INTRODUCING: Modified FUE (mFUE)

[Mickey85]

A Gold Standard technique shouldn't need a marketing strategy that highlights the weaknesses of the competing products in order to look more attractive on the market.

 

Just look at the most popular phone on the market. It lets the quality do the talking.

 

Perhaps this is why few FUE Doctors have bothered coming online to defend their technique and talent? The quality speaks for itself.

 

So true my friend. Just let the results do the talking. Many surgeon's take their jobs very seriously and I applaude them for that. I respect Dr Feller's strip work but most of the great surgeons have no interest in getting into an e-war online. Alot are booked out well into 2016 and in their spare time I'm not so sure they would be wanting to sit infront of a computer debating hair transplant methods with other surgeon's across the world. There are conventions for that where they can showcase their talents and methods live and in person. Just my opinion anyway.

[Sethticles]

IMO...

FUE clinics only show the best & cherry pick there Pts, for sample.. guys with great donor with good overall density which is clever sexy marketing, showing a shaved down donor on a pale guy looks very good indeed.

 

Same can be said to FUT clinics they show a great outcome with Pts who will never shave down.

 

All I can say don't believe everything you see on the news or read on the internet.

Its all Marketing & its up to us the Pts to work out what's best for us & once you made your bed then lay in it..

Simple as that.

 

agree !! nicely said thanks

[Blake Bloxham]

Maybe the tactics the FUE clinics are using just aren't as obvious. Keep an eye out for an announcement.

[ontop]

Blake...

 

LOL...I won't ask for a teaser, it be WW4 ...Ha Ha.

[irishsailor]

Maybe the tactics the FUE clinics are using just aren't as obvious. Keep an eye out for an announcement.

 

Dr B. You can't keep us hanging with that comment

[thisguy1]

Blake,

 

Excellent write up. And sure to spark controversy too.

 

Listen...everything has tradeoffs. The informed patient and reputable doctor OUGHT to discuss the tradeoffs with different approaches before any decisions are made. But this is the real world...not everyone is reputable, and not everyone wants to hear the pros and cons of various choices regarding their own health care. I know...I just had a medical procedure 2 days ago, and just filled out the surgerycenter survey listing several things I wasn't told and wouldn't know had I not been a doctor myself. I sympathize with the consumer/patient in wanting all the info to make the best decision I can too!

 

Regarding MFUE, FUE, and Strip:

 

Strip has the advantage of giving you great grafts, even with skinny hair roots because the techs can not skeletonize the root bulbs during dissection. And you can get tons of hair in 20 minutes. The disadvantage is you have a linear scar in the donor region. Some people get bad scars and some doctors are not skilled in closure and sometime you have both of those factors BUT even crappy scars are well concealed with 1/2 inch long hairstyles in almost everyone....and I see a lot of poor scars come in for visits. 80% of those guys with poor scars, who want more hair...tell me to not worry about fixing their scar at all...just give them more hair. So for me, strip works, most people have no trouble with their scar, and it works. Were I getting an HT...I would pick strip. I personally know several HT docs who chose strip for themselves over FUE. That OUGHT to tell people that strip may be the best choice in many, but not all, situations.

 

FUE has the advantage of no linear scar. BUT it has the disadvantage of LOTS of little depigmented scars and frequently lots of subcutaneous donor region scarring that will limit the ease and success of future FUE cases. And like it or not....avulsing the hair out of the scalp does stress the hair. But, its a great option for people who need a true crew cut and who don't need a ton of hair, and who have anything better than fine hairs. I did FUE on my own son...he had a scar and needed hair put in it...didn't want a second linear scar and he has thick wirey hair...FUE is perfect for him.

 

and if you need to understand how fue stresses the roots...particularly in fine hair...watch this video of me working with plants.

 

 

 

Readers...I wish FUE was the end all be all but it isn't. It is great in select circumstances and is ok in most circumstances but its simply not the answer to all of hair's problems. I stumbled across a US surgeon video saying that strip surgery was antiquated and ought to be outlawed.... interestingly he appears to have just gotten into FUE and has no apparent "grown-out" results of his own...but its hype that that that fools many a potential patient into not becoming educated PRIOR to making a decision. That is more of a greedy doctor issue than a duped patient issue but that is another topic.

 

MFUE is simply another approach. It too has advantages and disadvantages that reputable doctors ought to discuss prior to offering or performing it. MFUE has the advantage of giving you really nice grafts...strip quality or almost strip quality...even in fine hair...in a very short period of time, just like strip. It has the disadvantage of giving you a bunch of small linear scars. The guy that Blake shows above that I did, really scarred well. Clearly he scars "ok" with linear scars as he has a couple of small linear scars from trauma over the years sewn up by ER doctors...but they show...his MFUE really are hard, but not impossible to find. (I'll put up a video of his head shortly showing those other scars and this guy in and out doors).

 

Now as of today, I think I've done 28 MFUE cases, starting in Nov 2013. I'm guessing now, but I would guess that I've seen 20 of those people back for scar pics (8 either live away...or despite me begging them to come for scar checks for this novel procedure...they just didn't show). None of the 20 I've seen back have significant scarring. Almost all had some shock loss around the MFUE sites at weeks 4-10, just like strip. All that I have done were closed with one or 2 sutures left in for 10 days...up from the 7 I use for strips. And all got tired of those sutures after a few days....

 

But its a good technique to consider in people who: 1. need a real crew cut 2. are deathly afraid of a linear scar despite reassurances 3. have been all "plugged out" (we've done several guys who had too much scarring for fue and too tight of scalps for strip...and gotten good results with MFUE--I've posted a few and just not said it was MFUE). 4. people who have fine hair 5. need hair for a scar repair and don't want another linear scar 6. and people in whom you just can't extract FUE grafts without unacceptable transectioning.

 

I realize that lots of people will say this is a step backward in HT. I'd suggest it is more of a backstep and counter...to use a tae kwon do analogy from my past. You back up, block and roundhouse so that you can get power...its not a retreat.

 

With proper planning, and closure of the extraction sites...not leaving them open like in the plug days...or simply doing one running suture to close them all poorly...to date we are getting good to excellent scar results. Tension free closing..not putting the sites too close to each other...and 10 days of sutures with vitamin e post suture removal is working at my office so far.

 

It is not perfect...but it has advantages and disadvantages that my weigh out favorably in lots of potential patients. When Dr. Feller and I first started talking about this we both knew it would be threatening to some people, and fools folly to others....but consider strip or near strip quality hair, with limited scarring...and that is an option that warrants consideration.

 

Now let the arguing begin.

 

Good post Blake.

 

Dr. Lindsey McLean VA

 

Great post and educational. I hope to see mFUE cases posted by your 2 clinics in the coming year. Has either clinic posted any yet? Sounds like you Dr. Lindsay started this in late 2013 and I assume Feller & Co soon after. Would love to see some of these patients post their opinions too.

[Dr Blake Bloxham]

ThisGuy,

 

Dr Linsdey specifically has been posting some great updates along the way. Mostly of the surgical process and the scarring in the donor. We are starting to see patients come in for follow-ups, and the results, thus far, are consistent with what we saw during the trial phases: FUT growth and -- obviously -- no linear scar. Very pleased with the technique all around.

 

We'll be posting some in depth presentations and updates on the technique in general in the not-to-distant future. Stay tuned!

 

In the meantime, I highly recommend watching the mFUE videos on Dr Lindsey's YouTube channel. He's done an excellent job documenting the process.

[kian222]

Great thread, this is the first time I'm hearing that FUE scars are more prominent on darker skinned people. I would have thought it was the opposite.

 

Also, I had a question for some of the proponents for FUE. In Europe and Asia they allow their technicians to do the work, how would there be any consistency. I was considering Dr Koray but I found out he doesn't do the work himself, what if there's a new technician that day? That seems to be a major shortfall.

[Dr. William Lindsey]

Yes, you have the issues figured out.

 

As to scarring...I'm now up to around 80 mfue cases. In about 75, my best guess given some are travellers and send pics..., the scars really are between really difficult to find and fairly hard to find ( I realize this is vague and subjective, but its what I have used to describe them to the specific patient who seems to agree with that adjective ). In the remaining 5...2 have had a significant amount of shockloss which seems to be recovering, and 3 have scars roughly 3mm x 5mm at each and every site. To try and reduce this further, we've started doing 2 layer closures on each of these punch sites but I don't have long term views of this yet. That adds time and cost to me, but may be worth it.

 

So 5 out of 80 have scars that are more than tiny dashes. Pretty similar ratio to the 8 poor scars I openly admit to getting each and every year from our roughly 130 strip cases. Probably the same "people" with poorer scar recovery, although I can't prove that.

 

I posted this elsewhere, but here is one of the "75" good scars at 7 months last week.

 

 

Dr. Lindsey McLean VA

 

 

 

[Sethticles]

Great thread, this is the first time I'm hearing that FUE scars are more prominent on darker skinned people. I would have thought it was the opposite.

.

 

well the scarring can be seen as little white dots, hence why it may look more obvious on darker skin. for me the scarring is impossible to see

[Gasthoerer]

Dr. Bloxham,

 

This mFUE topic is very interesting. And no, I do not like the name either, but I think for an educated client the name is really not important. FUT is also wrong name for strip.

 

Why it is interesting: I would like to have strip like grafts, but I do not want a strip scar as there is a stigma with it. Actually, I do have many scars in my face, so I would not mind a scar, but I do not want a scar which says "cosmetic surgery".

 

Anyway, I have some questions:

- If you actually close the "wounds" similiar to strip, why don't you just do mini-strips. I know you mentioned that Dr. Feller (!) tried but scaring was poor. Why is that? Why should this method give better scaring. I just do not understand it.

- How do you avoid dissecting the grafts around your punch? Compared to a real strip you score just very few grafts per "cut". The transection rate in the donor has to be very high, or am I misleaded?

- Do you only score classic safe zone as strip or in the extended zone of FUE?

[aWidowsPeek]

"Mfue" is the lamest thing I've seen on here in a long time. I had a good laugh though.

 

Like many posters have already said in this long boring thread bash FUE all you want. In the right hands it's amazing and the results speak for themselves.

[Gasthoerer]

I would not call new inventions (even with a not so wisely chosen name) lame.

But I would love to have my questions answered.

[Dr Blake Bloxham]

I would not call new inventions (even with a not so wisely chosen name) lame.

But I would love to have my questions answered.

 

Somehow I missed your original questions. I'll happily answer these when I have a minute. Stay tuned.

[Gasthoerer]

Somehow I missed your original questions. I'll happily answer these when I have a minute. Stay tuned.

 

Thank you, I understand that you are busy. Answers will be appreciated at any time :-)

[Shampoo]

Dr Linsdey specifically has been posting some great updates along the way

 

I agree. Dr. Lindsey is a real asset to this forum with his easy to understand educational videos and explanations about issues both pro/con about the different types of hair transplant procedures.

[Bill - Seemiller]

Shampoo,

 

If I could "like" your reply, I certainly would. But I agree that Dr. Lindsey is an excellent participant and I truly appreciate his videos as well.

 

Best wishes

 

Bill

[Dr Blake Bloxham]

Why it is interesting: I would like to have strip like grafts, but I do not want a strip scar as there is a stigma with it. Actually, I do have many scars in my face, so I would not mind a scar, but I do not want a scar which says "cosmetic surgery".

 

You're not alone. In fact, I personally think one of the reasons why FUE scars "work" for a lot of people is NOT because they aren't there or they are "invisible to the untrained eye" -- these are both simply untrue -- but because they don't appear as "surgical." I don't think patients have as much of a big deal with scarring as they may have with the "stigma" of a scar that people can identify as surgical. If the scars look traumatic, secondary to some sort of inflammation, etc, then they aren't as stress-inducing if noticed.

 

And mFUE scars -- even when I take large pieces -- fit this bill; they are visible, but they don't scream surgery -- cosmetic or otherwise.

 

- If you actually close the "wounds" similiar to strip, why don't you just do mini-strips. I know you mentioned that Dr. Feller (!) tried but scaring was poor. Why is that? Why should this method give better scaring. I just do not understand it.

 

I think it depends on how you define "mini strip." The principle behind the modified approach is pretty simple: instead of taking one big strip in one shot or taking little individuals follicular units one-by-one, we take out little bites or pieces. The size varies greatly depending on the patient, overall goals, the reason they would rather have modified above FUT, etc. So if these get big enough to fall into the undefined category of a "mini-strip" or a "broken up strip," then I have no problem saying this scarring works well. Imagine little dashes placed very strategically throughout the donor or a stuttering strip incision line. The scarring actually works quite well. And I'm still doing more trials with the sizes of the pieces.

 

However, the reason why I never accepted the "mini-strip" argument in the beginning was because Dr. Feller and another colleague had experimented with TRUE mini strips in the past and he wasn't pleased with the scarring. Don't think of these as little dashes a cm or 2 long; think of a third of an FUT line.

 

- How do you avoid dissecting the grafts around your punch? Compared to a real strip you score just very few grafts per "cut". The transection rate in the donor has to be very high, or am I misleaded?

 

The transection issue was something brought up many times, but it's a red herring if you actually watch videos of Dr. Lindsey performing the technique. Initially, it was presumed that we were using a punch to score all the way down to the bulbs basically. Now, if this WAS the case, using a punch that large and that rigid in shape would cause a lot of transection. But that's not what we were doing. We were only using the punch to superficially score the very top of the skin, and then using blades of differing sizes to make the cuts. Just like an FUT. The superficial scoring prevents the blade from skipping around, and just like in FUT the natural pressure "fluid wave" as the blade moves through the skin moves the follicles out of the way and prevents transection. I've run the numbers myself, and transection is on-par with FUT. The only time the false charge was made that it could not be is when people thought we were using the punch in a different manner.

 

Do you only score classic safe zone as strip or in the extended zone of FUE?

 

All patients are evaluated on a case-by-case basis. But I don't believe in the VERY expanded donor zone we often see in large FUE cases; put it that way.

[Gasthoerer]

1. ... I personally think one of the reasons why FUE scars "work" for a lot of people is NOT because they aren't there or they are "invisible to the untrained eye" -- these are both simply untrue -- but because they don't appear as "surgical." I don't think patients have as much of a big deal with scarring as they may have with the "stigma" of a scar that people can identify as surgical. If the scars look traumatic, secondary to some sort of inflammation, etc, then they aren't as stress-inducing if noticed.

 

And mFUE scars -- even when I take large pieces -- fit this bill; they are visible, but they don't scream surgery -- cosmetic or otherwise.

 

2. The transection issue was something brought up many times, but it's a red herring if you actually watch videos of Dr. Lindsey performing the technique. Initially, it was presumed that we were using a punch to score all the way down to the bulbs basically. Now, if this WAS the case, using a punch that large and that rigid in shape would cause a lot of transection. But that's not what we were doing. ... and just like in FUT the natural pressure "fluid wave" as the blade moves through the skin moves the follicles out of the way and prevents transection.

 

 

Thank you very much for this detailed answers. This was very helpful.

 

1. You excatly nailed my point. Just watch the NBA finals: Steph Curry hair type makes his fade cut look like the one of someone with FUE (or the other way around). FUE can just look awkward but typically not like cosmetic surgery. The scar of LeBron screams strip or mini-strip (true or not).

 

2. Thank you. A lot of new information in this part.

Just a hint from my side: Maybe you should change the initial post. I think the despricption (pictures and wording) of your methode is misleading (and not for your benefit I have to say).

 

The part about the "fluid" wave was very (!) interesting. I have read in the net and even heard from clinics that there is (!) transection in strip. Hence they perform strip only above a certrain number of grafts. You knw say, that this is not the case in strip and your new method, correct?

 

a) Do you have links to any papers about transection in strip? In the intital post there is a number (1.5 %) which seems to come from a study.

b) Is the surrounding tissue of this (close to the cut so to say) grafts as good as for the grafts in the center of the strip?

c) In your initial post, you claim that positiong of you tool helps with transection. I have a hard time understanding this looking at the non symmentrical placement of the grafts in an average donor.

d) I still failed to understand why you are not directly do real Mini-strips of 1-2 cm and why your new tool is actually required. I guess I am not the only one. Maybe you can bring some more light in it.

 

Again, I am just asking these questions, because this is interesting and (!) the answers I receive from different clinics/surgeons are not matching. Hence, I do have do make my own mind, as simply not both can be true. It is no offence against you.

 

And sorry for getting greedy for answers...

Edited June 15, 2017 by Gasthoerer