Costs of FUE - US vs Europe/Asia

[scar5]

I want to continue discussing the (nominal) theme of the recently shut down tread about FUE pricing, laws, ethics and a multitude of other useful things that help our understandings mature.

 

Unfortunately the thread stuck an iceberg and became tussle between the interests of the forum owners and the advocates of a particular clinic who felt slighted and unfairly shut down.

 

I don't particularly care about names, clinics, testimonies etc., - all docs are perfectly wonderful people as far as i am concerned. I do care about the realities docs and clinics work within, industry momentum, innovation, changing consumer awareness etc.

 

 

i want to copy an paste a comment by a poster named Delancey, that was posted in as the thread was in its death throes.

 

 

...............Delancey's bit...................................................................................................................

Firstly, marketing expenses are just as expensive in Western Europe as in the U.S.. In fact, many clinics advertise online; therefore, the expenses are exactly the same. Secondly, the cost of labor in Western Europe is very high. Have you ever lived in Sweden or in Norway? I highly doubt that techs in the U.S. are earning more than in Belgium, Sweden or Denmark. Thirdly, malpractice insurance is a fixed and variable expense that is held in case a contingency occurs. It's smart business and surely it is just a fraction of the total earnings from 10 dollars per graft that some FUE surgeons are charging in the U.S..

 

 

I've lived in 5 countries and I can assure you that running a business in the U.S. is not more expensive than in Europe. Quite the opposite, in fact. European countries can be very expensive, depending on the country. Finally, I will note that supply and demand will determine what U.S. surgeons can and will charge, but I surely couldn't afford to pay $80,000 for two FUE surgeries. Most people can't! Hence the large supply of FUT in the U.S..

.....................end of Delancey's bit......................................

This is what it is all about.

 

Will Costs Come Down?

 

The only way FUE pricing will come down is with tech extraction.

Artas, Neograft may help, but not to anything like the extent.

 

What About in America Where Strip Rules?

 

Blake wants to tell us that US docs stick with strip because they have a good conscience.

I want to say US docs stick with strip because of economics and legal issues.

 

Ethics of tech-extraction - a question to ponder

 

If you are appalled at the ethics behind FUE tech-extraction protocols in in Turkey, how can you take the ethics of a US doctor putting a strip scar across a 28 year old's head and sending him away with a bottle of meds?

 

For Brit and 66 etc.

Of course I care

As a strip victim/beneficiary and FUE advocate I had to watch the three biggect FUE clinics that I thought might have made a positive impact, banned from all the major US forums for many crucial years whilst the guns of Hasson and Wong, Feller etc. and their willing shills controlled the territory, laid down the ground fire, telling a whole generation of us all about the horrors and deceitful nature of FUE. And no, FUE docs are not good guys either. I dislike several prominent ones but that means nothing useful to anyone here IMO.

Edited March 22, 2015 by scar5

[Sean]

Strip is economical in US. fUE is more labor intensive and time consuming that many clinics in North america cannot follow doctor extraction fue protocol like in Turkey and India and Europe. Costs are

Much high in North America. I think the cheapest i heard was Dr. Vories in North America who extracts grafts himself and at $4 per graft. He does one patient at a time and still offers such a price. Haven't heard of another North American doc at that price and that type of personal service with FUE. Dr Bhatti in India offers low rates too. Even some docs in Turkey. Yea you just have more security paying less and if some physiological blame game starts against you, you are not too financially screwed if things hit rock bottom. Rarely anyone gives refunds. Most docs in North America try to waste your time by waiting 24 months and trying to have you come back for a redo to save face online. $1 dollar fue grafts in India and Turkey, even with a flight and hotel, you pay 1/3 the price, such a huge cost disparity.

[wylie]

U.S. docs stick with strip because it's the easiest way to get a good result, it's far more difficult to be an expert at FUE, but with strip, the learning curve is comparatively small. I have seen all the same critics of FUE also go after body hair, specifically beard hair, and I know that it works, as it saved me from a lifetime of wearing a hat.

 

Just because a doctor pans FUE/body hair does not mean that the procedure itself is ineffective, it often just means that the critics are not proficient enough at the procedure to practice it effectively. If they were, they would be shouting from the rooftops of its benefits.

[BUSA]

strip compared to FUE to me is the equivelent of an VHS tape to Bluray.... both work but one doesn't require the other to fix it wen it goes wrong.

 

costs here are much higher because doctors pay $500k to go to medical school then have to pay for malpractice insurance. europe unlike the US isn't sue happy so europe has much lower overhead.

[hairweare]

Overhead and malpractice have nothing to do with it. HT docs in NA are not bound by Medicare rules or private insurance contracts that force deep discounts. OTOH they can charge whatever they please or more precisely what the market will bear. Ask me how I know.

[SySperling10]

Overhead and malpractice have nothing to do with it. HT docs in NA are not bound by Medicare rules or private insurance contracts that force deep discounts. OTOH they can charge whatever they please or more precisely what the market will bear. Ask me how I know.

 

Insurance and overhead/malpractice are unrelated. Insurance refers to a patients coverage for health insurance, where as malpractice is required for all practicing medical doctors, assuming they don't want to cover issues out of there own pocket.

 

Medicine as a whole is expensive in the US. The technicians in the US likely cost more than other countries, along with the medical facility. Marketing should not be a huge expense in this space, I good doctor just needs positive word of mouth. This is not to say the are the primary drivers, a doctors time is the most expensive, which IMO cause FUE to be more expensive. Georgraphically speaking, I can see prices being different depending on the practices location in The US.

[Sean]

Average income in Turkey is far less in North America. US and Canada follow a more capitalistic model of making money. Highly commercial based industry and less labor intensive by the surgeons themselves(very very few extract FUE themselves and use manual fue) This even when charging a very steep fue per graft premium. Some tech ran clinics may do it too in Turkey but charge less Still. However, there are also heavily involved doctor clinics in Turkey and in other countries that charge much much less, even if they do manual fue, one patient a day, all steps done by doctor for fue. That said, price is not going to go change much in North America. It barely did for fut too. This is when there were international clinics offerring less than a dollar a graft for fut during north americas fut boom. A lot of folks are going for complete plastic surgeries internationally due to lower costs and coming back with the same results. Difference is would you pay $3000 or $30000 for the same quality of work. Most people are shifting to lower cost clinics overseas. Remember the saying on this forum, dont let distance be a factor. Get a passport and be ready to travel.

[starr]

Remember the saying on this forum, dont let distance be a factor. Get a passport and be ready to travel.

 

Hey Sean, just wondering... since you seem to be an advocate for going international, why is it that you chose Dr. Rahal for both of your surgeries? I'm in a similar boat...I'm looking at my options for HT #2.

[hairweare]

Dr. Vories may have the most reasonable fees for a dedicated FUE clinic in NA. but I do not know if he does beard extraction. FWIW, Lorenzo told me that it is easier to extract beard follicles than that from the scalp. May be worth inquiring about.

[scar5]

Strip is economical in US. .

 

 

Exactly!

 

This is the one thing we must get into our balding heads!!

 

If you take only one thing from your research, take this!!

 

Bless Dr. Vories.

 

What punch does he use?

 

If it's all manual, I'm sorry to say, it won't be long before he either gets fed up or injured.

I expect to an admission similar to Blake's, when all of a sudden, he begins to doubt FUE!

 

People are getting wiser.

[hairthere]

Dr. Vories uses Neograft and he has shown some really nice results on this forum. His site says he has been in HTs since 2002, but I would certainly ask him how long he has been using Neograft and to see as many Neograft specific patients as possible.

[Blake Bloxham]

Scar,

 

My thoughts on FUE were definitely not sudden. Like I explained before, they were a result of actually seeing and performing both procedures. This transition happened over 2 years. It also reminds us of something relevant in our entire culture today: the difference between what we read online and what actually occurs in real life.

 

Online, FUE makes perfect sense. You see impressive FUE transformations and assume it's perfect yield without the linear scar. However, this isn't the truth. FUE, even when performed in the most expert hands, will always have lower yields.

 

Let's look at some objective facts:

 

In a 2014 review published in the Journal of the American Academy of Dermatology and the Journal of Dermatological Surgery, the manufactures of the ARTAS system found FUE transection rates as high as 29.4% in large FUGs in Korean patients and 32% in all FUG sizes in Caucasian, Indian, and Middle Eastern patients. The average transection with strip was quoted at 1.59%. Granted, the overall averages for FUE transection were not as high as 29-32%. However, the authors said the importance of these statistics is the fact that it's possible with FUE, but nearly unheard of with strip harvesting.

 

 

Keep in mind that follicle transection is only one aspect of poor growth yield as well. It does not take failed extractions or growth yield of implanted follicles into consideration. Let's look at that further.

 

 

This data comes to us from Dr. Beehner and Dr. Wesley. In it, they show us a few interesting things:

 

1. That growth yield with skeletonized FUE grafts is between 48 - 68.7%. Keep in mind that using smaller and smaller punches (0.7mm, 0.8mm etc) creates severely skeletonized grafts.

 

2. Growth rates improve when grafts contain an appropriate amount of supportive tissue. This means either taking more donor tissue and dissecting it under a microscope or using much larger punches - which will significantly increase scarring and thinning in the donor region.

 

Dr. Wesley expands upon this further and explains that in a double blind, 16 month trial featuring 6 patients, he found that grafts harvested via a non-traditional FUE approach had a 45% greater survival rate than those harvested via FUE.

 

I also wanted to include a side-by-side comparison of grafts extracted carefully with manual techniques compared to those dissected microscopically from a strip:

 

 

This image (courtesy of Dr. Bernstein) highlights some of the reasons for poorer yield. As you can see the splayed direction of the individual follicles in the follicular unit is a result of traction during the delivery process. Not only does this demonstrate the amount of force placed on a very delicate graft, but it also shows us that the graft will undergo more stress and strain when trying to fit it into a small slit or pull it into an implanter pen. The image also shows us the skeletionization effect. Note how this is most obvious around the base of the follicle. Unfortunately, this is where the dermal papilla stem cells lie. This means damage or cellular death via dehydration in this region is detrimental.

 

Now, I wanted to address the "economics" comment. I've said it before and I'll say it again now, FUE is much more lucrative and a much better business model for hair transplant surgeons. Let's look at some more objective data:

 

I want to compare two different clinic models operating on the same patient. Clinic 1 is performing a 2,000 graft strip procedure on patient X, and clinic 2 is performing a 2,000 graft FUE procedure on the exact same patient. In this example, I'm going to use $5 (US) a graft for FUE (quite a fair price) and strip pricing from a US clinic:

 

 

As you can see, the hypothetical FUE clinic made $1,400 more than the strip clinic operating on the exact same patient. When you extrapolate these results on a monthly and even yearly basis, the conclusion is crystal clear: it is more profitable for clinics to perform FUE. Period.

 

So, why should clinics bother with strip? Well, like I've said before, I think these doctors don't feel comfortable offering patients a procedure at greater cost with less yield. This is bad for the patient, the doctor, and the highly important ethical reputation of the physician.

 

Alright, fair enough. Right? Well, you'll probably ask, what about the scar? What about that blasted strip scar!!?

 

The strip scar is the reason we are even discussing this today. And honestly, I get it. Patients don't want the scar. It's reasonable. So, what are we to do? Two options:

 

1. Wait until we've developed a procedure with strip-level yields and FUE-level scarring (more on this later ; ) )

 

or

 

2. Make sure doctors are properly consenting patients and performing the right surgery on the right patient. This means doctors need to share the above objective data with patients. They need to say that FUE is more likely to provide lesser yield - even in the best of hands. BUT, strip is going to leave you with a linear scar - even in the best of hands. If the patient is a 25 year old male who wants to buzz his sides short and sport an undercut or may buzz it all off in the future and struggle with a linear scar, he needs to be made aware of the yield issues and probably opt for an FUE. If the patient is a 50 year old NW 6 who wants to part his hair to the side and has no intention of ever buzzing his head, a doctor shouldn't waste limited grafts on a procedure with less yield. This gentleman should be made aware of the linear scar and should probably opt for strip.

 

This is the ethical way to proceed. And I implore all patients to proceed as such. Make yourself aware of the objective facts above. Consult with doctors who will explain the pros and cons of both procedures and help you objectively pick the right surgery for you. And move forward confidently.

 

Sorry for the long post. I really hope this helps. I think you're doing a good thing investigating this issue, Scar. And I hope this information helps explain my perspective!

Edited April 28, 2015 by Blake_Bloxham

[starr]

I did email Dr .Vories about FUE from beard and I was not impressed by the response.

Doesnt do it nor does the clinic manager seem to be aware that it is actually a procedure (to take from the beard and use it as filler on the scalp).

[Michael Vories, MD]

As has been discussed before, FUE is a descriptor for only one aspect of the procedure. The method of placing FUE grafts has to be considered in these studies.

[scar5]

Scar,

.....Let's look at some objective facts:

...I wanted to address the "economics"...

 

 

 

Indeed.

 

Is anyone capable of deceiving themselves that this nonsense is real?

 

It takes a strip doc about 40 minutes (max) to pull out 4000 grafts in a strip.

 

The same doctor needs two to three days to pull out the same through FUE.

 

In New York, you have to do it yourself as a doc (see above) , unless you go Neograft and then well...who is doing your transplant and who will be in court?

 

In the state of New York, you are now now (officially condemned-edited out) condemned to strip because of laws and all the BS the docs will spin you and I recommend anyone considering a transplant in the state of New York to consider flights to Turkey and India.

 

 

Blake's figures mean diddly squat.

 

However, I don't doubt that the quality of service in the Feller/Blake clinic technically wise.

Your choice is whether you ultimately buy into their gambit, or you move on.

 

I say no excuse. get a passport and (Edited in) - keep in mind, that yield with FUE could be lower and budget for a higher number of grafts!!

Edited April 22, 2015 by scar5
The italics parts. officially condemned? It is my hunch and that's all. Apology.

[hairweare]

As one if not the only adopter of Lorenzo's method for FUE in NA, I would have expected a more impassioned response from Dr. Vories.

[scar5]

I want to retract some of the comments I made from my own quote below. Sorry to hog the flow, so to speak, but some of it is clearly reactionary and boorish.

 

I was pretty dissed at Blake for blowing smoke at us, IMO, with figures about FUE economics.

 

The key economic stat is this,

 

It takes a strip doc about 40 minutes (max) to pull out 4000 grafts in a strip.

 

The same doctor needs two to three days to pull out the same through FUE.

 

The rest of FUE is the same as strip from the doc's end, give or take. The tech picture is completely different, but it is the doc that is the golden goose and it is the docs' time and energy that is front and center.

 

I apologize for the childish, insulting and butt hurt tone of the rest and I don't recommend everyone fly to Turkey because I don't know about Turkey. On this board there are plenty of members who who about it.

 

My Last HT

 

My last FUE was a tech driven, rotary job and the results were poor.

I'm not completely sure about how much of the result was caused by the techs, the tools, the protocol or the doc himself,because the docs placement of slits was atrocious, tardy and completely unacceptable. My gut feeling is that he didn't give a damn .

 

He was one of the most experienced HT docs in the world. I am one of the most experienced HT recipients in the world. Guess we are both jaded.

 

Research and think about current circumstances, and that means laws and the economic reality that the clinic is compelled to work within first, then look at the choices they are making within that reality, and then the spin they use to justify it.

Finally, don't rely on 'legends' or reputation. Things can change.

 

 

 

 

Scar,

.....Let's look at some objective facts:

...I wanted to address the "economics"...

 

 

 

Indeed.

 

Is anyone capable of deceiving themselves that this nonsense is real?

 

It takes a strip doc about 40 minutes (max) to pull out 4000 grafts in a strip.

 

The same doctor needs two to three days to pull out the same through FUE.

 

In New York, you have to do it yourself as a doc (see above) , unless you go Neograft and then well...who is doing your transplant and who will be in court?

 

In the state of New York, you are now now (officially condemned-edited out) condemned to strip because of laws and all the BS the docs will spin you and I recommend anyone considering a transplant in the state of New York to consider flights to Turkey and India.

 

 

Blake's figures mean diddly squat.

 

However, I don't doubt that the quality of service in the Feller/Blake clinic technically wise.

Your choice is whether you ultimately buy into their gambit, or you move on.

 

I say no excuse. get a passport and (Edited in) - keep in mind, that yield with FUE could be lower and budget for a higher number of grafts!!

[SySperling10]

As one if not the only adopter of Lorenzo's method for FUE in NA, I would have expected a more impassioned response from Dr. Vories.

You're asking him to reveal the economics of his practice, I could see it not being an aspect many would be willing to divulge. If you ever chat with him, it's clear he does FUE because he's trying to do what he thinks is right by his patient, not to stand out, or make money other docs are passing on. His philosophy on HT is progressive for NA but common practice in the rest of the world, due to the economics, expect a slow paradigm shift in the states.