The ideal FUE

[Julius]

If money, time and travel were of no concern where would you go for FUE? And why?

E.g. SMG, BHR etc

Edited February 1, 2012 by Julius

[chrisdav]

There isn't a 'Lionel Messi' of FUE but several very good surgeons who get solid, consistent results.

 

If there was, our hair loss websites would be all very similar

[Julius]

Excellent, I am looking forward to your results with Dr Feriduni.

 

 

Anyone else?

[guipago]

"in my opinion the patient themselves have a great deal to do with the success of the procedure."

 

Could please elaborate on this Spex. I'm thinking about surgery but not too sure about FUE and FUT

[Tjavs]

There isn't a 'Lionel Messi' of FUE but several very good surgeons who get solid, consistent results.

 

If there was, our hair loss websites would be all very similar

 

 

Who are these surgions, and what are their prices?

[Julius]

Thanks Spex

Guipago unfortunately many are not candidates for fue and results do vary even if you are.

[Levrais]

 

Hi Julius, as far as where to go, I think this can depend on how much work you need. The why part is easy, customer service and proven results are the key. As you might guess, my favorite is BHR. Rahal has also shown some amazing results recently. But if someone is a nw 7 and wants to go for full coverage with body and nape hair, its hard to overlook umar.

[NEWHAIRPLEASE]

In no particular order...Rahal, Feller, Shapiro...

[scar5]

Have a look at injertocapilar. They are not, as far as I understand, a member of the coalition, but here is a very clear high definition vid of them on doing manual punching FUE and it is quite instructive. http://www.youtube.com/watch?v=Gn3-FBZj3q0&feature=related

 

This is a bit of a problem recommending FUE surgeons here. Shapiro, Feller, Bisanga and others are excellent, but they are primarily strip clinics. The old FUE = small jobs.

 

IMO all patients which have hair which is not extremely curly are candidates for FUE, not some, all. Any of these patients can have hairs safely extracted via FUE. The candidate game is just a gambit to steer you towards strip most of the time.

 

I would be careful of composite clinics telling you are not a candidate for FUE and speak to FUE clinics first. It is not easy however, as the coalition has only one.

[Dr. Alan Feller]

Scar5,

Years ago when FUE first came out and was incredibly over-hyped there were indeed some clinics that claimed all patients were candidates. Those clinics now no longer make that wildely inaccurate statement publically, or they are now flat out of business. And well they should be.

 

FUE is a very traumatic procedure on delicate human tissue. Some people's physiology will allow for it, some will not, but most fall somewhere in the middle. That's just a fact bourne out of time. Just look at the number FUE results posted over the years compared to strip results and that conclusion is obvious.

 

There are a number of techniques to decrease FUE graft trauma and increase yield, however none represent the "magic bullet". Yes, the video you show demonstrates one practitioner's techniques, and they are good. I know this doctor very well as a colleague and a friend. In fact we share information and send each other patients. But he also experiences patients who are just not good FUE candidates.Even if they have straight strong looking hair. He was even doing a surgical demonstration recently and had the unfortunate luck to be working on a patient who turned out to be a poor candidate. As a result, alot of the grafts were severely traumatized or torn. This was his report to me, and this is very consistent with my own experience and that of other reputable FUE doctors as well including Dr. Shapiro, Dr. Rahal, Dr. Lindsey, and others.

 

Some patient's skin are too mushy, brittle, or hard to allow for safe removal of the grafts. So follicular units themselves are just to splayed or wide to allow for safe removal. That's the reality of the situation and one the doctor MUST by LAW share with every patient who requests FUE procedures.

 

In my clinic I tell the brutal truth because in the end it is up to the patient to make the decision, but in handing that decision to him I make darn sure he has all the information and concerns that are in my head. Then I put it in writing so there can be no question as to the risks of this procedure. That's the right way to do it. If offering these realities and informed consent sways a patient toward the more reliable strip method, then that's the way it has to be. For a doctor to ignore, downplay, or hide these realities, then this doctor is comitting bad practice and malpractice. Failure to give informed consent will get a medical license suspended or even revoked.

 

I don't consider myself a "strip" doctor. I can do both FUE and Strip to the highest industry standards and have demonstrated such over the years on a consistent basis and in full public view. But there is a proper time to perform FUE and there is a proper time to perform Strip.

 

Dr. Feller

[Sparky]

Scar5,

Years ago when FUE first came out and was incredibly over-hyped there were indeed some clinics that claimed all patients were candidates. Those clinics now no longer make that wildely inaccurate statement publically, or they are now flat out of business. And well they should be.

 

FUE is a very traumatic procedure on delicate human tissue. Some people's physiology will allow for it, some will not, but most fall somewhere in the middle. That's just a fact bourne out of time. Just look at the number FUE results posted over the years compared to strip results and that conclusion is obvious.

 

There are a number of techniques to decrease FUE graft trauma and increase yield, however none represent the "magic bullet". Yes, the video you show demonstrates one practitioner's techniques, and they are good. I know this doctor very well as a colleague and a friend. In fact we share information and send each other patients. But he also experiences patients who are just not good FUE candidates.Even if they have straight strong looking hair. He was even doing a surgical demonstration recently and had the unfortunate luck to be working on a patient who turned out to be a poor candidate. As a result, alot of the grafts were severely traumatized or torn. This was his report to me, and this is very consistent with my own experience and that of other reputable FUE doctors as well including Dr. Shapiro, Dr. Rahal, Dr. Lindsey, and others.

 

Some patient's skin are too mushy, brittle, or hard to allow for safe removal of the grafts. So follicular units themselves are just to splayed or wide to allow for safe removal. That's the reality of the situation and one the doctor MUST by LAW share with every patient who requests FUE procedures.

 

In my clinic I tell the brutal truth because in the end it is up to the patient to make the decision, but in handing that decision to him I make darn sure he has all the information and concerns that are in my head. Then I put it in writing so there can be no question as to the risks of this procedure. That's the right way to do it. If offering these realities and informed consent sways a patient toward the more reliable strip method, then that's the way it has to be. For a doctor to ignore, downplay, or hide these realities, then this doctor is comitting bad practice and malpractice. Failure to give informed consent will get a medical license suspended or even revoked.

 

I don't consider myself a "strip" doctor. I can do both FUE and Strip to the highest industry standards and have demonstrated such over the years on a consistent basis and in full public view. But there is a proper time to perform FUE and there is a proper time to perform Strip.

 

Dr. Feller

 

 

Nicely explained, some people just don't know about the "mushy" or "brittle" aspect.

[scar5]

Re: Unpredictable physiology, the same could be said about strip scarring as one cannot predict the scarring on a virgin scalp any better than one could predict the tendency for a patients tissue to disintegrate through FUE. I (big me!) am not aware of a single case of a patient with a virgin scalp, being turned away from strip because of an unpredictable strip scar, whilst a patient undergoing FUE could, after say a few hundred grafts, have a contingency on offer, if the doc notices some sub-par results during extraction. And furthermore, we are often reminded that FUE docs have a variety of tools (they are not welded to one tool) at their disposal which could be utilized as the outcomes become apparent. Manual punches, motorized, different diameters, sharp/blunt tip etc.

 

And yet it rarely, I suspect, reaches this juncture, because the patient has already been sold strip, not because of physiology, at least on first timers, but because of some story like they need strip for the big bang result and volume and many grafts etc.,

 

So I say, straight to moderately wave hair, FUE first in an ideal world. Quite the opposite of what most folks say here, which is strip first, FUE to top it off (and fill the scar)

[mattj]

I would be careful of composite clinics telling you are not a candidate for FUE and speak to FUE clinics first. It is not easy however, as the coalition has only one.

 

I know I work for a "composite clinic" (from the context I assume you mean doctors who offer both procedure methods), but I do have to disagree with you here. If I were a patient seeking impartiality with respect to the right procedure choice for me, logic would tell me that there might be a higher chance of finding neutrality at a clinic which performs both FUE and strip. This of course doesn't mean that a clinic offering one over the other cannot advise their patients in an unbiased manner, but your comment was coming from a cynical perspective and I think I'm just applying that cynicism evenly. (I'm not saying cynicism is a bad thing - a patient must be careful).

[thanatopsis_awry]

Re: Unpredictable physiology, the same could be said about strip scarring as one cannot predict the scarring on a virgin scalp any better than one could predict the tendency for a patients tissue to disintegrate through FUE. ]

 

The same could be said. Except the rate, and severity, of unpredictability is what matters most.

 

The rate of unpredictability, and severity of when that unpredictability strikes, is virtually inconsequential with the FUT scar; in the hands of a world-class doctor, the variability is so slight, that even an outcome ranging on the poorer side of the spectrum is of little consequence to patients.....in contrast to the extraordinary and extraordinarily consistent results of the hair that's actually being transplanted.

 

The mastery that world-class docs have achieved with FUT over the years has, in my opinion, been taken for granted -- in a certain sense. And shifted the dialogue away from the actual hair being transplanted, and onto the area of the scar -- almost to the point that people just looking into HTs, who cruise the forums for a bit, go into their research focused on what will produce the least (visible) scarring, and assume that any clinic will be offering the transformations of hair that they have seen, which is often FUT work, to boot.

 

Anyways, cruise the forums for people being horribly, permanently scarred by FUT in the hands of ultra esteemed clinics in recent years. What do you find?

 

Cruise the forums for cases of young men (I generalize, but it is they who have been most easily preyed upon) being horribly, permanently damaged by FUE in the hands of (*supposed*) world-class clinics. What do you find?

 

Very important to the statement you made is that Dr's *can* tell beforehand with very high degrees of certainty, the relative "candidacy" of a patient undergoing FUE.

 

The same can simply not be said for a FUT scar.

 

The bottomline is that at the end of the day, hype aside, the vast majority of people care most about achieving the most hair they can, with the greatest % of liklihood that all the hair will grow.

 

There's a very good, and very simple reason the FUT scar in this day in age is a moribund issue -- and it has nothing to do with Dr's fear-mongering or dissuading people from FUE:

 

it's because patients know what they really want, and it's hair; and it's the type of hair transformations that FUT has made a gold-standard out of.

 

And if they don't show a terrible fear of the FUT scar, it's because in reality, most don't fear it, and it's because they have good reason not to fear it. Ironically, many of the repair cases of today and tomorrow are, and will be, by way of FUE -- and it will be from clinics that operated under assumed "refinement" and "class".

 

The risk of the FUT scar has not been marginalized; it has simply been made marginal by way of the world-class consistency and excellence of top surgeons who perform FUT.

Edited February 19, 2012 by thanatopsis_awry

[scar5]

Very important to the statement you made is that Dr's *can* tell beforehand with very high degrees of certainty, the relative "candidacy" of a patient undergoing FUE.

.

 

I didn't say they can tell beforehand. I said that the doc and patient can have options during the procedure. a) Stop b) change diameter, c) tool type , d) discuss with patient. I know in reality that won't happen - or at least not often, but as I said, an ideal world.

 

 

 

If I were to make a key point it is this.

 

1) A perfect scar is just as big a nightmare than a fat horrible one, from the patients perspective, if he loses his crown when he's older. He still has to explain that 'pencil thin line' ear to ear if he buzzes. He probably wont for obvious reasons

 

2) Let's assume scars, for this moment, as you suggest, are less of an issue than they were. IMO, that reason is Propecia. Drugs do change the picture. Without drugs, strip might be less of big business these days, but because people can reasonably expect to keep the crown going for longer, the prospect of hiding the scar without a horse shoe for a 25yr old NW5 is real.

 

I have no doubt that strip is reliable and easy for a clinic and get's predictable results. If I were an HT doc, I would recommend strip to nearly everyone requiring more than one hour of me sitting or kneeling, concentrating, sweating, wondering if the grafts are marginal, wondering how these results will look posted on HTN, over their heads. Or else I would move offshore to a place where it is legal for the technicians to perform extractions, have them trained and then be exclusively FUE and trash strip thoroughly.

 

Alot is said about FUE hype around here. I think we ought to pay tribute to the anti-hype hypists too, because they have done a good job over the years. Showing moth eaten scalps, warnings that FUE has technically MORE scarring than strip, (which is true, but hardly aesthetically a consideration) warnings about 'the next time around FUE is more difficult to extract because of the previous one. And yet still, despite this, FUE has moved forward (there have even been been warnings that it hasn't progressed too!) . The reason is patients demand the options. The option to drop drugs, to step out of the HT race as they age for what ever reason. Some people obviously, will never have a quibble or desire to cut their hair short and with luxurious hair maybe they shouldn't.

 

I agree we will get more FUE repair jobs. Twice as many people were killed by sharks last year. Reason - more people in the water.

 

I have been over harvested through FUE. But I also have strip scars. I have been you could say, butchered by FUE. When I buzz down, or shave, no one says to me, "Man, what happened in that overly thin area down on the side there?" THey say, "Man! You got some long scars there buddy!"

 

It is impossible to deny that strip yields great results and that big volume transformations are possible and with drugs, many will never look back. You got 8 people in heaven, 2 in hell if the ships sails. Do you set sail? I guess the answer is yes, but many are staying ashore with FUE too.

Edited February 19, 2012 by scar5

[Sparky]

How much fue have you had? I feel the same about strip as you do by the way.

[scar5]

... If I were a patient seeking impartiality with respect to the right procedure choice for me, logic would tell me that there might be a higher chance of finding neutrality at a clinic which performs both FUE and strip..

 

.....your comment was coming from a cynical perspective .....

 

Yes, you would think so, but it doesn't go that way. I think composite clinics are in some kind of way more perplexing. They do both, but they have a well oiled gambit-cum-manifesto about who suits one or the other. The prospective patient has to rationalize things like, Clinic 'A' does only strip because of rationale 1, 'B' does both, but they choose based on rationale 2 and 3, which to invest any faith in this scheme of things, even to temporarily consider their propositions, requires me to suspend faith in rationale 1. Where as the clinic that just does FUE, well one can say, the reason is clear. The don't trust rationale 1.

 

My comment is cynical perspective? Yes, I'm afraid so. Can't apologize for that.

[chrisdav]

I would have Strip over Fue every day of the week, even if my scalp was untouched.

 

The purpose of a hair transplant is to gain more hair, with the highest chance of a positive outcome.

 

The purpose of a hair transplant is not what scar I am going to obtain at the end of the process.

 

With a limited donor supply and the higher cost involved with Fue, Can you really risk paying a huge sum of money (for most normal people) with the chance that it may/may not work and the added fact that if it doesn't work, you decrease the crucial finite donor supply, leaving you with less hair to achieve the required coverage you previously requested.

 

Then to top it off, the new difficulty of transplanting again on to an area of scalp that has already been transplanted on, spending more money AGAIN, on top of what has already been spent.

 

I don't really understand people’s argument.

 

The scarring now for fut is minimal and in cases possibly better than fue.

 

People interact with people head on, face to face, not by the back of the head.

 

If you wrote down all the positives and negatives of both procedures, Fut wins hands down.

 

The top surgeons do meet several times a year, where they share information, and perform on patients in workshops.

 

If the majority of the all seem to come to same agreement,which they do, it is very hard to disagree with them.

Edited February 19, 2012 by chrisdav

[Sparky]

I agree that strip yeilds higher, pretty easy to see that, there's not many cases of full restorations with fue only, and where there is, the patient normally has very high density donor hair, or has had a lot of BHT done aswell.

 

Anyone who is worried about scarring shouldn't have an HT in the first place, because you will get a scar or scars, 100% guaranteed.

 

Really with hindsight, I'd say I wouldn't have either.

[chrisdav]

Sparky,how happy are you with your Fue?

[Levrais]

The original question in this thread was where to go for the ideal fue and why but it has now turned into an fue/fut debate somehow. I've heard over and over on this site how fut is the way to go and fue isn't. But, it seems to me (as far as with the top clinics) whenever there is a poor result or even a failure, its from a srtip procedure. With very few exceptions whenever there is a complaint about an fue result, its from a clinic with either no reputation or a bad reputation. Where are the failed fue from Rahal for example?

[scar5]

Yes, indeed the original question is lying dead under a cactus tree miles back down the track.

 

RIP original question.