. I believe it's because the recipient area is actually OVER vascularized by the body during the first 18 months, and then the new extra blood vessels are withdrawn, inadvertently leading the graft into "thinking" it is suffering a deficit of oxygen and nutrients. As such it responds by lowering it's metabolic output and thinning the hair. Think of this as having scaffolding around a building and then removing it. Difference here is that by removing the scaffolding, some of the "support vasculature" goes with it. Thus the graft has to move to a lower "hair producing" level to sustain itself and get back into homeostasis. OR, the other way around: It may also be that the graft itself just decides it is better off producing a thinner shaft and the blood supply is adjusted after the fact. The graft is a living thing that was just traumatized so it's reaction can be unpredictable. It may also be that the healing and scar tissue formation in the recipient area is resulting in a small "choking off" of the blood supply, which is why it is key NOT to implant grafts TOO densely. This is the same phenomenon that literally kills follicles in the recipient area after FUE where the skin is brutally scarred throughout after FUE megasessions. See this youtube video: I believe the more fragile the graft is naturally (thin, short, wispy type follicles) the more prone it is to this "miniaturization after the fact" phenomena. In FUT there is very little direct trauma to the graft. But in FUE there is tremendous trauma by comparison, thus not only higher rates of miniaturization after the fact, but greater chance of miniaturization from the start. It is a disappointing problem, but one that can not be predicted. One may, however, perform another transplant using the following protocol: 1. If the HT was FUE, switch to Strip (FUT). This will provide the most hardy and uninjured grafts 2. If the HT was FUT, lower the density of the new recipient sites as they are placed between the surviving prior transplants. I did this in a patient who used to post regularly on this site ten years ago and it worked like a charm. Best of luck to your friend, and to all patients whose ultimately goal is just to improve their looks and confidence. Here's a YOUTUBE video of a normal patient grown out post op: And here is a YOUTUBE a patient who experienced the opposite of your friend. He was thin for a slightly longer period than is considered "normal" but then bulked up. Dr. Alan Feller Feller and Bloxham Hair Transplants Great Neck, NY 516-487-3797

I'm an HT patient myself so I know exactly where you're coming from. Glad I could help. Grow well

Post Operative Regret can be an over powering feeling and is always worst when the patient is traveling. I had a patient years ago who traveled from another state to my clinic, had a procedure, then was off the next day to a European country for a month long stay with family. He called me from that country completely freaked out about the procedure (which was textbook perfect by the way). He called several times and each time he was more and more anxiety ridden. He was so worried he was literally ready to pull out all his grafts by himself! He was serious. I did the best I could to dissuade him, but he seemed pretty intent on doing it. I never heard from him again. Why would this happen? Of course the patient may have clinical mental health problems that were undiagnosed or simply undisclosed during consultation and surgery. Nothing new there, people do that all the time. But putting this aside, what could have happened? I believe that the specter of "buyers remorse" is ever present in patients because they know in an internet world they have a choice of doctors, but never feel they've done enough research to justify their actual choice-no matter how much research they do. So a lingering doubt always pervades the decision even after the fact. But this passes as the mind begins to accept and believe that there is only so much research one can do. The second reason may well be the medications. Patients don't usually take narcotic pain killers and antibiotics and either one, or both in combination, after an HT can cause emotional variations for the time they are being taken. Steroids in particular (which I believe are unnecessary for modern HTs) may cause vicious mood swings. Combine this with the feeling of buyers remorse and the feelings of doom may be overwhelming. Now add to this the stress and exhaustion of travel. This leads to impatience, short temper, and generalized frustration and anguish. A partial helpful solution is simply to travel with a friend or loved one. This way the patient can vent or just get support from someone who will standby them when they feel most vulnerable. I wouldn't worry too much as the feeling passes for most people. But in a very few it simply doesn't- irrespective of how good the transplant ultimately grows and looks. It's not right or wrong, it's just how it is sometimes. If you picked the best doctor you thought was right for you, and the procedure was done to modern day standards, then you are very likely to be satisfied with not just your results, but your decision as well. Grow well, Dr. Feller Feller and Bloxham, PC Great Neck, NY

Time for another episode of Scar Search, the video series that shows what your average FUT scar should look like when properly performed under normal circumstances; and often times when not performed under normal circumstance. Take this patient who has a low density donor area. Lots of space between hair. He's ten months out from his procedure. His donor incision closed beautifully and it completely obscured by his hair.

Bill, There is no “selection” choice between me and Dr. Bloxham. Not at anytime. We are an unbreakable team. So no patient can ever make a valid claim that they expected Feller for surgery but was blindsided on the day by only getting Bloxham. Do you really believe I work that way after 22 years of practice and sixteen years of being the most open, active, and transparent doctor on HTN ? Do you think Bloxham would engage in this behavior after being a trusted moderator on HTN for the past 5 years? We know we are scrutinized more than most because we enjoy greater visibility. As a result patients have higher expectations of us. We get it, and we don’t disappoint. Let me explain why there is no chance for your concerns to become reality. In our office all patients MUST meet with Dr. Bloxham in consultation during which Dr. Bloxham explains what we (he and I) will attempt to do regarding their surgery should they chose to have one with us. Long before any deposit is offered, all patients know and understand that we perform procedures together. Should a patient ask to only have me perform the surgery to the exclusion of Dr. Bloxham I would deny the request. To date not a single person has made this request. Should a patient happen to make this request just before a procedure I would deny that request as well. To date not a single person has made this request either. But if they did I would give them their deposit back and go enjoy the free time. Maybe make another educational video to post. I obtain informed consent for everything I do. It’s not like a patient isn’t going to notice that 9 people other than myself are going to be working on them that day. But they read it and sign it because they have trust and faith in me. They trust that I am working in their best interests and that I will pick the best instruments, protocols and people to perform their procedure. Because in the end it is MY name on the work. No misrepresentations, no "bait and switch", no “blindsiding”. Just an excellent team of high quality people, as always, which now includes the talented and brilliant Dr. Blake Bloxham. I get where some of the anger on these threads are coming from. Of course some comes from disingenuous people who will jump at any opportunity to impugn me or my reputation. That's just the nature of the internet nowadays. But still there are others who believe that my inclusion of Dr. Bloxham into any procedure demonstrates arrogant disrespect toward patients.That patients should have the option not to have Dr. Bloxham participate in the surgery if they don't want him. And should I deny that request I am guilty of disrespecting patients wishes thus viewing them as second class people. I get that. I'd be angry, too. But what these posters have yet to realize is that I give nobody the choice to decide whom I will include in my procedures nor how I will perform my procedures. The Queen of England herself could come into my office tomorrow and say I want my two grandchildren to have their procedures with you Dr. Feller, but only with you and not Dr. Bloxham. And I would deny Her Royal Highnesses request even at the risk of being sent to the Tower because I treat all patients the same and know that having Dr. Bloxham on board makes my procedures better and my practice better. Even if outsiders don't yet understand this. You all have no idea how exceptional this man truly is. You shall soon all find out. I have been making the right decisions for my patients for the past 22 years. I have no intention of stopping that now. Bloxham is the right decision for my practice and this will become more and more self evident in time. If you come to Feller, you come to Bloxham. And you will be the better for it. Dr. Feller

Another example of what made FUT king of hair transplantation, and what continues to keep it on the throne. Notice that even after over 3,500 grafts being removed in a single sitting most of the donor area is pristine and untouched. Unfortunately, a similar sized FUE procedure, or even smaller, would have created scar tissue throughout the donor area diminishing the number of grafts obtainable in the future should more work be needed. Many more examples to come.

Bill, Dr. Bloxham is a partner, not an employee. I believe an owner makes a better surgeon and caregiver than an employee. As such he is responsible for every patient that comes through the door whether he touches that patient or not. Likewise, as a partner, I am responsible for each patient that he touches, whether I touch that patient or not. We are responsible for each other's actions and so we both need to have access to all patients equally throughout the day. Dr. Bloxham and I perform our procedures together. So yes, I have a hand in every surgery. But far more than a hand. Since I'm the one with greater experience and I created the practice I am the lead surgeon. This is as it should be. While I could perform a second procedure while he does a first, we choose not to do this. I don't even see consultations. The second patient of the day waits for both of us. This will change, but not as yet. Our clinic is the better for Dr. Bloxham's presence and ensures that our brand of surgery will continue on for many more years to come.

Every once in a while we will post photos and videos under the banner of "Scar Search" because that's simply what it is. In this day and age of FUE hype and FUT vilification we think its important to reacquaint the public with how most donor scars look after properly performed ultra refined hair transplantation and why it is still the gold standard today. Note that the all the hair and skin above and below these scars are perfectly intact. Way more to come, but enjoy this short video and presentation. Thank you. Dr. Alan Feller Dr. Blake Bloxham

That is correct. Patients have no say over how I or my staff perform any part of the procedure. In fact I have that in my consent form and it must be agreed to and signed before a procedure may commence. There can only be one chef. As for your question to the moderators. My inclusion of a qualified doctor into my established practice is far from unprecedented in general medicine or HT in particular. I know of several other Coalition members off the top of my head who have included new associates who still work in these practices to this very day. To name a few in no particular order: Dr. Robert Bernstein, Dr. Michael Behneer, Dr. Robert True, Dr. Ron Shapiro, Dr. David Segar (my mentor r.i.p.), Dr. James Harris, Dr. Edmund Griffin, At one point most if not all of us were apprenticed to a more experienced HT doctor. Without this right of passage there would be no continuous existence of a method or practice. A successful practice needs to bring on new personnel as it ages. But it must be done responsibly and systematically. Those doctors listed above have succeeded in doing that, and I shall as well.

1. No. Procedures are performed together 2.No. Every case performed here, as always, is done as a team from the physicians down to the techs. Patients are informed of this prior to surgery AND is included in our consent form as well.

Not EVERY patient who seeks out a hair transplant initially had hair and then lost it. Some never had it to begin with like this actor who said his asymmetric hairline has bothered him since birth. His procedure went smoothly. Typical dense pack ultra refined hair transplant. But after taking his photos he reminded me of someone... VIDEO:

5,500 grafts over two procedures. After photos are over a year after his second procedure. Enjoy.

This patient told me he got the corners of his hairline done for free. Does it look ok to you, or do you see some issues? Try and guess how many grafts he got. Look at the close up before you answer. Dr. Feller Feller and Bloxham Hair Transplants Great Neck, NY

Sammi, Most of your post does not comport with reality. You are most grossly mistaken on American doctors having patients sign "wavers". There is no such thing. Patients sign consent forms that prove that they have been informed as to how the surgery is to be performed, by whom, and what the risks are. There is no agreement not to sue should the doctor engage in medical malpractice or an unlawful act. Even if such a clause were included in the informed consent paperwork it would not be upheld in court. The UK, Belgium, and the others you listed are not considered the third world. You need to read more carefully. You need to do your "research" more carefully as well. The vast majority of FUE patients on this and all other chat forums are either incomplete presentations, disappointing results, or utter failures. There are handfuls of complete and satisfactory FUE results and those come from the FUE doctors who very carefully screen their patients and treat the grafts with the utmost care during extraction. The rest of the practitioners are hit and miss at best when compared to properly performed FUT procedures. I have yet to see satisfactorily CONSISTENT results come out of the third world. If artis or neograft really worked better than standard FUE or FUT every established hair doctor would abandon their current methods and buy several of them and make a fortune. To date this has not happened.

After a transplant the hair doesn't automatically grow, nor grow normally. If only it did. Rather, the follicles go into a sleeping phase and then wake up slowly. As the follicle wakes up, not all of the hair producing cells come "online" at once, so the hair that is produced is incomplete. This "incompleteness" is seen in the form of a kinky hair, even if the patient's hair had always been very straight. By month 8 their may be new hair on top of a bald area, but it can look frizzy and hard to style. Rest assured this is completely NORMAL. The follicle and hair have to go through a "normalization" period wherein the follicle wakes up completely and starts producing a complete hair. The photos below show a patient of ours in whom we implanted about 3000 grafts. Look at how frizzy the hair looked by 11 months. One might think that was going to be it. But in reality, the normalization process kicked in and the hair became much more straight, flat, and silky. Look at the ends of the hair in the 14 month photo. You can see the last of the frizz is growing out. We got the 14 month photos today as we are now lowering his hairline and filling in the crown.

Usually I have Tara post a megasession case because they generate the most interest. However for this months presentation I am going to post a patient in whom we did two relatively small procedures. The reason for this is that this patient represents many people who are not extensively bald but are still proper candidates for an HT IF it is planned and performed properly. We actually did two procedures on him. The first was in March 2013 to re-establish the hairline and thicken the front with 1,300 grafts. This worked and he was happy. But as SO OFTEN happens, he wanted to lower his hairline. Since the area he wanted to lower it into was appropriate we did a second procedure December 2014 of only 1,100 or so grafts. Of interest is that he was extremely concerned by the 7th month that the second surgery wasn't growing in well. He posted photos on this site that confirmed that. To me, it looked like not only did the second round of grafts not grow well, but that the first round of grafts and native hair were miniaturizing. Not good. But, as it turned out, he had been on minoxidil for years and had to stop it temporarily after his second procedure. Because a few months later his hair was thick everywhere again. Both transplanted areas and the native areas. This can be seen in the after photos. I suspect that he had minoxdil withdrawal, which was a rapid falling out in response the stopping the medication. But once restarted his hair returned. I believe it might have returned anyway once it got used to the minoxidil not being there. Here are his photos. Enjoy. Dr. Alan Feller Feller and Bloxham, PC Great Neck, NY

I asked myself the same question. Why come to the U.S. for a hair transplant ? Surely there are those who are just as good in the U.K. and Europe ? The answer is that there may be equivalently good clinics abroad, but I do not think that this is the conception among most of the non- U.S. public. I think in general most of the world knows the "best of the best" in technology of any kind is in the United States and that if you have the means your best chance for success for any kind of particular medical procedure is in America. This may or may not be true, but I believe this is the conception. But there may be a bit more to it than just subjective "conception". There may be something more tangible that the general public abroad has picked up on, and that's the fact that in America the clinics are not only held to very high standards by law, but that those laws are invoked and enforced regularly and seriously. I believe this is why we have not seen FUE clinics popping up all over the United States as opposed to parts of the rest of the world. Where have FUE mills really sprouted and grown? In second and third world enclaves where the legal system does not concern itself with such "petty" issues as medical standards of care or unsatisfactory cosmetic surgery civil litigation. In other words, good luck suing your doctor for malpractice or failing to provide at least the current standard of care in these countries. But in the United States, even a hint of malpractice is met with swift and serious legal action. And believe me, just about every doctor knows it. Just not providing the standard of care will have the doctor called in on the carpet before the State medical board in a heartbeat. Not to mention a word or two from his malpractice insurance company. The fact that FUE mills have not taken root in America signals to the world that America's standards are still the highest and that this credibility likely extends to all other American surgery as well. Hence, your average European who can afford it may very well opt to fly to the United States for their FUT hair transplant instead of doing so locally. And they do. In droves. Thankfully. Dr. Feller