Dr Feller or Spex

[PLEASE GROW PLEASE]

I posted about a couple of brothers having hairline work ,with one recieving temple point reconstuction that consisted of around 150 grafts on each side .

Well speaking to the each brother hes sorry he didnt have some grafts put there also.

I told them about your lunchtime fue {200 grafts] and the possibility of you maybe doing 300 .

Would you be willing to do a fue session thats a little over your usual 200 graft lunchtime offer?

[PLEASE GROW PLEASE]

I posted about a couple of brothers having hairline work ,with one recieving temple point reconstuction that consisted of around 150 grafts on each side .

Well speaking to the each brother hes sorry he didnt have some grafts put there also.

I told them about your lunchtime fue {200 grafts] and the possibility of you maybe doing 300 .

Would you be willing to do a fue session thats a little over your usual 200 graft lunchtime offer?

[Dr. Alan Feller]

PGP,

Sure. No problem.

Please post a link to the photos. That was very nice of you to think of us.

Dr. Feller

[Dr. Alan Feller]

I'm not sure if you know, but we are capable of doing large FUE sessions when they are called for and appropriate.

Here is a patient I did 1,850 FUE grafts on just in the hairline this past monday. It took us just one FULL day to do it.

 

[Bill - Seemiller]

Dr. Feller,

 

The number of FU grafts extracted via FUE is impressive just as are the immediately post op pictures.

 

I hope you or the patient will come back to show us the finished product when it grows in.

 

Pat and I have often used you as a prime example of a hair restoration physician that produces high growth yields with FUE while not overselling its benefit.

 

Because there has been a lot of recent controversy about FUE megasessions, in your professional opinion, can you explain your views on the limitations and potential problems that need to be overcome with FUE? Why might or might not these potential problems prevent megasessions of this magnitude (or higher) from being available to ALL hair transplant patients?

 

Bill

[PLEASE GROW PLEASE]

Thanks for the reply That looks really nice .

Its good to know about going a little over your lunchtime offer ,as far as grafts .

Im also interested after this next scar revision

[gazzasgoin2]

Dr Feller, as ever the work looks great.

 

Does this now mean you can safely extract approaching 2000 FUE grafts per day for patients or did this particular patients physiology allow for easier extractions?

 

Also, you can see from the donor pics just how quickly the extraction sites have healed even during the course of the day. What size of Feller punch was used in this instance?

 

best wishes

[Dr. Alan Feller]

Yes Bill,

The number one limitation of FUE are the doctors themselves. Since its introduction to the world circa 2001, FUE has been shunned, ignored, or outright maligned by every strip doctor who saw it as a threat. VERY few embraced the challenge and did the HARD work necessary to achieve any level of proficiency. When I was one of several FUE docs who gave a lecture at an ISHRS meeting in 2003 I could see the absolute hatred being beamed at us from most of the doctors in the audience. They THOUGHT FUE would wreck their livelihood, but what they didn't realize is that it could be an adjunct that would give them and their patients ANOTHER option.

 

Even to this day MOST doctors shun the procedure. Make NO mistake about it, it's not because of the procedure itself, but rather their aversion to learning how to do it. There are even doctors who CLAIM to perform FUE. It will say it right on their websites, but you will NEVER see any before/after photos. This should be policed and stopped in my opinion because these doctors are engaging in a "bait and switch" scheme and it just confuses the general population.

 

Then there are doctors that use 1.1 and greater diameter punches and CALL it FUE when in reality it's just the old plug procedure with the wrong name hung on it.

 

You name it, it's been done. FUE has been over-hyped, understated, and plain lied about. That's the NUMBER ONE problem with FUE today.

 

After this comes the technical difficulties. FUE will always be at a disadvantage when compared to strip because of the extra forces involved with getting them out of the scalp. Unlike strip grafts, FUE grafts must endure twisting, pulling, and squeezing forces. NO organ likes to be man-handled and follicles are no exception. To minimize these forces I came up with two things. The first is "follicular perforation" (which was included in the authoritative text on HT called Hair Transplantation 4th edition Unger/ Shapiro)- this technique helps to reduce the pulling forces. The second is my patented Feller Punch- this device minimizes twisting forces. Together they make for a powerful combination that has allowed my patients to enjoy high FUE yields.

 

FUE can only improve if those forces I mentioned are reduced. For this to happen a REVOLUTIONARY new tool must be invented.

 

I don't believe an FUE surgery, or ANY HT surgery should exceed 12 hours. It's just too much for the patient. Therefore, the proper amount of FUE that should be performed is that amount that can be done SAFELY and RESPONSIBLY within 12 hours in my opinion.

 

When you read of clinics claiming to do a greater number of grafts it is usually because it was done over more than one day but was CALLED one procedure. This is simply distorting reality to fool the public. Nothing more. This should be policed and stopped as well.

 

To date, there have been NO revolutionary tools invented for FUE. If there were, none have been registered with the patent office AND those doctors claiming to take the lead in FUE HT have NOT filed patents on any new devices, at least not under their names because I check regularly. That should tell the public something about the over-hyper FUE docs.

 

If a clinic claims to regularly perform FUE megasessions but refuses to disclose their technique, then I believe the following is actually happening:

1. The clinic is lying to the public and perhaps to the patient about the actual number of grafts given. This also happens in strip surgery but has become limited thanks to internet sites like HTN whereby photos can be posted for all to see. A clinic trying to seriously short change a patient will get busted in minutes. This is a testament to the power of sites like this one and is a very powerful force.

2. The clinic is employing a large number of techs and docs in an effort to BRUTE FORCE the case. This started with a Greek company and their results, as predicted, were pitifully poor. You can't brute force FUE any more than you can brute force a sculpture, a painting, or a poem.

3. The clinic is splitting all follicular units to singles or mostly singles, thereby turning a 2000 graft case into a 3,000 graft case with a commensurate increase in fee.

4. That clinic actually created a revolutionary new FUE tool but the doctor is clinically paranoid which prevents him from enjoying the fame, fortune, and wealth associated with being the one to solve the FUE problems of torsion, traction, and compression

 

While we would all like to believe #4 is the case, and you can be certain that's what EVERY supposed FUE megasession clinic has tried to imply in their marketing, I WON'T believe it until I see it. If you claim to have a flying carpet you sure better be ready to show it and give me a ride on it or else I'm going to call you a fake.

 

The bottom line is that FUE is hard work, but it is do-able with moderate to good results WHEN performed responsibly by an HONEST doctor who OWNS his own clinic. For my part I would make a law that required all FUE surgery to be filmed and posted in real time on the web. If that law passed, watch every megasession FUE clinic go belly-up.

[Dr. Alan Feller]

PGP,

Thanks.

 

Gaz,

Yes, he had exceptionally good physiology. I used nothing bigger than a .9mm Feller Punch, but his skin was so good a standard punch would have done the job just as well.

 

If ALL patient's skin were as good as this, then I would offer 2,000 FUE grafts to all that wanted it, but the sad truth is that most patients are not that lucky, AND there is no way to tell BEFORE hand how his skin will be.

[Bill - Seemiller]

Dr. Feller,

 

Thank you for your detailed reply. One thing that I really like about you (besides the fact that you produce first-rate hair transplant results) is that you cut right through the debris and get right to heart of the matter.

 

I like the fact that your post was well balanced. Not only do some hair restoration clinics oversell the benefits of FUE, but there are still a number of hair restoration physicians animately against it. I personally feel that there are benefits to FUE as it gives the patient an option. The key is selecting the right hair restoration physician.

 

When you read of clinics claiming to do a greater number of grafts it is usually because it was done over more than one day but was CALLED one procedure. This is simply distorting reality to fool the public. Nothing more. This should be policed and stopped as well.

 

 

I have actually called out a few clinics on this. Some even argued semantics with me debating the word "session" over "procedure". Whereas I was able to buy into their definitions - I suggested that their subjects be less ambiguious such by posting a subject such as "3000 grafts in one procedure over 2 sessions over 2 days). Of course - to me, this is the same as stating "2 X 1500 back to back procedures" or "3000 grafts via FUE in two procedures", etc.

 

4. That clinic actually created a revolutionary new FUE tool but the doctor is clinically paranoid which prevents him from enjoying the fame, fortune, and wealth associated with being the one to solve the FUE problems of torsion, traction, and compression

 

While we would all like to believe #4 is the case, and you can be certain that's what EVERY supposed FUE megasession clinic has tried to imply in their marketing, I WON'T believe it until I see it. If you claim to have a flying carpet you sure better be ready to show it and give me a ride on it or else I'm going to call you a fake.

 

 

I agree. Seeing is believing. This is one of the problems I have with a few of the consultants who post on our forum community. There is a lot of talk but no walk. I am seeing the material that a flying carpet is made of (equivolent: immediately post op pictures) without seeing the carpet fly (final results)!

 

If you don't mind, I'd like to post this on our Hair Loss Q&A Blog. I will credit you and provide a link back to your physician profile.

 

Let me know.

 

Thanks,

 

Bill

[Dr. Alan Feller]

Of course Grand Wizard, post it where ever you like.

 

Dr. F

[Bill - Seemiller]

Dr. Feller,

 

LOL...thanks!

 

If you don't mind, can you further explain how a patient's characteristics can play a part in the difficulties faced with FUE?

 

Can you also explain in further detail how your patented "Feller Punch" minimizes twisting forces?

 

I do indeed own and have only started reading the Hair Transplantation 4th edition by Edited by Unger and Shapiro so I look forward to reading about follicular perforation. If you could however, provide a brief summary here, I'm sure our members and guests would be interested.

 

Bill

[Dr. Alan Feller]

The first harsh force that a FU is subjected to during FUE is a twisting or torsion force. This occurs when the punch is applied over the target follicles and twisting is applied with a downward pressure in order to cut through the skin. The problem here is that as the punch advances into the skin the top part is freed and begins to twist WITH the punch. Since the bottom is still attached or anchored to the lower dermis and the top is freed and turning with the punch the graft experiences a significant torsion force. It's like twisting a towel to ring the water out of it. Sometimes the graft will break and this is called a transection. Other times it will APPEAR intact, but in reality so many cells have died that the follicle has become virtually useless.

 

The twisting of the graft can only happen IF it adheres to the inside wall of the punch. This is the same as when you were in grade school and made two microscope slides stick together by placing a bit of water between them and then squeezing them together. It's the same effect.

 

The way to minimize the torsion force was to minimize the ability of the graft to get hung up on the inside wall of the punch. I did this by simply making the punch expand just past the cutting surface. Until I identified this problem, all FUE punches had the same inside diameter (or less) as the cutting surface. So if the cutting diameter was .8mm, then the inside diameter of the punch was .8mm. In a Feller Punch, however, the cutting surface may be .8mm, but the inside diameter of the rest of the punch is .85 mm or greater. This was achieved by reaming out the shaft AFTER the cutting surface had already been milled in. The end result was that the graft didn't get hung up as often on the inside of the punch nearly as often as happens in a standard punch. I received 3 U.S. patents for this and a few other innovations.

 

I'll get to "follicular perforation" in another post.

[Bill - Seemiller]

Dr. Feller,

 

Thanks for taking some time out of your busy day to share this information.

 

I have an obvious though maybe over simplified question. When applying the punch devise over the target hair follicle, why not just use downward pressure without torque? Wouldn't this also minimize or even eliminate the twisting force? Or is the torsion force a necessary component of properly extracting the follicular unit and can't be avoided? Why or why not?

 

I look forward to your response.

 

Bill

[Dr. Alan Feller]

That's a good thought, but it doesn't work. You are, however, CLOSER to what I believe is the answer to the problem.

 

The problem with going straight down with a circular punch is that the dynamic friction (friction created as the blade is in motion) is very formidable. What happens is that the graft will bend or kneil under the pressure allowing one side to get cut off.

 

I have had some success with a solenoid device I built that shoots the punch down at an incredible speed, but there were problems.

 

Now, if you could make a laser cut in a circular fashion without buring the follicles within the circle THEN you'd have an answer.

 

I have a new punch design that represents a radical departure from what the world knows as a "normal punch" that may just be the answer to the problem. Send my your private email and I will send you a photo of a mock up I made in cardboard. If nothing else, you will say you have never seen anything like it before. I have already given it to my fabrication house that make my current punches and while they say it is tough to build, it can be done.

[Bill - Seemiller]

Dr. Feller,

 

Excellent information. I appreciate the few hair restoration physicians that will take the time to explain with pride their actual techniques and the tools they use rather than the simple-minded "We are FUE specialists and do it every day - so trust us" type responses.

 

I've sent you a PM. I'd love to see the prototype of your new potential extraction tool.

 

Bill

[bverotti]

I agree with dr. Feller that at ISHRS there seems to be a almost general dislike for FUE.

I know this first hand as I was a showcase patient in 2003. The discussions between panel member and the audience where quite agressive of tone at certain times.

 

It is also true that procedures are to be limited to maximum 12 hours. Therefore we work hard for the patient, even using seperate morning and afternoon teams to avoid fatique.

 

FUE is hard for the surgeon, but it is just sooo rewarding for the patient.

[Bill - Seemiller]

Bart,

 

I appreciate that you can relate and agree on some of foundational concepts.

 

But whether you know it or not, you are one of the biggest over-promoters of FUE megasessions. I believe you claim that your clinic(s) regularly performs between 2000-3000 FUE graft single sessions in a single day.

 

When asked time again to address how your doctors have overcome the potential problems and risks associated with FUE (defined above), you beat around the bush, ignoring the questions.

 

You have also been asked to display before/after pictures as evidence of your claims. To date, you still fail to produce these results.

 

I've asked you before when I put you on "watch" and I'll say it again to remind you since you went into hiding for awhile.

 

I will not tolerate blatant promotions here without evidence. If you can't answer technical questions posed to you about your clinic's work, then spend your time providing the visual proof of your doctor's work. If your clinic is legitimately producing high growth yields with these regular FUE megasessions - this is the easiest thing in the world to produce. Failing to produce these results makes you look bad when you are asked to do so.

 

If you choose not to do either of the above, I am going to be forced to see you as a spammer - here solely to gain publicity for your doctors and promote. You will then be treated as a spammer.

 

Bill

[bverotti]

WTH,

Bill, please take it easy,

I took great caution not to enter a debate in this thread, yet you attack me as if I did.

 

I am working on getting pics, no need to get into discussions. The proof will make any discussion pointless.

[Bill - Seemiller]

I am working on getting pics, no need to get into discussions. The proof will make any discussion pointless.

 

Ok then get to it. As the expression goes...

 

Sh** or get off the pot!

 

You are also welcome to contribute anything technical to this discussion. I've been pleading with you to do so many times now - you just haven't addressed them.

 

Bill

[Dr. Alan Feller]

Bill,

Did you get my email on Friday with the new FUE tool design? Check your spam folder if you haven't.

[Bill - Seemiller]

Dr. Feller,

 

Yes, I found your email in my junk email folder and just responded. I look forward to hearing back from you.

 

Bill

[Dr. Alan Feller]

"...describe how patient characteristics play a role in the difficulties of FUE?"

 

It's very simple. Some patient's skin contain just the right amount of collegen to provide the support necessary for the graft to come out intact.The patient I posted on this thread is an excellent example of this.

 

If a patient's skin is very mushy (low collagen content) then the graft will just succumb to the three major FUE forces: Torsion, Traction, and Compression. What will happen is that the graft will tear apart like twisting a piece of overcooked spaghetti and then pulling it apart.

 

If a scalp has too much scar tissue from prior trauma or surgery, then that scar tissue will invade virgin areas of scalp and make the skin in those areas very brittle. So when those three FUE forces are applied, the graft literally cracks apart. This is very commonly seen when trying to extract old plugs from the recipient area and explains why it is not so easy to reverse obsolete plug work in just one visit.

 

Some people have a variation of all three skin types (Bad, Good, Great) throughout the scalp so it takes patience to carefully map out a donor area and take the right number of FUEs from the right place.

[Bill - Seemiller]

Thanks Dr. Feller. I appreciate your answer to this question. I've learned a lot from this conversation and hope the other members/guests of our community do too.

 

Bill

[NervousNelly]

This has turned out to be a great thread with a good deal of valuable info. I appreciate Dr. Fellers insight into FUE as this is the type of info that we all have been needing. His work is extremely clean, but once again is meaningless to me until I see the final results (No disrespect intended towards Dr. Feller--I'm sure he understands that).

 

Bill--thanks for asking the necessary questions and remaining optimistically skeptical about FUE so that members aren't going to jump into things until fully educated.

 

NN