Feller, Cole, Rose

[TheHairLossCure]

Good post Dr. Feller.

 

But you never answered the question - Feller, Cole, Rose? (just kidding )

[Bill - Seemiller]

But you never answered the question - Feller, Cole, Rose? (just kidding )

 

Now THAT made me laugh! Thanks...I needed that!

 

Bill

[Janna]

Dr. Feller,

What percentage of your HT's are FUE cases?

[felixthecat]

thats a good question and one i'd like to know the answer to also...

 

so Dr.Feller - What percentage of your HT's are FUE cases?

[BareBeGone]

I don't think Dr. Feller pushes FUE. I had a strip procedure done by him -- I'm at over 5 months and I think it's starting to come in well - he went back about 2/3 from my hairline - the front 1/3 is coming in nicely -- hoping the 2nd third will start to come in soon.

 

When I had my consultation, I asked him if a FUE procedure might be a possibility. He told me right off that since I needed over 3,000 grafts (and possibly later do 500-1000 in the crown if I wanted, though I might have enough hair to comb it back with this procedure) that strip would be the way to go. And of course, FUE would be so much more expensive anyway so I thought Dr. Feller was being quite ethical - other doctors conceivably could make much more money pushing the more expensive FUE. Also, I believe that Dr. Feller said that you might have to start a FUE procedure to actually see if a patient is going to be a good candidate - if not, he would switch to strip. Anyway, I'm hoping my hair continues to come in and thicken; he had told me since I had some previous procedures that it would start around 4 months rather than 3, so I'm trying to adjust my expectations about a month longer than some of the other posted charts (i.e. Mrjb's 12 month chart).

[felixthecat]

start a FUE and then switch to strip ?????

ive NEVER heard of this before .

[Janna]

I'm just curious about the percentages as couple years ago Dr. Harris said only 10-15% of his overall surgeries were fue's. I was wondering for both clinics if the percentages went up as doctor's skill and techniques get better. I'm aware the session sizes for fue's are bigger too.

[Bill - Seemiller]

felix,

 

Regarding FUE,

 

Dr. Feller has posted elswhere on this forum (some time ago) about FUE and candidacy.

 

Below is MY summary of what I REMEMBER from the conversation. None of what I say below should be in place of Dr. Feller's comments.

 

I recall Dr. Feller stating that though one can a physician can get a good idea before surgery, that the physician cannot know for sure until FUE surgery begins.

 

If after a short period of time, Dr. Feller determines that the patient may not be a good candidate, he doesn't want to continue for the patient's sake. Personally, I think this is commendable.

 

Clearly anyone can brute force FUE, but in the interest of obtaining high growth yield, it isn't advisable to force what just isn't meant to be.

 

All of this is discussed beforehand with the patient and the patient is well aware of the choice to either stop surgery or go to strip. The only thing I didn't like was that there was a minimum fee required and if the patient chooses not to undergo strip surgery, he is out a good amount of money with nothing to show for it. I debated him on this point some time ago. However, since the patient is fully aware of this risk going into surgery, there is nothing unethical about this.

 

This conversation however, was some time ago and I wonder how much of this information has changed.

 

I'll be curious as to Dr. Feller's thoughts on this.

 

Bill

[Dr. Alan Feller]

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.

[felixthecat]

thanks for your reply dr.feller - that was pretty quick !

i still dont understand - what specifically could make you decided to stop a FUE session after starting it ?

and how many times have you had to do this ?

thanks

[Janna]

I thank you for the reply as well. I appreciate the pics, especially the third one of the donor. The works looks very nice.

 

Would you say majority of your lunch time fue sessions are around 200-300?

[Dr. Alan Feller]

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.

[Janna]

Thanks so much for the offer. We may just take you up on it. Thanks again.

[Bill - Seemiller]

Dr. Feller,

 

I'm just wondering...

 

how do you reconcile this statement:

 

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.

 

With this one:

 

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.

 

 

The first statement seems to imply that the problem is mostly physical and out of the physician's control. The second statement makes it appear that the physical CAN be overcome with the right state of mind.

 

I look forward to your response.

 

Bill

[Dr. Alan Feller]

The problem is still physiological, however, when you are performing a small FUE session of say only 200 plus grafts, you can harvest from all over the head to find the most conducive areas. However, in a large FUE surgery you run out of room real fast.

 

The problems with FUE increase exponentially as you increase the number of attempts. So a 1,000 graft FUE surgery isn't just twice as difficult as a 500 graft FUE but rather 4 times as difficult.

 

The smaller the procedure, the more room you have to pick the best areas to harvest. That's why the novice should just focus on performing many smaller FUE procedures rather than going for 300 and up.

 

Janna, I look forward to you and Dr. S. visiting when you find the time.

[Bill - Seemiller]

Dr. Feller,

 

That makes sense. Thanks for the clarification.

 

Bill

[the B spot]

Hey, don't forget about me!!!!!!

 

I want to come as well!!!!

 

I still owe Dr. Feller a beer or three

[Dr. Alan Feller]

Sure B, of course your invited.

[Al - Moderator]

Originally posted by Dr. Alan Feller:

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.

 

Wow! Where were you when I had my lawsuit going? You should see what they had me sign as a consent form. It doesn't even mention anything about a scar. We couldn't get a single Dr to go on record saying anything negative about the consent form or the work done.

http://members.aol.com/longscars/htconsentform.jpg

 

State medical boards take informed consent VERY seriously, as do the courts.

 

LOL. Not in the state of NJ!!!!!

A medical malpractice lawyer I went to called the NJ State Attorney General on the phone while I was in his office. The State Attorney General said that since the person performing the consultations and surgeries was not a licensed Dr (his title was Medical Director)it was not legally medical malpractice and we couldn't sue for that. They also were not interested in stopping him from practicing because he was only performing elective procedures which meant what he was doing was something not necessary, yet I had agreed to allow him to do.

 

No kidding! That was the answer from the NJ State Attorney General. I was in the office during the phone call. That lawyer hung up and said he was sorry, but he couldn't take my case if the state was going to be against him on the major issues regarding the case.

 

I eventually found a lawyer to base a case mostly on consumer fraud with medical malpractice as a secondary issue, but that didn't get very far either.

 

EDIT: Sorry I'm off topic, so just to answer the question, of the 3 mentioned (Feller, Cole, Rose) I would put them in this order:

 

1. Rose - don't remember hearing any bad things about him

 

2. Feller - I personally probably wouldn't go to Feller because of other non HT issues. I think he does great hair transplants, but I don't agree with him on other things.

 

3. Cole - I would stay away from him. Anyone who threatens to sue for libel if you say anything about your own experience, threatens forums of lawsuits if they don't delete posts, etc is someone who is obviously afraid that people might find out how bad his work actually is.

[felixthecat]

2. Feller - I personally probably wouldn't go to Feller because of other non HT issues. I think he does great hair transplants, but I don't agree with him on other things.

 

and what exactly are these issues ?

[Al - Moderator]

and what exactly are these issues ?

 

 

We completely disagree on the laser comb issue. I feel laser therapy works and Dr Feller insists it's impossible for it to have any hair growing abilities. I'm currently using a laser comb and it's working for me, so I'm positive he's wrong on his stance.

 

I'm not saying that I think Drs should start promoting it and selling it to patients. In fact I would have agreed with him and had a lot more respect for him on this issue if he said something to the effect that he didn't feel it was right for Drs to be promoting it or selling it because there wasn't enough evidence of how well it actually worked or how many patients had any real benefits from its use. Something like that I would totally agree with. Laser therapy is working for me, but it's completely possible that only a very small percentage of people actually get hair growth from it and I could be one of the lucky few. I really don't know. But Dr Feller was just so outspoken and over the top about how it can't possibly work when I know for a fact that it is working for me, that I just wouldn't feel right going to him for a HT.

 

I think he does great hair transplants and I'm not trying to stop anyone from going to him, but if I went to him, we would probably get into a heated debate about the laser issue and that's probably not the best thing to be doing while having surgery performed.

[PLEASE GROW PLEASE]

Are you using the brush all by itself for your hairloss? No propecia ,foam or any other hair promoting agents. Dont want to turn this into a laser debate ,just curious.

[stevo]

I spent over 2 grand on Laser Hair Treatment and if anything it made things worse for me.

 

Back to Kriss's origonal post and i can only go off experience on this and i would have to say Feller. I have seen some of Dr Feller's FUE patients in person and i have also seen him at work performing FUE. Dr Feller's work speeks for itself....

[staplehead]

I had a fue repair procedure done by Dr. Cole about 14 weeks ago. Had 1000 fu's & 570 leg hairs. The biggest issue with his work was the placement of the grafts. Our plan before was to place 300 in the scar in the back and another 100 along a scar left by a Dr Brandy hair lift along the side of my head. He changed the plan before the prodecure. After the scars were filled, he put the left over fu's in the crown and the back rather than the front. Some fu's were a cm away from my existing hair line. Temple hairs were 2 cm away from my hair line. Found his work to be very sloppy and rushed. I couldn't even get a total fu count. No growth in the scars yet but its only been 14 weeks. Great growth in the crown and over the top but this is not where I wanted the hairs. I only have 200-400 left and will look into Dr Feller or Dr Wolfe. I would not recommend Cole.

[thanatopsis_awry]

Sorry to hear of your situation -- ridiculous for that to happen. Just recently it has been stated in various threads how vital clear and consistent doctor/patient dialogue and trust is.

 

I'm curious if you thinking he was "very sloppy" and "rushed" was because of anything concrete and specific, or if it was a general sense based off of the whole operation?