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

[Cant decide]

Can't,

 

The scarring is akin to the scarring you achieve with traditional FUE. It isn't several small strips, it's hundreds of small punches like FUE. You can buzz down as short as you would with traditional FUE. However, the extraction process with mFUE overcomes the issues that decrease FUE yield and hair quality. So the value is strip results with FUE scarring. Did you see the presentation thread?

 

Got it now. Thanks Blake.

[scar5]

..I had FUE in Istanbul...cost around US 2000 dollars

....hair has grown out well.

I made a mistake in getting ..strip surgery from Dr Feller....only 800 grafts.

....donor scar wasn't improved....

I still need one more to thicken it up a little..

 

Yes, the revision was probably a waste. People should know, even in the hands of experts, these guys can't guarantee you won't get in trouble.

 

Given another chance you would have been better going for a global FUE approach rather than a front-loaded one. However, in the days of facebook, tinder etc., front on profiles are important...but not, IMO, as important as having something you can walk around with without looking like a clown.

 

One thing, never assume the the FUE people are the good guys. They are just the same as the strip guys, except they are operating in a different environment. They will over harvest you in a heartbeat! But even if they do, as they did in my case, it is no big deal in a relative sense. I know that sounds bad, but at least you can buzz down if the punches are around .8mm. You may have to address the tone with SMP or hair bleach in really bad scenarios (greying will help) , but essentially, the integrity of your scalp from an aesthetic point of you, is still sound.

 

Just one strip scar trumps over-harvested in the clown stakes.

[LondonHTseeker]

Eh? I don't think you understood my post. The selective quoting confuses it. I don't have a front loaded transplant. I have what looks like a full head of hair, unless you study it up close with overhead lighting, at which point the hairline density isn't ideal, but not too bad. The strip scar doesn't bother me much because I prefer longer hair, so it's invisible. My last HT was the FUE op in Turkey.

[Blake Bloxham]

Scar,

 

I agree with the overharvesting comment.

 

I also think it's worth mentioning that you can do both approaches -- the "front loaded" versus the "thinner all over" with strip or FUE. It's more about patient preference. Some docs do advise one over the other, but I think this has more to do with the crown being such a black hole for grafts than anything else.

[Dr. Alan Feller]

"Front Loading" is not when the crown is bald and the front is covered. That is a natural distribution in men who lose hair-transplant or not.

 

Front Loading is when a doctor places the hairline too low on the forehead and uses way too much of the donor area to do it. The further you go down on the forehead, the more hair you need to get the job done AND the greater the requirement to make it thick-thus using even more grafts.

 

In my case, my hairline is appropriately high and covers just over half of my head making it a "balanced" procedure. My hair loss in the crown happened years after my transplants and was anticipated. While it would be nice to cover the crown, I simply don't have the donor area, but not doing so does not make people with my current hair/hair loss pattern "front loaded" by any means.

 

Front loading becomes a problem when someone has a very low and thick hairline without anything behind it extending to the bridge area of the scalp.

 

The usual sufferers of Front Loading are very young men who most likely should have been turned away for surgery. These men tend to think in terms of the present and not the future by requesting or demanding surgery to replace hairlines that you would normally see only on teenagers. Some doctors will give the patient what he wants and use a huge number of grafts to do it. Then the young man ages 5-7 years and all of a sudden there is a huge bald area just behind the front loaded recipient area-a pattern you don't normally see in nature. And even the most casual viewers of this person will pick up the fact that "there is something wrong" or "not natural" about the patient's look.

 

The problem of front loading has nothing to do with FUE or FUT- either could be used to front load.

[ontop]

Thanks Dr feller for sharing such personal info

 

I would of thought by looking at you that you had a great head of hair & kinda supprised

that you say that you haven't got the donor.

 

Goes to show that having a good hairline. HT makes a world of difference esp for you.

 

Thanks again.

[Noodles123]

Scar5, why do you keep trying to compare the best of FUE in the best hands, to the worst Strip procedure in the worst of hands. I keep seeing the same argument, that even in the best of hands one can end up with a badly stretched linear scar. Well conversely, in the best of hands, one could also end up with low yield from an FUE procedure. The fact is, in the hands of a good surgeon, the worst case scenario of either procedure is not likely to happen. As far as I know, you haven't even had an FUE procedure.

 

And how does the extraction method have any bearing on graft placement? I don't even see how you can conflate two unrelated issues. I'm not knocking FUE, I had one myself. But let's be honest, a big reason as to why FUE has taken off is because the barriers to entry are a lot less than with FUT, which requires a lot of resources.

[HairJo]

I agree that's why you have to choose the right doctor who has your best interest in mind for now and the future . You have to be careful a lot of doctors WILL do what the patient wants and not what the doctor himself thinks is right because of the money. So to the young guys out there listen to your doctor or doctors you consult with . Thanks doctor Feller for explaining front loading and future hair loss. By the way your hairline looks really good very natural and age appropriate

[delancey]

Some people have claimed that FUT does an excellent job in covering the frontal half but fails in covering the crown sufficiently. Why do you believe this to be the case?

 

 

Dr. Feller,

 

1) Do you believe that large FUT procedures, on average, result in a wider strip scar? (i.e., 5000-7000 FUT)

2) Do you believe that 2-3 strip procedures will result in a wider scar vs just having one strip procedure?

3) Most NW 5-6 patients need around 8,000 -10,000 grafts. Assume that someone has 10000 grafts via FUE. How long must he keep his hair for the scars not to show?

 

 

Thanks in advance,

 

D

[scar5]

 

Scar5, why do you keep trying to compare the best of FUE in the best hands, to the worst Strip procedure in the worst of hands.

 

And how does the extraction method have any bearing on graft placement?

 

 

I don't. Why do say that?

 

I have been consistent about this.

 

a) A perfect strip scar is a disaster if you lose your crown and don't like the empty crown, donut, horse shoe..whatever you call it

 

b) The best hands can give you a perfect or a terrible strip scar

 

c) The best hands can give you a perfect scar in the first pass, and a less than perfect scar next time

 

d) The "worst doctor" can give you a perfect scar.

 

e) The same doctor can give the same patient the perfect scar and the most dreadful scar.

 

f) FUE can be poor

 

g) FUE offers you a line of retreat if meds fail, loss continues or you are just fed up

 

h) North American strip jobs tend to be front loaded.

 

Why are strip jobs front-loaded?

 

Because you can get a bucket load of hair from a single strip super fast on your first pass and you are probably just starting your journey. They'll say, 'Let's do the front first and address the crown later" I can't tell you how many times I've been told this by strip doctors.

 

 

The slow and steady approach on the other hand, suits FUE. Low density crown filled scalps suit FUE. They can be buzzed for an even tone. Strip requires 4 /5/6 guard to cover the strip scar. A thin crown cannot stands out more at those lengths. YOu are trapped, and have to keep coming back for more to fight it, because you can't buzz.

 

This is what I do harp on about. Once you jump on the strip train, you are a passenger for life - you have to keep coming back to address the crown, each time risking the strip scar, but you have already had a strip, so why not again? This was the economic model for strip clinics. Now they will say that they will offer you FUE after you are stripped out, after having told you FUE was hype and unreliable in the first place. At that point it makes almost no difference.

 

Note, this Dr. Feller mFUE is not for virgin scalps!! Dr. Feller was quite categorical in stating that all patients will get strip as the default option (Gold Standard lol!)

[Blake Bloxham]

Scar,

 

2 points:

 

1) The strip scar should never be visible because of increased thinning. If a patient thins and the scar shows, one of two things happened: a) the strip was taken too high or b) the patient is a diffuse thinner -- DUPA, DPA, AA, etc -- and was never a candidate for surgery in the first place. This means the grafts thinned as well and the patient never should have been taken on by ANYONE.

 

2) Your description above is actually a perfect picture of my whole mantra: the right procedure for the right patient. You describe two difference scenarios: one patient who wants a "bucket full of hair," big transformation, and to move on with life, and another who isn't as certain, wants diffuse, sparse coverage, and isn't opposed to shaving down if they don't like the look in the end. This is a beautiful example of one patient who is suited for strip and another who is suited for an FUE approach.

 

It's funny too because there really is a division between these types of patients, and you can tell almost immediately. I frequently read emails/private messages from members/patients asking for advice and they general start off one of two ways: 1) "I've been bald since X and I'm sick of it. I want hair back in the front;" 2) "I've been concerned about my thinning for a few years, but didn't look into hair transplant surgery because I can't have a scar in the back of my head because I frequently wear my hair short."

 

Notice the difference: patient 1: "I want my hair back in the front;" patient 2: "I don't want a scar."

 

These are clearly two different patients with different goals who are better suited for two different approaches. Patient 2 shouldn't undergo 5,000 grafts via a huge strip because it sounds like he's very hesitant and content to just shave down. He can play around with FUE for a while -- and will probably not be satisfied with the results regardless of how good/poor they are, and end up shaving down in the end. In the same sense, why should patient 1 mess around with 3-5 procedures over 3-5 years, potentially risk 20% of his grafts, and end up with hair that's more "wiry/kinky?" This guy has no intention of shaving his head and is more than willing to undergo strips until he's satisfied.

 

Right procedure for the right patient. Both procedures existing in harmony. It's beautiful ; )

 

PS: I think he was trying to discuss the role of mFUE in patients who are stripped out/have tough scalps. Any patient who is a candidate for FUE -- like I discribed above -- is a candidate for mFUE.

[Dr. William Lindsey]

Guys,

 

I saw several posts giving Dr. Feller a hard time about him saying that FUE leaves a lot of scarring. Check out this young man who came in complaining of little FUE result, donor depletion with a longer hair style, and these scars when his hair is short...

 

Now he is in a bind, kind of damned if you do any more to fix the front and deplete the back more, and damned if you don't...

 

Regardless of folks' thoughts on FUE, and contrary to the ads I see from my local competitors and on the airplanes...FUE is not scarless. This ought to be discussed, up front, as part of the pros and cons before patients get in the operating chair. Now he might have had a strip scar that would require a longer hair length than this, but he would not have depletion of his donor area to any extent and he'd likely have gotten a better result (with that skinny fine hair he has) than with FUE. MFUE would have probably been able to give him better grafts with this type of hair...and if the case was designed and executed properly of course...but he'd still have a number of linear scars...way fewer than these FUE scars but I doubt if he could have a really short haircut like he has here..but at least with a fairly short haircut he would not show donor depletion like this.

 

I'm not saying this is the perfect option for everyone, but this young man was "taken" by unscrupulous ads.

 

Dr. Lindsey McLean VA

[Mickey85]

Guys,

 

I saw several posts giving Dr. Feller a hard time about him saying that FUE leaves a lot of scarring. Check out this young man who came in complaining of little FUE result, donor depletion with a longer hair style, and these scars when his hair is short...

 

Now he is in a bind, kind of damned if you do any more to fix the front and deplete the back more, and damned if you don't...

 

Regardless of folks' thoughts on FUE, and contrary to the ads I see from my local competitors and on the airplanes...FUE is not scarless. This ought to be discussed, up front, as part of the pros and cons before patients get in the operating chair. Now he might have had a strip scar that would require a longer hair length than this, but he would not have depletion of his donor area to any extent and he'd likely have gotten a better result (with that skinny fine hair he has) than with FUE. MFUE would have probably been able to give him better grafts with this type of hair...and if the case was designed and executed properly of course...but he'd still have a number of linear scars...way fewer than these FUE scars but I doubt if he could have a really short haircut like he has here..but at least with a fairly short haircut he would not show donor depletion like this.

 

I'm not saying this is the perfect option for everyone, but this young man was "taken" by unscrupulous ads.

 

Dr. Lindsey McLean VA

 

I don't disagree with some clinics wrongly marketting FUE as a scarless technique or that FUE leaves small scars and missing follicles. But I think the amount of strip patients who would gladly trade donors with this guy would be insanely high. If I shaved down to the grade this patient did, you would see my strip scar from 50meters away.

[Sethticles]

I just google Hair transplant scar, internet is over stocked with images, Dr FUT Butcher's know this, how on earth they sleep at night is beyond me.

 

"Honey I'm home, great day at the office, sliced and diced another fool's head open today, whats for dinner?"

[Michael Vories, MD]

I would be curious to the size of the punch used in the above FUE photo. In the vast majority of patients we see, the punch size can be limited to 0.8 mm to 0.85 mm. So when going in for a consultation for a FUE procedure, be sure to ask your physician (consultations should only be performed by the physician who will be doing the procedure) not only the amount of grafts needed, but also the size of the punch that will be used. Here is a photo of a clipped down donor area before a second surgery. He is about two years post-op of a large FUE procedure where a 0.8 mm punch was used. For sure there is scarring, but I would imagine most patients would gladly have this donor result than a strip excision scar.

[irishsailor]

I just google Hair transplant scar, internet is over stocked with images, Dr FUT Butcher's know this, how on earth they sleep at night is beyond me.

 

"Honey I'm home, great day at the office, sliced and diced another fool's head open today, whats for dinner?"

 

I don't think electing to go strip makes us fools. I have had both types of surgeries and both have its strengths and weaknesses.

[chrisdav]

I don't think electing to go strip makes us fools. I have had both types of surgeries and both have its strengths and weaknesses.

 

Agreed.

[Yonex]

I don't think electing to go strip makes us fools. I have had both types of surgeries and both have its strengths and weaknesses.

 

spot on pal

[Sethticles]

great I've sparked some conversations, sorry guys i retract the fools comment, which was more directed at the attitude of the salesmen FUT dr not his patience,

 

but I would like to ask, answer or not its up to you, what was your reasons for first choosing FUT I see that Chrisdav says 2 unsatisfactory HT, and Irishsailor has FUT in 2011 and only 3 years later as FUE,

 

please guys im not trying to piss you guys off, just open for chit chat.. peace seth!!

[HairJo]

sometimes a combination of fue and fut are recommended to help achieve your ultimate goal

[Sethticles]

fair enough

[Dr. Alan Feller]

great I've sparked some conversations, sorry guys i retract the fools comment, which was more directed at the attitude of the salesmen FUT dr not his patience,

 

but I would like to ask, answer or not its up to you, what was your reasons for first choosing FUT I see that Chrisdav says 2 unsatisfactory HT, and Irishsailor has FUT in 2011 and only 3 years later as FUE,

 

please guys im not trying to piss you guys off, just open for chit chat.. peace seth!!

 

Nope, he's not trying to "piss you guys off", just me and those who support my philosophy and viewpoints which are contradictory to his. And thank you, Seth, for making it clear that you have an agenda to attack me personally rather than address the information presented in this topic. Do you really want to be known as a "Hater"?

 

It is a violation of the rules of this chat forum to personally insult other members. If you had to use your real name and not an alias I'd bet you'd be more civil and tolerant.

 

Why so hateful ? You haven't met me nor know anything about me. You obviously don't understand the reality of HT surgery either. And why should you? You're not the one going into the operating room to perform it, nor will you be held accountable to the patient or the world for it's result. I am. And it is my job not only to EDUCATE patients as to the pros and cons of HT, but to counter the massive amount of disinformation and ignorance published in volumes on sites like this one and others. I'm "equal time" and I have been way to lax in attending to this responsibility. So have most of my colleagues. But I can't blame them, why come on here to be insulted and attacked?

 

As it happens, both Chris and Irish are patients of mine. Both had poor quality strip surgery results with other clinics before meeting with me. Both had scars in their donor area. Thankfully, because these scars were along a single very narrow plane in the donor area all the follicles above and below the scar were virginal. This means they had the very best chance of growing AND yielding the highest numbers. As both of them had already had prior surgery that did not produce good recipient yields it was critical that these repair surgeries grow to their maximal potential. The well was running dry.

 

Both stories had happy endings as they both grew maximally and produced beautiful results. Both patients kindly shared their photos online along with their experiences and I am very very proud to have been their doctor. They made the correct choice using FUT, the proof is on their heads and it's undebatable. What is it about products like this from my clinic, and many others like mine, that chides you so much that you'd actually come on here to attack them and me?

 

If I make posts online and willingly share my viewpoints based on actual experience it makes me a shameless "FUT salesman"? Doesn't that sound like a personal attack to you? If I didn't actually perform the surgical procedures and describe in detail the pros and cons you might have a point. There have definitely been classless, unscrupulous salesman on this site who have done that, but none performed the surgery and none stayed on for years to face the music and stand up to the critics. By the way, many of these were FUE salesman.

 

Seth, I wonder, if you had the power would you deny the right and privilege of non FUE doctors to post online? Would you shut my medical practice of 20 years down if you had the chance? Have my medical license revoked? Have all my possessions seized to "compensate" and redistribute to patients like Irish and Chris for the results my procedure produced on them and others? Would you have me put into jail? Is this what you would want? How much hate is in you?

Edited June 13, 2015 by Dr. Alan Feller

[Sethticles]

my agenda is no different to any other, if someone else comes on here and as rant that i strongly disagree with, then guess what I will use my sarcastic wit to annoy them, see how they react, further exposing them, hoping that some future HT patient sees this and has a better account of what is actually out there in the market.

 

to answer you question would I shut you down, what kind of question is that. would I have you put in jail? are you nuts?

 

whats scary about that response is that you consider yourself as a professional and allow yourself to write such bizarre responses to an open forum, you're digging yourself into a big whole without my help, best of luck

[Sethticles]

love how this so called professional is re-editing his comments, its a sign of an emotionally strung out unprofessional, note to people be very wary of him

[Dr. Alan Feller]

Seth,

So you do have an agenda, and it is purposefully designed to annoy. Got it.

 

When you write a hundred posts of uninformed and uneducated drivel that mislead people it's "exposing" the truth. When I write at length and detail about the actual facts of HT from experience it's a rant. Got it.

 

You call yourself a hybrid of a real name and genitals and hide behind it and I'M the one who's bizarre ? Got it.