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

[Dr Blake Bloxham]

I guess the newsletter generated some new interest in the thread!

 

Newhair,

 

Nicely stated. Glad to see Dr Rahal's FUT did the trick.

[mav23100gunther]

I guess the newsletter generated some new interest in the thread!

 

Newhair,

 

Nicely stated. Glad to see Dr Rahal's FUT did the trick.

 

Dr Feller has been quiet as late? He must be extra busy as a result of all the buzz he generated from the FUT is more popular than FUE thread, or did it indeed backfire on him and now he has gone out of business like Seth & HTsoon predicted - haha

[Dr Blake Bloxham]

Mav,

 

Still in business and quite busy!

[Brently]

FUE wreaks havoc on the donor and makes future procedures less and less certain.

 

Is there a way we can substantiate that statement beyond a doubt? I can't understand why scar tissue would extend beyond the damaged skin into healthy skin as seems to be the claim.

 

If you put a 1mm hole in skin, what will be the diameter of the scar tissue?

 

If "o" are hairs and "X" are hairs removed, then every "o" touching an "X" is a hair that is less likely to survive a future transplant?

 

oXoooooXooooXooooo

ooooXoooooXooooXoo

oXoooooXooooXooooo

ooooXoooooXooooXoo

oXoooooXooooXooooo

 

Then why not do this?

 

ooooooooooooooooooo

XXXXXXXXXXXXXXX

ooooooooooooooooooo

ooooooooooooooooooo

ooooooooooooooooooo

 

Same number of "X", but arranged touching less "o"

 

Whatever that scar would amount to, it couldn't be worse than FUT and the width of the scar would be more consistent than the scar of FUT. Right? It would be a 1mm scar 100% of the time. No genetic variable. No suture type variable.

 

Anyway, we still need to substantiate your claim before making progress in this debate. Even if you "think" you notice that 2nd-round FUE transplants fail 10% more often, without careful statistical documentation, it's not much different than me "thinking" I see the clock reading 11:11 more than any other time. This is especially true if you're biased to notice effects that seem to support your theory.

[Dr Blake Bloxham]

Hi Brent,

 

Let me try and address some of your questions:

 

1) This is simply the way the body heals. Here's a diagram demonstrating the wound healing process and showing how the non-specific inflammation that initiates wound healing results in a bigger scar below the surface than the one we see above it:

 

 

See how the surface wound is much smaller than the area of clotting, inflammation, and eventual scar formation below it? Now imagine the surface wound is a 1mm FUE punch. The area below it would likely encompass something double to triple this size. When you space the FUE sites less than this distance apart, you create a confluence of scarring under the tissue that creates a net of thick fibrosis -- which changes the way the tissue responds to FUE.

 

2) Very interesting visual. A few things: The width of the donor area, from ear to ear, is approximately 30 cm. If you took a 1mm punch and extracted right next to each other across the entire donor -- as you showed above -- you would be able to make approximately 300 punch sites and, in the best case scenario, obtain 300 grafts while creating a scar 30cm wide by 1 mm thick. This is opposed to a strip that would create essentially an identical scar, but give you closer to 3,000 grafts.

 

You do bring up an interesting point, however, because this linear pattern is actually one of the extraction patterns we can use with mFUE. Here's a video of Dr Lindsey utilizing this linear approach (opposed to spreading the sites randomly as in traditional FUE). He extracted 574 FUGs in a linear fashion ,like you described above, and actually created a better scar than a 1mm x 30 cm linear line; he instead created what appears to be a few dozen "dashes" and left all the surrounding donor untouched.

 

 

 

Here's another where he extracts 1,689 grafts via mFUE in a similar fashion:

 

 

 

3) I'm not sure where the 10% number came from, but the scarring phenomenon I described above is scientifically proven human physiology. However, there was a good article about this -- with pictures of the phenomenon -- in the hair transplant forum international journal a few years back. I'll find that edition and post it up soon.

[Brently]

Thanks Blake! Now I feel like we're making progress.

 

1) Excellent diagram. I can see how the scar would be bigger than the wound because the new tissue would need to anchor itself into the healthy tissue rather than being simply a plug that fits into a hole. Maybe we should call it "scar tissue" and "anchor tissue". Even with that revelation, you still haven't demonstrated how the anchor tissue "changes the way the tissue responds to FUE". My first assumption would be if the tissue is in the process of healing and containing fibroblasts and collagen, why wouldn't that same tissue (when transplanted somewhere else) be more able to assimilate than tissue containing no fibroblast or collagen? On the surface, it seems like 2nd-round FUE could have a higher rate of survival. Can you show why it doesn't?

 

2) That's a good point comparing 300 grafts to 3000 with the same scar... only it's not necessarily the same scar. Dr. Feller said he experimented with various suture types to determine the type that leaves minimal scarring, so that indicates that scarring varies according to suture type. Also, I've read that genetics plays a role and I'm assuming environmental variables. I accidentally cut my leg with a knife near the knee. The hospital used staples and I tried to not bend my leg for the entire 10 days the staples were in, but I guess I can't control what I do while sleeping. The scar is about as wide as my finger and about as long. Can you guarantee that an FUT procedure will leave a 1mm wide scar?

 

2b) It does seem like mFUE would leave minimal scarring because the wound is not very long. How many grafts can you get with mFUE from ear to ear? 1500? So, we would be comparing 300 to 1500 to 3000 with similar scarring?

 

3) The 10% number came from you:

 

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.

 

80% - 70% = 10% roughly and just for sake of argument. So your claim is that the 2nd round fails 10% more often and that is what you need to prove. Comparing shotguns blasts to random dashes or 30cm lines doesn't mean much if you can't show why it matters.

 

What if your claim is false and I can get 80% on the 1st, 80% on the 2nd, 80% on the 3rd? Or what if I can get 80% on the 1st, 85% on the 2nd, 90% on the 3rd?

 

I think if you can prove your claim, that would end the FUT vs FUE debate for good. But it hinges on the existence of what I've called "anchor tissue" and that tissue extends substantially away from the scar tissue and grafts extracted from the anchor tissue have a substantially less survival rate. If you can't prove that, then it's just someone's opinion against someone else's opinion.

 

Also, not only do you have to show that's it's possible for grafts taken from anchor tissue to have less survival rates, but that it's substantial and likely. Otherwise maybe it's 80%, 79.9%, 79% on 1st, 2nd, 3rd rounds only some of the time while the remaining could be 80,80,80. Or maybe it's 80, 60, 40 only 10% of the time while 90% of patients get 80,80,80. You seem to be implying that it's 80,70,60 in 100% of the patients.

[HairJo]

Great to hear you did so well with your HT that would be my personal choice also

[hairgoal]

Dear Dr. Feller,

 

I watched your video (twice) and I'm indeed one of the guys who prefer having an FUE rather than FUT although I'm sure you would recommend me to go with FUT... Few months ago, I went to few clinics of doctors whom are recommended here and I asked if they're sure whether FUE has inferior results compared to FUT but they told me that the results are the same as FUT. For me it was strange as according to what I knew (from this forum) this is not true at all...

 

Anyway, I have few questions regarding mFUE:

1) Can you forecast the baldness process of each patient? If so, assuming you asses that a patient won't experience further baldness will you recommend him to go with FUE/mFUE?

 

2) You mentioned in your video that if you go with FUE/mFUE the downside of it is that the donor area won't be "virgin" for next procedures if needed. However- what if you'll make scars only in one side of the back of the head and keep the other one clean and "virgin" - then the patient will enjoy from no linear scar, max yield and if he needs future op he has a clean "virgin" area. Is this feasible according to your professional perspective?

 

 

 

Last, I have 2 questions that is related to FUT:

 

1- Did you heard / saw any patient who had an FUT op and had a tattoo on his scar in the same color as his hair in order to minimize its' visibility (and allow him to wear his hair shorter)? Do you recommend on such a thing? or it can destroy the grafts around and in the scar?

 

2- Does forehead reduction surgery may assist getting better results (as this way a patient will need less grafts in his temples area)??? Also, if it can assist, do you recommend doing it before / after or even with the hair transplant surgery?

 

 

Your replies will be highly appreciated!

[Dr. Alan Feller]

Dear Dr. Feller,

 

I watched your video (twice) and I'm indeed one of the guys who prefer having an FUE rather than FUT although I'm sure you would recommend me to go with FUT... Few months ago, I went to few clinics of doctors whom are recommended here and I asked if they're sure whether FUE has inferior results compared to FUT but they told me that the results are the same as FUT. For me it was strange as according to what I knew (from this forum) this is not true at all...

 

Anyway, I have few questions regarding mFUE:

1) Can you forecast the baldness process of each patient? If so, assuming you asses that a patient won't experience further baldness will you recommend him to go with FUE/mFUE?

 

2) You mentioned in your video that if you go with FUE/mFUE the downside of it is that the donor area won't be "virgin" for next procedures if needed. However- what if you'll make scars only in one side of the back of the head and keep the other one clean and "virgin" - then the patient will enjoy from no linear scar, max yield and if he needs future op he has a clean "virgin" area. Is this feasible according to your professional perspective?

 

 

 

Last, I have 2 questions that is related to FUT:

 

1- Did you heard / saw any patient who had an FUT op and had a tattoo on his scar in the same color as his hair in order to minimize its' visibility (and allow him to wear his hair shorter)? Do you recommend on such a thing? or it can destroy the grafts around and in the scar?

 

2- Does forehead reduction surgery may assist getting better results (as this way a patient will need less grafts in his temples area)??? Also, if it can assist, do you recommend doing it before / after or even with the hair transplant surgery?

 

 

Your replies will be highly appreciated!

 

Think about this for a moment: If FUE is the same as FUT, then why does FUT still exist? Why hasn't it been completely abandoned? It's been 15 years since the introduction of FUE into North America, so why do we still primarily perform this procedure?

 

As for those you claim told you that there is no difference in result between FUT and FUE:

 

1. Please list the names of the doctors who claimed to you that FUE produces the same results as FUT in terms of consistency and yield. I was surprised you didn't already list them.

 

2. Get that statement, in no uncertain terms, in writing if you are going to have an FUE procedure.

 

That is my best advice to you and anyone.

 

Dr. Feller

Edited November 12, 2015 by Dr. Alan Feller

[frogger]

Regarding mFUE vs FUE...How would you compare the aesthetic difference of the donor hair afterwards once grown back in? I know the video mentions mFUE would have the same donor damage as traditional FUE, but I would imagine there would be some kind of noticeable difference in appearance of the donor hair afterwards between individually plucking out donor hair 1 by 1 with FUE, and a bunch of "mini strips" with mFUE.

[hairgoal]

I prefer not to mention it in public as I don't want to have a bad blood with no one. But for sure I was told by one clinic that I'm a candidate for FUE (I was told I need 2000-2300 grafts) and it has the same growth yield as FUT. I though that since I didn't visit this forum for a while perhaps things have changed but later I entered here and saw this tread... The second clinic wanted to meet me again to determine what would be best for me- FUT or FUE but confirmed that I need 2000 grafts. I haven't been there for a second evaluation yet.

 

 

I will really appreciate if you can also refer to the questions I asked in my last post.

 

Thanks in advance!

[hairgoal]

I prefer not to mention it in public as I don't want to have a bad blood with no one. But for sure I was told by one clinic that I'm a candidate for FUE (I was told I need 2000-2300 grafts) and it has the same growth yield as FUT. I though that since I didn't visit this forum for a while perhaps things have changed but later I entered here and saw this tread... The second clinic wanted to meet me again to determine what would be best for me- FUT or FUE but confirmed that I need 2000 grafts. I haven't been there for a second evaluation yet.

 

 

I will really appreciate if you can also refer to the questions I asked in my last post.

 

Thanks in advance!

[Dr. Alan Feller]

I prefer not to mention it in public as I don't want to have a bad blood with no one. But for sure I was told by one clinic that I'm a candidate for FUE (I was told I need 2000-2300 grafts) and it has the same growth yield as FUT. I though that since I didn't visit this forum for a while perhaps things have changed but later I entered here and saw this tread... The second clinic wanted to meet me again to determine what would be best for me- FUT or FUE but confirmed that I need 2000 grafts. I haven't been there for a second evaluation yet.

 

 

I will really appreciate if you can also refer to the questions I asked in my last post.

 

Thanks in advance!

 

Why should there be bad blood? If they indeed said it and you believe it has merit, why any hesitation in listing their names here ?

 

The best and easiest way to cut through the FUE hype and misdirection is simply to have any doctor claiming that their FUE grows as well as FUT simply put it in writing. This way it is documented and they can be held accountable for what they are telling patients to get them to sign on the dotted line. Should the results be a dismal failure you would then have grounds for a civil lawsuit. You can also report them to their state medical board for failing to offer the primary treatment and for fraud by falsely claiming that FUE is expected to grow as well as FUT.

 

In my office ALL FUE patients must sign a document that clearly states that to have an FUE performed in my clinic they acknowledge that FUT was discussed and either ruled out by the doctor for various reasons, or not desired by the patient with the understanding that the growth yields for an equivalent FUE procedure and subsequent donor damage is expected to be worse than FUT.

 

But I encourage you to post the names of the doctors who made the claim that their FUE grows the same as their FUT if that is in fact what they said. In the United States I highly doubt it. When I've heard these claims in the past usually the doctor didn't say it, but rather it was what the patient wanted to hear and simply embellished it or made it up outright.

[tommygun]

[quote name=Dr. Alan Feller;2452755

In my office ALL FUE patients must sign a document that clearly states that to have an FUE performed in my clinic they acknowledge that FUT was discussed and either ruled out by the doctor for various reasons' date=' or not desired by the patient with the understanding that the growth yields for an equivalent FUE procedure and subsequent donor damage is expected to be worse than FUT.

[/quote]

 

 

This paragraph reminds me of those crazy laws in some states that require a woman choosing to end a pregnancy to sit through numerous counseling sessions before actually moving forward with the decision.

[Rafael Manelli]

I’m surprised more surgeons haven’t openly adopted the mFUE technique. It seems to confer so many advantages. Perhaps they lack the skill?

[Melvin- Admin]

5 minutes ago, Rafael Manelli said:

I’m surprised more surgeons haven’t openly adopted the mFUE technique. It seems to confer so many advantages. Perhaps they lack the skill?

No, it wasn’t a good technique. It’s essentially old punches with suturing. The scarring is suboptimal, and the growth from FUE is just as good as FUT. The whole argument for this technique was that it would be on par with FUT. But now FUE is already on par and the scarring is a lot better.

[Sean]

Where is Dr Feller nowadays?  

[Melvin- Admin]

3 minutes ago, Sean said:

Where is Dr Feller nowadays?  

Pm sent