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

[fortune11]

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

 

Dr Feller -- I have a comment on this part . While I agree that FUT is the better route for max coverage (personally gone through 3 of them myself) , if max coverage is the intent, it is better to go for a mega FUT session (or two) right at the outset . My scar healed alright after the 1st and 2nd FUTs, but by the time #3 happened , scalp laxity had decreased considerably and my scar healing path is not the same as it was for the earlier 2 . As a result I am being forced to cut my sides at least #5 as opposed to #3 or #4 before and even at that length some part of the scar is visible (to a trained eye atleast). So this is certainly a potential drawback to multiple FUTs. Having been "stripped out " now is probably the right time for me to switch over to FUE. To be clear , I am very happy with my choice of going w FUT as my graft coverage has been excellent (for a NW6 diffuse) and something I likely could not have achieved with just FUE.

 

On a different topic that was touched upon earlier -- On the hairstyles , I do realize the current trend is for shorter hair (and maybe even shaved look) -- but the Fast and furious franchise inspired looks will not always be in fashion and ultimately you would rather have more hair than less. Opting for FUE just because you are scared of the scar means waving the white flag even before the fight has begun.

[Dr Blake Bloxham]

Yaz,

 

I didn't know you were coming in for an mFUE consultation in London. Flag me down when you're in! I want to take a look as well.

[irishsailor]

Dr feller, Dr bloxham,

 

I have a question please, I'm hoping to bring both my scars together, but is it possible to achieve this without taking too much of a strip and then using modified fue to gain the extra grafts I require?

Just curious if this would help me achieve a better scar, as this is my final ht before I head of into the sunset with my mop of hair

[Dr Blake Bloxham]

Hey Irish,

 

How far apart are they? It may work. However, there are two potential issues I see right off the bat: first, we could be taking too large of a strip and risk stretching if they are too far apart; second, we may not obtain any useful amount of grafts to use in the front if the strip contains mostly scar tissue from your two original scars.

 

Now, here's what may be interesting: Dr Feller and I have been toying with using mFUE to create a new method of scar revision. It involves removing some sections with the mFUE punch, reorienting pieces of the scar we don't remove -- to break it up and make it difficult for the eye to pick up, and using the grafts we get from the mFUE punches we took before to fill in some of the reoriented areas of scar we left. It's actually a really novel idea, and I'm talking to a few different patients about trialing it right now. Frankly, I think it will be much more effective than putting FUE grafts into the scar.

 

You may be a good candidate. I'll try to make a diagram to better explain the process this week.

[irishsailor]

Thanks dr bloxham,

 

I think the hospital group scar fell outside the safe zone. Dr feller said we might be able to bring more into play if I had another strip, but I've always known I will probably have part of a second scar.

I have pics on my web blog. I can shave to grade 3 so doesn't really bother me, but was just thinking earlier if modified fue might be best option.

 

See how the tide is turning on this thread now.

[MrMatt]

I'm headed for my second FUT procedure (haven't decided on a doctor yet)

 

How is the location of the second strip incision (or more) decided? I have seen many photos of HT scars above each other, to the right, left etc. If a patient has suitable donor hair around the existing scar can the second strip incision be combined with the first for a total of one scar?

 

I also noticed Dr Feller uses staples instead of sutures. What would be the benefits of that ?

[Dr Blake Bloxham]

Irish,

 

It absolutely is! We will check everything out in London and see what we think!

 

Matt,

 

Most will take the old scar with the new strip. In fact, this is standard procedure unless there is a big reason not to take the original scar -- which almost always means the first strip was taken from where it shouldn't have been taken. So yes, almost all second strip procedures will still result in 1 scar.

 

The staples provide us with the best cosmetic scars. However, we use a very specific type of staples. I can only think of 1 other clinic who uses these. Dr Feller experimented with just about everything; deep/internal suturing with external sutures, absorbable sutures, other types of staples, etc. He found the protocol we use now with staples creates the most cosmetically acceptable scars. Much harder for them to stretch initially and eliminates the risk for "train track" scarring with sutures AND eliminates the immune reaction issues and poor breakdown with anything "absorbable."

[Melvin- Admin]

Norwood 6 and 7 cases in my opinion should not seek FUT their is simply not enough donor available for a good cosmetic result. However, through FUE the result can be quite good when you utilize donor hair and body hair, this is not possible with FUT plain and simple, thats why I disagree when individuals state that high norwood cases are best for FUT, the fact is that rarely do norwood 6 or 7 patients get full restorations with FUT, if they do they have exceptional donor density and skin elasticity this is definitely not the norm.

 

Here is a prime example of a norwood 7 that got a strip surgery with poor results, through FUE he was able to achieve something he would have never been able to with FUT there are limitations to FUT in terms of donor hair that is available.

 

http://www.hairrestorationnetwork.com/eve/177006-dr-hakan-doganay-fixing-bad-hairtransplant-7058-grafts-choi-implanter-pen-fue.html

[Dr Blake Bloxham]

HT,

 

I disagree. Those who are high NW cases should only undergo strip surgery.

 

Allow me to explain, and then tell me what you think:

 

1) For these patients, hair restoration is a chess game. It's what they have in the donor versus a BIG amount of real estate we must cosmetically cover in the front. In this game, yield is king. Strip gives you about 95%-98% yield on average; FUE average is closer to 80%. Committing to an FUE "mega session" on these patients is akin to removing a strip, cutting off 20% of it right after removal, and throwing it in the trash. We need every graft, so they must be extracted in the most effective manner. This is strip. No question.

 

2) FUE "mega sessions," which is what high NW patients need, destroy the donor area. If the patient goes in for his first sitting of say 3,000 grafts and gets around 80% yield, the next is going to be 2,000 grafts with 70% yield. Even if you planned for a session of the same size. You're going to get decreasing numbers of grafts successfully delivered and decreased quality of grafts because the donor region is now a net of scar tissue from the first procedure. Like I said above, this is just wasting grafts the patient can't afford to waste.

 

3) This brings us to "body hair transplants." Why not make up for the phenomenon I described above with body hair grafts? Simple: the growth rate for these grafts is low. And when I saw low, I mean averaging around 30-40% low. Not only that, they retain their natural characteristics. This means they will grow like chest, beard, and armpit hair on the scalp. This is, of course, when they do grow. Extracting body hair grafts also creates hypopigmented scarring in a lot of visible regions, and this often isn't worth the poor grafts obtained from the extraction. Body hair grafts are a last resort after the scalp is exhausted. Period. If you "strip out" a patient with multiple strips and then go in and steal what's left with mFUE (our modified FUE technique), then there is no reason to resort to these body hair grafts.

 

The case you shared is really only an example of one thing: a very poor first surgery. Whether it was performed via FUE or FUT, it was performed poorly. Clearly the grafts were placed too far apart and too deep, and the donor site wasn't closed properly.

 

Sure, this patient was able to salvage with FUE/BHT. And I'm very happy he was able to knock this out and move on with life. But I'm confident that stripping the patient out and then stealing more grafts with mFUE would given him the best "bang for his buck."

 

What do you think?

[Melvin- Admin]

HT,

 

I disagree. Those who are high NW cases should only undergo strip surgery.

 

Allow me to explain, and then tell me what you think:

 

1) For these patients, hair restoration is a chess game. It's what they have in the donor versus a BIG amount of real estate we must cosmetically cover in the front. In this game, yield is king. Strip gives you about 95%-98% yield on average; FUE average is closer to 80%. Committing to an FUE "mega session" on these patients is akin to removing a strip, cutting off 20% of it right after removal, and throwing it in the trash. We need every graft, so they must be extracted in the most effective manner. This is strip. No question.

 

2) FUE "mega sessions," which is what high NW patients need, destroy the donor area. If the patient goes in for his first sitting of say 3,000 grafts and gets around 80% yield, the next is going to be 2,000 grafts with 70% yield. Even if you planned for a session of the same size. You're going to get decreasing numbers of grafts successfully delivered and decreased quality of grafts because the donor region is now a net of scar tissue from the first procedure. Like I said above, this is just wasting grafts the patient can't afford to waste.

 

3) This brings us to "body hair transplants." Why not make up for the phenomenon I described above with body hair grafts? Simple: the growth rate for these grafts is low. And when I saw low, I mean averaging around 30-40% low. Not only that, they retain their natural characteristics. This means they will grow like chest, beard, and armpit hair on the scalp. This is, of course, when they do grow. Extracting body hair grafts also creates hypopigmented scarring in a lot of visible regions, and this often isn't worth the poor grafts obtained from the extraction. Body hair grafts are a last resort after the scalp is exhausted. Period. If you "strip out" a patient with multiple strips and then go in and steal what's left with mFUE (our modified FUE technique), then there is no reason to resort to these body hair grafts.

 

The case you shared is really only an example of one thing: a very poor first surgery. Whether it was performed via FUE or FUT, it was performed poorly. Clearly the grafts were placed too far apart and too deep, and the donor site wasn't closed properly.

 

Sure, this patient was able to salvage with FUE/BHT. And I'm very happy he was able to knock this out and move on with life. But I'm confident that stripping the patient out and then stealing more grafts with mFUE would given him the best "bang for his buck."

 

What do you think?

 

I respect your opinion Dr. Bloxham, but I disagree, a high norwood case generally needs more follicular units than they have disposable I don't really think this is a fact that can be disputed its pretty well known, even with a higher percentage of growth in FUT, the difference is not enough to impact the patient cosmetically regardless, I believe that there was a study that stated that body hair holds a 60% growth rate, and I do believe that the growth rate is impacted by the skill of the surgeon just like any procedure. There have been some studies conducted by individual physicians that have shown that beard hair can yield a growth rate comparable to scalp hair when combined with Acell.

 

In regards to scarring, I have yet to see a bad case of body hair scarring, if there are please post it on here since it would be good for discussion, also I don't know about other men, but body hair is something that I have in abundance, and honestly, if it were not for bodyhair transplants I would probably have a lot of it lasered off because I hate shaving my chest, back, abs, that could be just me, but even if the bodyhair does not yield a good growth rate it wont be missed.

 

An individual study conducted by a physician using Acell

Growth Rate of Body Hair Obtained by FUE and the Benefits of Acell

 

In regards to the patient, looking at his donor area and the fact that he already had a strip procedure that was unsuccessful means his donor hair has already been compromised, he simply does not have close to 8,000 follicular units left of donor hair I think that is something we can both agree on, honestly if he came to you a norwood 7 with a botched surgery, do you honestly believe that you would be able to get close to 8,000 follicular units using the strip method? and honestly do think you would even touch the crown? The short answer I think is no. With the use of bodyhair FUE this can be achieved. As I said, FUE is only going to improve, body hair transplants will only improve in the future, transection rates will be comparable to FUT once instrumentation improves, I really do believe that FUE is the future as it does not have the same limitations that FUT has.

 

I do agree with exhausting the scalp hair first before using body hair, but in norwood 6 and 7 it's necessary if they want the crown to be touched at all.

[Dr Blake Bloxham]

Hi HT,

 

Thanks for the reply. Let me address some of your comments:

 

A NW VI or VII patient will never have enough grafts available to take them back to where they were when they were a teenager. This doesn't matter how you try and steal them. Scalp grafts, body hair grafts, et cetera. Until you have hair multiplication or donor doubling available, it will be a game of covering important areas to create the most restored appearance.

 

And no, BHT does not have a 60% growth rate. Let me share a few interesting pearls from the Unger Hair Transplant text:

 

-Leg hair grafts yield the poorest growth results. As the density of transplanted leg hair on the scalp increased (from 24 leg hair follicles/square cm to 49 follicles/cm^2) yield decreased from 38% to an abysmal 4%.

-The studies looking at back, chest, and beard were very, very small -- less than 200 FUGs examined altogether.

-Based on the data, however, similar results were seen: the higher density the grafts were implanted and the larger number harvested, the lower the yield.

-Technically, chest hair grafts had the highest yield in the study. But the size of grafts they looked at was too small -- in my opinion -- to really form an opinion (28 FUGs)

-Beard grafts had a 63% growth rate and back hair grafts had a 47% growth rate

-The authors note that the follicles did retain their donor characteristics -- with respect to cycling and hair shaft size/description

-They also note that the most common complication was scarring in the donor extraction sites

 

So, here is what's important: average growth yield is low; like 40% with everything averaged out low. And the more grafts you transplant into a certain area, the more the yield falls.

 

I also don't think the experience of the surgeon plays a huge role when it comes to BHT. These grafts just aren't good. And FUE, even when performed by the most experienced hands, damages grafts. Take poor quality grafts and add in a technique that intrinsically damages the grafts, and you're going to get poor yields. Period.

 

And I don't think ACell, or anything else, is going to change this. Even in the study you posted, 0 out of 6 chest grafts treated with ACell grew. BUT, if you look at the research I posted, chest hair grafts had the highest yield.

 

So what does this tell us? The results are unreliable. There is no trend in the data here, which leads us to believe that BHT is unreliable.

 

Yes, I have personally seen bad scarring from BHT.

 

This is not a BHT case, but it's an example of what small, circular, hypopigmented scarring looks like in darker skinned individuals:

 

 

I would be upset if I did this to a gentleman's face or chest. I'd be even more upset if I did it to get grafts that grew unnaturally in the scalp 30% of the time. BHT is a last resort option for those who do not have scalp reserve left.

 

He may have had 8,000 scored, but it's difficult to say how many were successfully delivered and even more difficult to say how many grew.

 

Let's look at it this way: say he had 6,000 grafts via FUE and 2,000 via BHT. 6,000 at 80% yield is 4,800 (and this is being generous) and 2,000 at 35% is 700, for a total of 5,500 grafts. Now you ask, could I get 5,500 grafts from 2 more strips and an aggressive mFUE session? I think I could.

 

And by definition, traditional FUE and BHT won't improve. The technique, even when performed with robotic precision, puts grafts under torsion, compression, and avulsion strain and yield and quality is lower. There is nothing that can be done to change this with traditional FUE methods.

 

However, we can overcome these issues with modified FUE (mFUE) which is why were are pursuing the technique. However, I would still only recommend one route for this patient: stripping out then stealing what we could with mFUE.

 

Really read this over and tell me what you think. Good discussion! Thanks for participating.

Edited August 2, 2015 by DrBlakeBloxham
spelling

[KO]

FUT and BHT are not mutually exclusive I will point out....

[Melvin- Admin]

Hi HT,

 

Thanks for the reply. Let me address some of your comments:

 

A NW VI or VII patient will never have enough grafts available to take them back to where they were when they were a teenager. This doesn't matter how you try and steal them. Scalp grafts, body hair grafts, et cetera. Until you have hair multiplication or donor doubling available, it will be a game of covering important areas to create the most restored appearance.

 

I also don't think the experience of the surgeon plays a huge role when it comes to BHT. These grafts just aren't good. And FUE, even when performed by the most experienced hands, damages grafts. Take poor quality grafts and add in a technique that intrinsically damages the grafts, and you're going to get poor yields. Period.

 

And I don't think ACell, or anything else, is going to change this. Even in the study you posted, 0 out of 6 chest grafts treated with ACell grew. BUT, if you look at the research I posted, chest hair grafts had the highest yield.

 

I would be upset if I did this to a gentleman's face or chest. I'd be even more upset if I did it to get grafts that grew unnaturally in the scalp 30% of the time. BHT is a last resort option for those who do not have scalp reserve left.

 

He may have had 8,000 scored, but it's difficult to say how many were successfully delivered and even more difficult to say how many grew.

 

Let's look at it this way: say he had 6,000 grafts via FUE and 2,000 via BHT. 6,000 at 80% yield is 4,800 (and this is being generous) and 2,000 at 35% is 700, for a total of 5,500 grafts. Now you ask, could I get 5,500 grafts from 2 more strips and an aggressive mFUE session? I think I could.

 

And by definition, traditional FUE and BHT won't improve. The technique, even when performed with robotic precision, puts grafts under torsion, compression, and avulsion strain and yield and quality is lower. There is nothing that can be done to change this with traditional FUE methods.

 

However, we can overcome these issues with modified FUE (mFUE) which is why were are pursuing the technique. However, I would still only recommend one route for this patient: stripping out then stealing what we could with mFUE.

 

Really read this over and tell me what you think. Good discussion! Thanks for participating.

 

Hair for hair will never be matched thats true, but what I was stating that is that through traditional FUT full coverage with a 45% density is not possible in most situations for norwood 6 or 7, we know that hairloss does not become visible until 50% of hair loss has occured, so say you have a norwood 6 or 7 with average to below average donor density, you will not be able to bring this patient back to 45 % density and achieve full coverage, however it can be done with FUE utilizing BHT and such cases have been documented.

 

I have to humbly disagree with you again Dr. Bloxham, there are many documented cases, of individuals who are not transplant candidates who have had fantastic yields from BHT, however only a handfull of surgeons have posted these results, surgical skill has a lot to do with this, the reason why bodyhair fails is the same reason FUE of the scalp fails (transection), bodyhair changes direction in the skin, this makes it difficult to extract, however a skilled surgeon with experience will have better yields than an inexperienced physician, just like physicians who specialize in FUE, there are certain physicians that perform FUE that I challenge their results against top FUT physicians yields, their rate is nearly the same, perhaps graft for graft FUT might still be better, but visually the density looks the same, for example, Dr. Lorenzo, Dr. Doganay both physicians have shown fantastic results with rather big FUE sessions.

 

Also, another thing that must be mentioned is that with repair cases, a lot of times elasticity of the scalp is lost, which does not make them good candidates for FUT. Not to mention, when a poor FUT is performed the scar is stretched out, I doubt any person would want to risk the scar getting even bigger.

 

FUE will improve with instrumentation, currently there is no way to appropriately know the angle of the follicle when extracting, especially body hair this makes it difficult, the machines currently available are not better than human hands, I think Dr. Rahal has proven that discontinuing his use of Artas. However, in the future I believe there will be a machine that will able to calculate the angle of the follicle prior to extraction, I'm absolutely certain of this, this device is probably much closer to being available than hair multiplication im also certain of that.

 

I'm not bashing FUT, I think there is a time and place for FUT, patients that are let's say 50 years old, norwood 3V and below, sure one big procedure gets them a full restoration wonderful, but patients who need several procedures its simply not a good idea, not only will you not be able to harvest body hair but you run the risk of getting a big stretched out scar that in many cases is worse than being bald.

 

Here is an example of a hybrid FUE performed using 5,500 scalp follicular units and 15,000 body hair follicular units, even with 40% yield that means 15,000 would be 6,000 and 80% of 5,500 would be 4,400, together that makes 11,000 follicular units, the fact of the matter is that majority of men can not extract 11,000 follicular units from their donor area, the majority of men simply do not posses such donor density. Therefore, such results would be impossible with out BHT FUE. Notice this patient is able to wear his hair short with out visible thinning this is almost a complete restoration, meaning the illusion of coverage or density is no longer necessary, true coverage and density exists. I believe this is the future of hair restoration, where FUT is bound by scalp follicular units FUE is not.

 

 

Great discussion Dr. Bloxham, again I respect you and your opinions, and I think its great to have open dialogue with physicians.

[Dr Blake Bloxham]

HT,

 

Thanks again for the reply.

 

I don't want to write too large of a reply, but I'll just re-state my points for the record:

 

-Patients who need multiple procedures are actually much, much better candidates for FUT not FUE. This is because FUE wreaks havoc on the donor and makes future procedures less and less certain. This is different than FUT where all scalp around the scar region is virgin.

 

-BHT has very poor yield (the average of all body extraction sources is around 30-40%), retains it native characteristics in the scalp (beard hair grafts grow like beard hairs, chest like chest hairs, et cetera), and creates the risk of unacceptable scarring in the donor regions. What's more, it should not be attempted until the regular donor is tapped and patients need it for severe repairs. Even then, it still doesn't change the problems with yield, scarring, and unnatural appearance. BHT is not a useful technique for the vast majority of patients and should be a last resort.

 

What's more, because of the poor quality of growth, it really doesn't add a lot of additional grafts that can be used in addition to scalp grafts. This is even truer when the studies published in the text show that yield becomes worse and worse the more BHT grafts are packed on the scalp.

 

-It also really doesn't matter how perfectly the BHT grafts are removed; they can be removed with robotic precision and still won't grow well. They just aren't strong enough, nor are they meant to live in the scalp environment.

 

-FUE will not continue to improve because nothing can be done to remove the detrimental forces FUE places on the grafts. Even if you did create a device to reduce transection, like you describe above, this does nothing to reduce the compression, torsion, and avulsion the grafts experience. Nor does it do anything to reduce the skeletonization that leads to dehydration while the grafts are out of the body or death while the grafts are in the scalp. This is something that I must hammer in again: nothing will improve traditional FUE. Until a doctor or device can remove all of the forces I described above, nothing will change.

 

-The only way to maximize grafts and best treat these high NW patients is to strip them out and then steal more hair with mFUE. FUE + BHT is NOT the best treatment plan for these patients.

 

-Since I mentioned it above, the only true change you'll see with FUE could be modified FUE (mFUE). This is because it removes the forces I described above and provides microscopically dissected grafts with appropriate amounts of supportive tissue that will survive and grow. It also does this with FUE-level scarring.

 

I think if you really read through and research these points, you'll see a lot of what I'm saying is logical and fact-based. It's not as "sexy" as a 20,000 graft BHT case, but it's realistic and the most appropriate plan for a hair loss sufferer.

 

Thanks again. Obviously you're free to disagree, but I do encourage you to research what I've said above.

[Bill - Seemiller]

Dr. Feller,

 

I posted this reply on the FUT is more popular than FUE topic however, since it applies here as well, I wanted to post it here as well.

 

----

 

Dr. Feller,

 

I appreciate that you created this and several topics and your ongoing participation in both these topics and on our forum. However, many of your posts recently have come across as abrasive and insulting to many members, including other well respected physician members of our community. While you may not feel that FUE is a solid enough treatment to be offered as the only treatment, there are many who disagree with you. Likewise, many patients disagree as well.

 

The FUT vs FUE debate is a "hot topic" for a reason. People seem to have very strong opinions that often leads to members mudslinging and hurling insults at one another. Personally, I don't know why this is because in my opinion, both strip and FUE have merit and are both here to stay. Surgeons who have chosen to specialize strictly in FUE have chosen to do so because they firmly believe in the procedure and those we recommend on this community (which includes Dr. Bhatti) regularly achieve excellent results at their clinic.

 

While there is no way to know everything that goes on at every clinic, patients are welcome and encouraged to share their experiences and concerns on this forum. If FUE was a huge failure, I suspect there'd be many more patients coming online expressing this. The reality is however, FUE is here to stay and it is my opinion that the procedure and its tools have evolved and improved over the last several years. Are additional forces placed on the follicles during the harvesting process of FUE vs strip? Yes. However, whether physicians are beginning to overcome or work around them, in many cases, results from FUE are on par (or at least close) with that of strip.

 

Dr. Feller, I have a lot of respect for you and hope that you continue participating on this forum in a constructive way. But I ask that you be respectful to your physician colleagues also recommended by this community and treat forum members respectfully and as patients. Like the world at large, this community is full of dissenting opinions. I believe people can disagree and still discuss the hot topics respectfully without fighting. I ask you and all members of our community to work on this.

 

If in the future, you suspect someone in particular covertly representing a clinic (recommended here or not), please send me a private email and we will investigate this. We have investigated "Sethicles" and while he may speak boldly about Dr. Bhatti, I see no evidence that he is employed or represents him or the clinic in any way. Furthermore, I removed one of your posts that he is somehow "profiteering" for Dr. Bhatti as this is inappropriate.

 

Now, let's please get this topic back on track to being educational and not members fighting against one another. Or I will be forced to lock this and other topics where things are getting a bit too personal.

 

Thanks and best wishes,

 

Bill

[Bill - Seemiller]

Dr. Feller,

 

I posted this reply on the FUT is more popular than FUE topic however, since it applies here as well, I wanted to post it here as well.

 

----

 

Dr. Feller,

 

I appreciate that you created this and several topics and your ongoing participation in both these topics and on our forum. However, many of your posts recently have come across as abrasive and insulting to many members, including other well respected physician members of our community. While you may not feel that FUE is a solid enough treatment to be offered as the only treatment, there are many who disagree with you. Likewise, many patients disagree as well.

 

The FUT vs FUE debate is a "hot topic" for a reason. People seem to have very strong opinions that often leads to members mudslinging and hurling insults at one another. Personally, I don't know why this is because in my opinion, both strip and FUE have merit and are both here to stay. Surgeons who have chosen to specialize strictly in FUE have chosen to do so because they firmly believe in the procedure and those we recommend on this community (which includes Dr. Bhatti) regularly achieve excellent results at their clinic.

 

While there is no way to know everything that goes on at every clinic, patients are welcome and encouraged to share their experiences and concerns on this forum. If FUE was a huge failure, I suspect there'd be many more patients coming online expressing this. The reality is however, FUE is here to stay and it is my opinion that the procedure and its tools have evolved and improved over the last several years. Are additional forces placed on the follicles during the harvesting process of FUE vs strip? Yes. However, whether physicians are beginning to overcome or work around them, in many cases, results from FUE are on par (or at least close) with that of strip.

 

Dr. Feller, I have a lot of respect for you and hope that you continue participating on this forum in a constructive way. But I ask that you be respectful to your physician colleagues also recommended by this community and treat forum members respectfully and as patients. Like the world at large, this community is full of dissenting opinions. I believe people can disagree and still discuss the hot topics respectfully without fighting. I ask you and all members of our community to work on this.

 

If in the future, you suspect someone in particular covertly representing a clinic (recommended here or not), please send me a private email and we will investigate this. We have investigated "Sethicles" and while he may speak boldly about Dr. Bhatti, I see no evidence that he is employed or represents him or the clinic in any way. Furthermore, I removed one of your posts that he is somehow "profiteering" for Dr. Bhatti as this is inappropriate.

 

Now, let's please get this topic back on track to being educational and not members fighting against one another. Or I will be forced to lock this and other topics where things are getting a bit too personal.

 

Thanks and best wishes,

 

Bill

[Dr. William Lindsey]

Although I put this as its own post, since I was involved early on this this thread...or fraying rope as its matured...here is a video I did today with a guy on whom we did 2 strips in the past, and an MFUE 29 days ago.

 

Note that his recipient area looks normal...shedding at 29 days.

 

Note also that his old strip scar by me, which I grade as a "B" is seen below the MFUE donor area.

 

And note that even without any scar care, his MFUE sites are tough to find, and he has fine almost stringy hair and really white skin. He has white hair too..just colors it.

 

Lastly, he had a little temple lift by a good surgeon 2 months ago. His linear temple scars look ok, but there is definitely shock loss and redness around them, just as with a strip donor scar. They'll turn out fine, but its a good comparison for the viewers.

 

Dr. Lindsey

 

 

[Dr Blake Bloxham]

Nice! We did a 1,024 graft mFUE yesterday. It was a blast!

[Dr. William Lindsey]

Here is our guy at 7 weeks. Given his hair characteristics, this hopefully strip quality bunch of grafts ought to do a good job in his crown next year. And his donor scars are virtually impossible to find.

 

Dr. Lindsey

 

 

[Dr. William Lindsey]

This fellow walked in for a consultation. Says he had 2000 FUE grafts across town with limited results. While he has VERY DENSE donor hair that partially obscures my picture, he has a "shot gun" blast of scar across his donor region.

 

Dr. Lindsey

[Dr. Alan Feller]

This fellow walked in for a consultation. Says he had 2000 FUE grafts across town with limited results. While he has VERY DENSE donor hair that partially obscures my picture, he has a "shot gun" blast of scar across his donor region.

 

Dr. Lindsey

 

This is exactly what I've been talking about. Thank you for posting this photo.

 

Those FUE scars speak for themselves. Prime example of FUE confluence of scar.

Of course in and of themselves these scars are not bad, but they exist in stark contrast to the claims made by FUE advocates on this and other forums. Fortunately he has plenty of hair to cover them. But if this is the case, he should have just gone for FUT and his growth yield would have been better.

[Dr Blake Bloxham]

Dr L,

 

That's a bummer! Hope you're able to help this patient out as well! Keep us updated.

[Dr. William Lindsey]

Another "fue" guy coming in for repair consultation. On exam it looks like he has about 300-400 minigrafts plunked down along the hairline and this donor area full of scars.

 

Again this is not indicative of all FUE results...but, when seen in the frequency that I'm seeing them this summer, does indicate alot of marginal cases occurring out there billed as inexpensive, often automated, FUE.

 

And over the weekend I heard that a prominent ENT group (full disclosure--I'm an ENT prior to my facial plastic fellowship in 95) just bought an automated FUE system. The staff person from their office that I saw casually, said they were excited to have a new "revenue generator" for their practice. Having dabbled in hair for several years before going "all in" I can tell you that it is not likely to work out as a worry-free revenue generator as they expect... Their staff person said the company was sending their own techs to do the case so that it was really just a self propelled operation.....I would bet that most of the patients would not like to hear that they are signing up for that!

Dr. Lindsey McLean VA

[NEWHAIRPLEASE]

Wow. I'm just now getting through all 45 pages of this thread, one of the greatest HTN threads of all time...thanks Dr Feller for the video , honestly, it opened my eyes! I've never thought about FUE scarring the way you've described it in the video. Excellent video!

I totally agree with the results about FUT. I wish I were ( would have been ) an FUE candidate but I wasn't. Fortunately I've had great FUT results with Dr Rahal and I have great laxity for another 3-4K ( according to add Rahal ) in the bank!

I'll take strip any day of the week over FUE. Great post

[NEWHAIRPLEASE]

Wow. I'm just now getting through all 45 pages of this thread, one of the greatest HTN threads of all time...thanks Dr Feller for the video , honestly, it opened my eyes! I've never thought about FUE scarring the way you've described it in the video. Excellent video!

I totally agree with the results about FUT. I wish I were ( would have been ) an FUE candidate but I wasn't. Fortunately I've had great FUT results with Dr Rahal and I have great laxity for another 3-4K ( according to add Rahal ) in the bank!

I'll take strip any day of the week over FUE. Great post