Is there a rash of poor results out there? Dr. Feller repairs another clinics HT

[FellerMedical]

I have worked for Dr. Feller for years. In that time he has distinguished between "repair" work and "finishing" work. Lately, though, there have been a higher number of patients coming into the clinic who have had megasessions at other clinics with little to no cosmetic improvement and therefore need "repair" work. This patient is yet another such patient.

The concern Dr. Feller always has is WHY did this patients hair not grow well in the hands of another clinic and should he be concerned that his procedure may suffer the same fate. After all, what is the point of doing a procedure on someone on whom it SEEMS an HT will not work?

Fortunately, Dr. Feller has determined that most patients with such poor results do not suffer from physiological limitations and therefore such results are likely the result of an inexperienced clinic. Cold truth, but nevertheless a fact. While the doctor may be experienced, the staff most likely are not.

 

In each case we have uploaded to the internet demonstrating "repair" work, the clinics that performed the work used three and sometimes only two technicians to get the job done. For a small procedure of about 600 that may be ok. But these patient were told they received thousands of grafts in one session. The famed "megasession". But how can a clinic perform 2000 grafts and more with only two or three techs? Dr. Feller doesn't believe it's possible on any consistent basis. This is why he always employs no less than six to ten techs for any given procedure in the megasession range.

 

Here is just a typical example of what he has been noticing. This patient had a megasession somewhere else and his results are practically non-existent. Furthermore, the donor area had been significantly disrupted. A factor that had to be dealt with. Dr. Feller was able to extract about 2400 grafts and placed into the exact area of the prior procedure performed elsewhere and look at the difference in growth at just 8 months. This begs the question: why did he not grow nearly as well after his first procedure elsewhere? A question ALL who are thinking about an HT should ask and be aware of.

 

The internet has done a great job filtering out amateur clinics who don't make the grade, but it's up to YOU to do your research to make sure you aren't the one who winds up with no growth that are due to circumstances that could have been controlled. Take your time and scan the forums and READ READ READ about the clinics available to you for an HT. There are PLENTY of great ones out there. Do your homework or you may wind up doing TWO procedures when one would have been sufficient.

 

Feller Medical, PC

[JayWalker]

Must be a factor that any doctor can perform a procedure and the yield isnt a favourable outcome?

Dr Feller has a few of those documented on here, so surely nobody can have a 100% hit rate, Dr Feller included.

[Cant decide]

I have had 2 procedures with Rahal and both have had great yields. While I am sure other clinics would do a fine job on me as well, since I am batting 100% with Rahal, I would never think to go to another doc. Once you have a procedure with a great yield, I would never switch to another doc. The way I see it, the procedure worked well on my head with that doc, those techs, etc...

 

I find it curious when I see people have three good resulting procedures with three different good docs. I can understand it to some level but to me, why fix something if it is not broken? There is always an off chance that for whatever reason, your procedure just yields better when done by one great clinic vs another great clinic. I would not want to change that variable.

[GoForIt]

Every clinic has poor results - just some have more than others. There are some clinics where you almost never hear of bad results, and when they happen the clinic does what is right by the patient.

 

When doing my research, there seems to be some discussion as to yield with the larger megasessions. A few physicians seems to do pretty well, but it would be interesting to see comparisons of patients with two smaller procedures versus one large procedure.

 

So what do people think would look better . . . two procedures of 2500 units each (total 5000 FU) or one 5000 FU procedure?

[GreatPelo]

So many factors can play into this. Improper care of grafts before placing them, incorrectly harvested or split, etc. Some unethical doctors have also been known to over split grafts. A patient pays for 1500 grafts, but the doctor takes 1000 and over splits them to add up to the 1500 count. Not only is this a rip off, but results will never come about due to follicles being damaged.

[Dr. Alan Feller]

There is no doubt that no clinic bats a thousand. Mine included. That's just a fact of any surgery...including cosmetic.

 

The problem I'm noticing is that I'm seeing more and more patients like this one coming to my office. They paid thousands of dollars for thousands of grafts but have very little growth to show for it. Sure, it may just be that they are not "good growers". But these people are few and far in between in my experience.

When I see a patient like this I wonder is it smart to do a procedure on them. After all, they did poorly after their first procedure, right? What's worse is now that they've had a procedure, the chances of good growth on the second one should be even less due to the disruption of the skin from the prior surgery.

So what does a doctor do? Does he turn the patient away saying he is obviously a poor grower, or does he assume there was a problem with the surgery and perform a second procedure right on top of the first?

My thinking is simple. If the graft distribution looks poor and it looks like there were a large number of multihair grafts in the hairline I determine that it was clinic error and not patient physiology. So I do the surgery as if he never had one in the past.

The fact that this patient and so many others grow very well shows me that their prior HT failure was likely due to technique and not physiology.

What is so strange is that I have been performing HT for twenty years. For the first five years of my practice I saw this kind of patient all the time. But it dropped off tremendously since then...until now. In the past six months alone I've seen at least 7 cases identical to this ALL which grew after we performed our surgery.

 

In my opinion, the number one reason for graft failure is poor technique which mostly includes either an inexperienced staff or too few staff. If memory serves this patient told me that during his first surgery he had two technicians working on him. For a megasession! During our procedure he had 8 techs working on him. The difference is obvious.

 

Do your homework and find out how many fulltime "in house" techs your potential clinic has and uses EVERYDAY. Get it in writing!!! My suggestion is there should be one tech for every 450 grafts plus a minimum of one extra tech. So if you are slated for 2,500 grafts you should have 7 techs available for your surgery. Use this formula and ask your clinic how many techs will be used for your procedure. Had the patient above known this before his first procedure things would have turned out a lot different for him.

 

Dr. Feller

[garethbale]

Thank you Dr Feller for the wise words.

 

May I ask a query...

 

In your experience, is there a better result for patients who are prescribed propecia, than a generic finasteride in conjunction with undergoing hair restoration surgery.

 

Propecia is obviously far more expensive but is there much difference between the two?

 

Thanks

[GreatPelo]

Dr. Feller,

 

These patients that are having bad results, have they had FUT or FUE or you've seen bad results with both? One of the causes that I feel will cause a wave of bad results are doctors who are not specialized getting into the FUE method of HT. They were sold a certain FUE machine and sent technicians to do all of the work, which should not be allowed.

 

Interesting how time and the "waves" of bad results can bring us "interesting" information......

[Dr. Alan Feller]

Gareth,

I and other doctors have noticed a difference in the efficacy of generic compared to the brand name. I recommend sticking with the brand.

 

Great,

I have consistently seen poor growth from FUE patients. Even in my own clinic the expected high yield is only about 85% on a any kind of consistent basis. That's why I think FUE is a good surgery, but only in smaller cases. So nothing new here.

 

But the number of poorly executed and poorly grown strip (FUT) procedures coming into my office in the past year or so has noticeably increased. Sure, every clinic gets a poor yield from time to time-mine included. But after twenty years of practicing in the same place you get to learn the numbers and the patterns and lately the number of just awful results coming through the doors has increased noticeably. So the question is WHY? What's going on?

 

I do not think there are enough FUE machines out there to make a dent in the statistics, so I don't think it is that. So it has to be something else. In the end, I believe it comes down to the team of technicians. They are the front line soldiers. The unsung labor and heroes of this field if I may use some purple prose.

 

My best guess is that fewer techs are being used for these cases, AND these techs may not be well experienced. That makes the most sense to me. But until a law is passed (which never will be) that ALL clinics must disclose and document the techs and the experience of said techs on the record we will never know.

 

I have asked each of these patients how many techs worked on them and invariably it was three or less. To me, that's the problem if the case is over about 1300 grafts. Which all of them were.

 

Going back to FUE tools. I was a manufacturer of FUE hand instruments and motorized instrumentation. I sold my company and patents so I no longer have a financial stake. I will say, as I've always said, an instrument or machine will NOT take the place of experience. It will no doubt improve the ability of experienced and inexperienced alike, but it will not REPLACE practice. And if the doctor isn't experienced, then by definition his techs aren't since they must work as a team.

 

You bring up a good point about "waves". HT improved when chat sites like this one started allowing people to see what is being done and how the results looked. In the late ninties and early 2000s the HT field really got shook up and the overall techniques and results skyrocketed. But now I'm seeing a return to poorer and poorer results. It may simply be that there are so many good HT clinics out there that potential patients don't bother doing their research because they figure every clinic is more or less the same now. That is a possible explanation. And while that MAY be a reason, I can't think of a solution.

[greatjob]

It could possibly be a result of the economic problems since the recession. I'm sure many cosmetic surgeons saw a down turn in their business, and maybe they started adding new services like hair restoration to try and compensate.

[hairthere]

Dr. Feller, I know how proud you must be of your techs/staff. Having seen them in action more than once, it's amazing how well and efficiently they work together. And it's a very reassuring feeling when you walk in 7 years post your first surgery to find almost all 7 of the same techs churning away.

[Noodles123]

Some great points brought up here. I do believe that the rash of poor results is due in part to many doctors jumping into the cosmetic fields. Here in LA, there are med spas that offer hair transplants, invariably through the use of the machines. The cosmetic medicine arena has exploded because many doctors realize that you do not need any special kind of licensing to be a "cosmetic surgeon." Cosmetic surgery is the wild wild west of medicine.

 

Oftentimes many of these so-called "cosmetic surgeons" have literally taken just a weekend course, and then set up shop offering all kinds of procedures that traditionally were the purview of true Plastic Surgeons. The end result is that you have family doctors opening up med spas and doing botox and injections, and yes hair transplants. This is also compounded by the fact that most lay people assume that "cosmetic surgeon" is the same as a "plastic surgeon." A doctor can only legally call him / herself a Plastic Surgeon if they are board certified by the American Board of Plastic Surgery, which is the only one recognized as one of the 24 specialty boards recognized by the American Board of Medical Specialties (ABMS).

[wylie]

I don't have an answer as to why this is happening, but I am grateful that someone in the community of hair transplant physicians is actually asking the question. Over the past 20 years I have always noticed a distinct lack of introspection on the part of physicians in this community on matters such as these, and an unwillingness to ask questions as to why patients are needing repair and how to address the often inherent lack of accountability amongst the community as a whole.

 

While your query may only be a ripple in the ocean, it is a very welcome and valuable addition to past and prospective patients alike. I commend you for asking it, as well as employing such a large staff of technicians.

 

My own personal opinion is really it always boils down to money. Do more with less is practically a virtue these days, except, well, it isn't. It means less overhead for the doctor and it means less attention is paid to the patient. And the results are often another patient steps onto the repair treadmill.

 

Any industry where egos, large sums of money and no regulation are in play is bound to have abuses, be it this community, Wall Street, or wherever. We can all judge a doctors results by the pictures they post, but how can we measure their integrity? We can start by asking questions like the ones you raise.

[rev333]

FELLER: "Do your homework and find out how many fulltime "in house" techs your potential clinic has and uses EVERYDAY"

 

BRAVO, Dr. Feller!

 

TECH TURNOVER is a HUGE concern considering they are the ones trimming and placing the grafts (in most clinics). In the case of FUE, I've heard some are even removing grafts from the scalp.

 

thank you for acknowledging this

[hsrp10]

after visiting Dr. Konior I have no desire to have any more procedures where the techs place the grafts (he places them himself)

you pay more but it's simply worth it