Strip vs FUE vs mFUE - Dr. Alan Feller Great Neck, NY

[Dr. Alan Feller]

Hi Dr. Feller,

 

Well I am not nearly as qualified enough to answer that, but here are my own personal thoughts, and as a disclaimer I am just an average guy on the street who really doesn't know much about this topic other than what I have read online:

 

1) The cherry picking aspect makes alot of sense to me, although as stated, if Maras is really looking for singles, why is it a disadvantage by going with FUT and cutting up doubles and triples into singles? Ido agree that if he is looking for more doubles or triples, then he is limited to what he gets from FUT. Overall, I found this argument for going with FUE weak, and in my mind doesn't outweigh the higher risk of transection of grafts by electing FUE over FUT. Once again, I have no personal view on this, and have to trust what you and other doctors claim. This is also the first time I have really heard the argument of cherry picking grafts resulting in a significant advantage of a strip, but it does make logical sense though. I dunno, you tell me?

2) In my opinion, the only pro of going with FUE over FUT when I am not stripped out yet, is the linier scar, but as a previous FUT patient, I already have the linier scar, so isn't this a mute point in my case anyway? I didn't buy the stretching of the scar statement either, as isn't the risk of stretching the same as my 1st procedure? In addition, my scalp laxity has still been assessed as good, and this procedure would only go after 2,500 grafts, so is the risk of scar stretching even that much elevated? I may buy it if I was going after 4,000 odd grafts.

3) Dr Maras hasn't disclosed the risks of FUE you mentioned, and disclosed that I would get a better result by going with FUT. Once again, I don't have a view on this matter, but I do trust the view you have shared on this forum as I haven't seen evidence to the contrary. Thats the reason I declined the procedure with Maras and will be going with a different surgeon via FUT for my 2nd procedure.

4) Finally, he never disclosed that by switching to FUE, i would be reducing my lifetime grafts available to me than if I remained with FUT until being stripped out. I had an estimated 6,000 odd grafts available for strip when first assessed prior to my 1st procedure. The 1st procedure was for around 2,000 grafts, so that leaves around 4,000 FUT grafts. This is the biggie for me. I want to get the absolute maximum number of grafts over my lifetime, and if that means a linier scar, then hell yes - I will take it.

 

Finally, no disrespect at all to Dr. Maras. I am a nobody, and he is a qualified and well respected HT doctor, so the views I made above may be total nonsense.

 

Well done Mav.

 

Well done, except for the false notion as presented in the quote that obtaining single hair follicular units via FUT involves or requires cutting down doubles and triples. This is simply not true, and in fact it is FUE clinics that cut down double and triple hair FUEs to obtain enough singles for hairline work. Most FUT procedures produce about 20% singles which in a 2500 graft case would yield about 500 singles, which is usually enough to build a new hairline on the average head.

 

One of the biggest FUE myths is "cherry picking" grafts. Unless you have X-ray vision you cannot cherry pick grafts during FUE because there is no way to know before you extract a target graft if there is one, two, or three hairs in it. Often times what appear to be a single hair FUE may actually be a double with one hair in telogen (sleeping mode). This is a real problem for FUE. Not so for FUT where the follicles can be seen easily under the microscope.

Edited August 1, 2015 by Dr. Alan Feller

[mav23100gunther]

Well done Mav.

 

Well done, except for the false notion as presented in the quote that obtaining single hair follicular units via FUT involves or requires cutting down doubles and triples. This is simply not true, and in fact it is FUE clinics that cut down double and triple hair FUEs to obtain enough singles for hairline work. Most FUT procedures produce about 20% singles which in a 2500 graft case would yield about 500 singles, which is usually enough to build a new hairline on the average head.

 

One of the biggest FUE myths is "cherry picking" grafts. Unless you have X-ray vision you cannot cherry pick grafts during FUE because there is no way to know before you extract a target graft if there is one, two, or three hairs in it. Often times what appear to be a single hair FUE may actually be a double with one hair in telogen (sleeping mode). This is a real problem for FUE. Not so for FUT where the follicles can be seen easily under the microscope.

 

Thanks Dr. Feller - the cherry picking myth blows my mind - wow. And Maras is a doctor recommended by this site. Guess it shows you how important it really is to research research research. We now have two recommended surgeons saying two completely different things, and you know both can't be right.

[Raj Jayukdht]

If the future of hair transplant is the Robot, then FUE is the future harvesting technique! Why? Because they have not taught the ARTAS to harvest the strip! And who have bought the ARTAS? Mostly Strip surgeons!! Doublespeak!!

[Dr. Alan Feller]

Thanks Dr. Feller - the cherry picking myth blows my mind - wow. And Maras is a doctor recommended by this site. Guess it shows you how important it really is to research research research. We now have two recommended surgeons saying two completely different things, and you know both can't be right.

 

 

Now you get my point totally.

 

We have already been through two "FUE hype" eras. We are now in the third. FUT still rules and will continue to do so until someone comes up with a way to reduce the three detrimental forces associated exclusively with the FUE procedure. To date, nobody has. What's even more amazing is that almost nobody has even tried. I tried, and had some success. But I have yet to see anybody break down the problems as I have and come up with real world solutions that are better than mine.

 

The robots and other semi automated devices are not useful advances. They still subject the grafts to the same detrimental forces, but just do so while making it easier for the practitioners. That is not an advancement for the patient and it just serves to hike the price needlessly.

 

Over 16,000 hits on this thread and not a SINGLE FUE doctor chiming in to "set the record straight". Telling, isn't it?

 

But I have gotten feedback from other honorable and transparent FUE doctors and the responses are not going to make the FUE advocates on this thread, or any other, smile very much.

 

More to come.

 

Dr. Alan Feller

Feller Medical, PC

[Mick50]

Well it begs a question Dr Feller if these honourable and transparent FUE Docs that

you have spoken to is; why don't they inform potential patients of these dangers you have

taken the time to point out,? which I for one am grateful to read about, but for me it's too late

as I have already undergone a 4200 FUE hair transplant in Turkey actually done by techs

yea I know you and Blake cringe when you read about techs doing the transplant but that's another thread, even if I had paid to go with one of the top FUE Docs I still wouldn't have been told the whole story I'm not saying I would have opted for FUT but it would have been nice to have had

an informed picture before going ahead surely these FUE Docs are duty bound to inform patients, the only negative things I have read about FUE on clinic's websites are the slightly less yield than FUT nothing about the fibrosis you mentioned in the donor area

Edited August 1, 2015 by Mick50

[lileli]

Very informative thread. As we know, there have been many patients who have been very well served bi FUE and FUT.Untimately, FUE will continue to be here and grow. Too many patients have had good results to be ignored by everyone should make am informed decision.

[Mick50]

I agree but up to now most guys who opt for FUE haven't been able to make an informed decision, fair play to Dr Feller for in a sense putting his head above the parapet, love or hate his for some people his strident attitude you have to respect his passion, I for one don't think he's doing it because he's worried about losing business can't see him applying for welfare any time soon.

Edited August 1, 2015 by Mick50

[lileli]

I agree but up to now most guys who opt for FUE haven't been able to make an informed decision, fair play to Dr Feller for in a sense putting his head above the parapet, love or hate his attitude you have to respect his passion, I for one don't think he's doing it because he's worried about losing business can't see him applying for welfare any time soon.

 

Are you happy with your results?

[Mick50]

I will put up my result next week at the 7 month mark, not really the thread to discuss my results but since you ask yes I'm happy so far, I'm not going to have a Tom cruise head of hair but being

52 years old and a Norwood 5-6 I have realistic expectations in saying that there has been a great improvement just short of the 7 month mark, with hopefully more growth to come

[Dr. Alan Feller]

Well it begs a question Dr Feller if these honourable and transparent FUE Docs that

you have spoken to is; why don't they inform potential patients of these dangers you have

taken the time to point out,? which I for one am grateful to read about, but for me it's too late

as I have already undergone a 4200 FUE hair transplant in Turkey actually done by techs

yea I know you and Blake cringe when you read about techs doing the transplant but that's another thread, even if I had paid to go with one of the top FUE Docs I still wouldn't have been told the whole story I'm not saying I would have opted for FUT but it would have been nice to have had

an informed picture before going ahead surely these FUE Docs are duty bound to inform patients, the only negative things I have read about FUE on clinic's websites are the slightly less yield than FUT nothing about the fibrosis you mentioned in the donor area

 

 

An excellent question. One that I can't answer for others. Ask them yourself. Call an FUE clinic. I encourage it. And then post their answers on this topic. If you tell them you are going to publicize their answer, wanna bet it will virtually match everything I've been writing, or be clutched in such language as to blur the lines as much as possible? I've seen it all.

 

The only reason FUE clinics have written on their websites at all that FUE has lower yields is because of topics I created and defended years ago. Here we go again. At least we got them to go that far in giving the public the truth. But don't just brush past it. Ask WHY they get lower yields with FUE so consistently that they felt they had to publish it on their websites. What is actually happening? And don't accept minimization qualifiers like " a bit lower yield". The qualifier "a bit" may make you feel better, but in a court of law it means nothing. The doctor "informed" you of lower yields on his website so case closed. And disclosing lower yields does not inform you of donor damage. In this case it's don't ask, don't tell. A legal no no that is engaged in all the time.

 

But you can bet there are FUE doctors right now re-writing their informed consent documents. And now patients have a way to test if their doctors are being up front with them. If a doctor denies what I've been posting, then simply get it in writing with the doctor's signature. Wanna bet it will NEVER happen?! It never has.

[Mick50]

but I have gotton feedback from other honourable transparent FUE transplant doctors and the responses are not going to make the FUE advocates on this thread, or any other, smile very much

 

Dr Feller are these Docs you mention going to go public about agreeing with you on this matter?

[Yaz89]

Of course these guys won't go public, they will lose patients and a ton of money.

 

Dr Feller, I have to admit you have converted me favouring FUE to FUT. I always have thought fue is more superior to fut. But from my own research (I have been researching the last 5 years) with fue vs fut, I have came to the conclusion fut IS the gold standard! And I, for one had FUE

[Dr. Alan Feller]

They have not asked me to withhold any information nor their names.

[Yaz89]

That is great news Doc. It should always be surgeons discussing with each other the pro and cons of the science behind hair transplant techniques. It takes years just to practise general medicine as a GP. Even more, to qualify as an excellent hair transplant doctor. Keep it up doc!

[Dr. Alan Feller]

Of course these guys won't go public, they will lose patients and a ton of money.

 

Dr Feller, I have to admit you have converted me favouring FUE to FUT. I always have thought fue is more superior to fut. But from my own research (I have been researching the last 5 years) with fue vs fut, I have came to the conclusion fut IS the gold standard! And I, for one had FUE

 

Well done, Yaz.

Perhaps you'll share the details of your research and at what point you converted. I personally look forward to that and it will be very educational to the thousands of people reading this topic.

 

Dr. Feller

[Mick50]

Fair play if these Doc are willing to go public, how much it will affect their business as Yaz 89 suggested is moot, actually they may gain more respect, in reality how many people will refuse FUE given all the facts is also moot

[Yaz89]

Well where to begin? From my thread, many would know I am looking for a second surgery to gain a great head of hair. But I am concerned about the scarring which results from fue. No matter which surgeon you go for fue, even if they are the best there will always be scarring, donor will look like shreds etc.

 

I did fue because I always did the 0 grade fade look. Well, I have not done this type of cut for a while because my fue scarring is partially visible. I know it will be much worse if I did another fue. It is true, the more grass you rip, the less will be left. Anyways, I have matured as a man and sporting a more gentleman type of hair style

 

. Dr Feller mentioned, guys who had FUT hardly cut their hair short. Now I have to keep longer hair just for my previous transplant. Again, Dr Feller stated that totally eliminates the idea of having a transplant.

 

I say once again both methods have their flaws. Neither is perfect. I believe even fue is more suited to smaller cases such as 2000 grafts. Fue is a scar surgery. The more grafts taken the more scars. It does depend on donor capacity

 

Thats why I am looking into MFUE. And have an consultation with Dr Lindsey in October at London. See you there Dr Feller if you come along!

[newbie33]

Somewhere near the beginning of this thread I said this type of debate makes me less likely to have any sort of transplant. I said this because to a large extent we laymen rely on 'expert' advice, and what I've read or been told by various reputable doctors seems contradictory.

 

I think we'd nearly all agree Lorenzo is in the top tier of FUE surgeons. Yet his website directly contradicts a fair bit of what Dr Feller says. I think it isn't entirely consistent with what he'd tell me himself if I asked him.

 

Here's Lorenzo's website comparing strip versus fue: differences_fue-strip (or if the link gets blocked, look on site under the 'Technique' tab and then 'Differences FUE-Strip').

[Yaz89]

No doubt he is good. But again how many fue surgeons do all the work themselves from extracting to implanting. Plus how many use Dr Lorenzo's tool; the Lion Implanter. I believe his success lies entirely in his tools and doing most of the work himself. I might be wrong as a few have said he uses techs now.

 

My fue doctor is also well established. I would rate him top 5 in the list of fue surgeons. He has given me an excellent start to my transplant journey, has given me my self confidence back and overall is a kind hearted person. But no surgeon can predict the end result, the scarring or the final outcome. But I do believe fut gives the better grafts

[Dr. Alan Feller]

Newbie33,

Well done.

 

"I think we'd nearly all agree Lorenzo is in the top tier of FUE surgeons. Yet his website directly contradicts a fair bit of what Dr Feller says. I think it isn't entirely consistent with what he'd tell me himself if I asked him."

 

And what would you ask him? What strikes you as questionable?

[Yaz89]

Each one to their own. Make your choice, research and take the plunge! But not many reputable surgeons are out there. Just google in what clinic and 255 hair transplant clinics pop in Turkey. But how many are reputable? Not many

[newbie33]

Basically I'm disappointed by his site because I think it's demonstrably incorrect in some places, and fairly leading in others. I'm disappointed because I think he has some very good results and when I consulted with him, he didn't say these things. Anyway...

 

Follicular damage and quality of units - "more than 30%... may be" in strip. "No damage" in fue. So the question is: which procedure causes damages/transects more grafts? (I think it's fairly accepted FUE would be the answer). Or, put it another way, from the possible/attempted number of grafts taken during a procedure, what is the percentage which remain viable for implantation and growth?

 

Scarring - is it true that FUE gives 'no kind of scars whatsoever'? (Again, I don't think Lorenzo would say it's scar free).

 

Strip graft limit in one session - is it an absolute maximum of 3500? (We can pretty much google plenty of results over 4000)

 

I'd also ask about comparing strip, where techs naturally do some of the work, versus fue, where the site says a doctors does all extracting and implanting, as I think that isn't the case with Lorenzo now.

 

And while there's mention of scar tissue limiting possible future number of grafts for removal in strip, there's no equivalent mention of the possibility in FUE. Is that a possibility?

 

Also, I'd want clarity if there is possible nerve damage with FUE. (My guess is no - which is what the site says).

 

And a question for you, Dr Feller: on the average man, how many viable grafts are able to be removed without being noticed (i.e. to the naked eye, with hair covering the scar, so no one is any the wiser of a procedure) with strip, and how many with FUE?

 

I ask that because you say that fue scarring can limit further procedures, but Lorenzo seems to manage to get 5000-6000 over a few passes pretty regularly.

[Dr. Alan Feller]

Well done Newbie. You've made some very important observations that should be addressed. I have to admit that I was shocked by what I read. Absolutely shocked.

 

The answer to your question is you can get more grafts with strip in most people and then follow up with FUE. That's why I never understood the allure of FUE for mega sessions. You can get the grafts out quicker and safer with FUT and simply cover the scar with your hair instantly. But as I've said, I believe the primary reason patient want FUE is because they are afraid to have the FUT procedure. Best way around that problem is find a doctor you are comfortable with and put yourself in his hands. That's how all surgery is performed and should be performed. It's literally nothing for us, but we understand many of the public are frightened. But we know how to help get patients through the anxiety. We do it every day.

Edited August 1, 2015 by Dr. Alan Feller

[newbie33]

Thanks for the reply, Dr Feller.

 

I think there's actually two reasons most guys are weary of strip. The first, as you say, is the idea of having a chunk of your head cut out. The second is that the scar will stretch and leave an area that is not easily hidden.

[Dr. Alan Feller]

Thanks for the reply, Dr Feller.

 

I think there's actually two reasons most guys are weary of strip. The first, as you say, is the idea of having a chunk of your head cut out. The second is that the scar will stretch and leave an area that is not easily hidden.

 

In my experience covering the linear scar, even a stretched one, is no problem.