FUT is more popular than FUE

[Swooping]

@Yaz89

 

There is are no ISHRS members who run hair "mills". These statistics are solely from members from the ISHRS which show the 50/50 scenario in 2014. The growth furthermore of FUE in these years is obvious. Have a look at the reports yourself and the picture that I posted. Correct me if I'm wrong. Furthermore the forums I talk about are generally well researched members. It's quite obvious to me why even the most elite FUT practitioners are forced to offer FUE now (Konior, H&W). Quite simply because demand forces them to do that.

 

This is the "era" of FUE already. I concur with Dr. Bhatti that FUE is already a standalone treatment. FUT will still exist but will slowly fade away. You'll see. And this development will stimulate more and more practitioners who will perform FUE to the highest standards possible.

 

Anyway good for you that you did good research and got a great result. I am happy for you . Your friends were just not the smartest to walk in uneducated. There have been/are enough bad FUE practitioners as there are bad FUT practitioners and they will always exist. That's why research is crucial.

[Yaz89]

Swoop, I am not talking about the graph posted in the link but the general conception of hair transplants. Not many people will research but are more concerned about the cost. How many people actually come on these forums? Thousand a month maybe more?

 

Again, last night my friends were talking about hair transplants and the costs popped in again. 'Yaz spend too much'. One friend said 'oh my cousin paid 1800 euros'. And I have seen my friends cousin; nothing special about his result. They do not understand the pro and cons, the various techniques, the different punches for graft removal or the different salines! Like my friends, there are other thousands of people who have the same conception about hair transplants.

 

I think Dr Feller needs to give them a good lesson and a good hiding for them to realise!

[Yaz89]

Triple post deleted! Damn my iphone!

[Yaz89]

Double post deleted

[voxman]

Swooping and Yaz89 posts #976 and #977 are both well thought out, informing, and balanced summations of what's really happening out there.

[Dr. Alan Feller]

FUE is only gaining popularly thanks to the all the hair mills offering FUE especially from novice surgeons, tech run clinics (Dr M anyone!) and inexperienced clinics using micro-motors. FUT will never go away. FUE might surpass on the above points I have stated. How many surgeons are there offering FUE to the highest standard possible? Not many? All the proven FUE surgeons charge a premium which the common working man simply at times cannot afford. The diamonds such as Erdogan, Bhatti, Vories, lorenzo, Keser and the others are simply too expensive to the common man. (Bhatti in Indian standards is quite expensive). Thus the rise of FUE thanks to budget, amatuer run clinics whose patients hardly research and only think about the cost but not the quality!

 

For example, I paid nearly 7k in British pounds. England is well known for high living costs, low wages. When friends, family and people who I knew found out I paid this amount; they were like "fcuk why did you pay so much when you could have done it for 1200 pounds!". They did not understand I had researched for nearly 3 years (still am) and I chose an reliable surgeon. My result speaks for it self. Meanwhile, 6 of my friends used whatclinic.com and chose the cheapest clinics in Turkey. And guess what! Horrible donor extractions, donor destroyed by micro-motors, I was told all the nurses did the work; the end result? Little growth, lack of yield and density. And permanent shock loss to non-transplanted areas. How do I know this? Thanks to my 5 years of research!

 

FUE will only increase in popularity thanks to these rogue clinics scattered around the globe. But the diamonds are rare. There are not many Feller's, Lindey's, Bhatti's, Erdogan's, lorenzo's or Vories's out there.

Amen.

A rational and common sense statement of reality. Well done!

Edited August 23, 2015 by David - Moderator
Fixed quote tag

[Dr. Alan Feller]

Would the recipient site be effected with fibrosis when you place grafts?

 

I talked to Greco about his stand alone PRP/CRP I have to admit results look impressive not just from him but form others. Granted they only show the best. Actually it's like a HT and the patient starts using Fin and you see an amazing result from the HT. I can only wonder if fin did 70% of that amazing results.

 

What could drive down the cost of FUT or FUE?

 

I don't think PRP has any place in HT. And I believe it injures the recipient area with fibrosis if used at anytime prior to an HT.

 

What could drive down the cost of FUT? I can think of nothing except perhaps a machine that can divide the grafts out of the strip as safely as a human can. To date this technology does not exist and is beyond human ability to create.

 

What could cut down the cost of FUE? Well, the cost in injured grafts has to be reduced first. To do this new technologies have to be invented. To date, the only technologies that have evolved only make the procedure faster, not safer. Or, makes it easier for novice doctors to enter the HT field. To make it safer a revolution in technology needs to be invented. That's why I boiled FUE down to the three detrimental forces: Torsion, Traction, and Compression. Anyone who will address those forces and significantly overcome them will become an overnight hero and Billionaire.

[Sethticles]

I also have doubts that transplanted hairs are DHT resistant, I am also unsure if i want to remain on meds for more than 5 years,

 

Regardless of FUT or FUE this is a concern, can anyone shed some light on the matter.

[Mick50]

well that's a new one on me I thought the whole basis of hair transplant is that the transplanted hairs are DHT resistant we may as all pack up are bags and go home if that's the case

[Swooping]

Swoop, I am not talking about the graph posted in the link but the general conception of hair transplants. Not many people will research but are more concerned about the cost. How many people actually come on these forums? Thousand a month maybe more?

 

Again, last night my friends were talking about hair transplants and the costs popped in again. 'Yaz spend too much'. One friend said 'oh my cousin paid 1800 euros'. And I have seen my friends cousin; nothing special about his result. They do not understand the pro and cons, the various techniques, the different punches for graft removal or the different salines! Like my friends, there are other thousands of people who have the same conception about hair transplants.

 

I think Dr Feller needs to give them a good lesson and a good hiding for them to realise!

 

So did you talk about your friends between FUT and FUE? What do they want. I would bet they want FUE.

 

Also these "hair clinic mills" often do offer FUT for a even lower price than FUE. Yet most people seem to pay that little extra more for a FUE procedure?

 

You are right also that these bad FUE only clinics pop up. But it's obvious why there are no FUT only clinics popping up. Simply because it would be a pretty bad idea business wise to open a FUT only clinic in 2015. The demand simply doesn't ask for that. If demand would ask for FUT there would be FUT clinics popping up currently but these people opening these kinds of clinics understand that FUE is increasingly more popular. I would do the same in their shoes (not that I would ever do that lol). Wouldn't you?

 

FUE was bound to overtake FUT. Was just a matter of time.

[wylie]

There are always advances in the HT industry. FUE is the advance that is slowly being accepted by the community as an alternative to strip scars. As this procedure advances, it will replace FUT as the gold standard in HT's, and in another 10-15 years, people will view FUT in the same fashion as we view mini-grafts and micro-grafts of the 90's (multi-haired grafts being placed all over ones scalp, the standard in the 90's, which gave a wonderfully pluggy appearance to ones hair)

 

There is a dearth of qualified surgeons to practice FUE, or as someone posted because the prices are too high, and these are external factors with no connection to the actual procedure. Over time the prices of FUE will drop as more and more physicians become experienced with the procedure, as many are now in the learning stages of this, while most have opted out.

 

How many doctors in the U.S. practice FUE exclusively? I think I can count the number on one hand. Think about that for a second. The world leader in cosmetic surgery has only a handful of doctors practicing this. Most are unwilling to do the work that FUE involves. I know from experience that Dr. Umar uses a small device that quickly extracts the grafts (a device that fits in the palm of his hand) while I have heard Dr. Bisanga extracts the grafts by hand. If that is true, you can imagine the amount of work involved in the extraction process, and how long it would take to do this procedure. And that is the chief reason no one is eager to practice FUE in this country. (It is arguable which procedure for extraction is better. Some might say by hand, but an extraction device offers uniformity in the procedure, while manual extraction does not, due to stress and fatigue during the process)

 

But technology will change this, and extracting grafts will become easier in the coming years when someone invents a device to safely extract grafts. ARTAS, Neograft, and other devices will either be improved or discarded as technology builds a better mousetrap, and naysayers of FUE will likely be retired and their doors closed for business when FUE becomes mainstream and doctors find practicing the procedure to be as easy as it was doing FUT.

 

It's coming, and given the choice between having a scar and not having a scar, the choice is obvious. Nothing will stop FUE from replacing FUT, but it will take time, training, and options for the HT patient, options simply not available at this time due to so few able to practice this, and due to the difficulty in getting high yields for inexperienced doctors who do not want to get the training and fully invest in this procedure. I think the paramount reason FUE is practiced by so few doctors is the amount of work involved in the extraction process.

 

Economy of time and getting the best result, this insures FUT being the industry standard for the time being, but FUE, done by the right doctor, will insure they are very busy with patients banging on their door. That is what will motivate doctors to learn the procedure, it always ends up being the same thing:

 

$$$

[Dr. Alan Feller]

There are always advances in the HT industry. FUE is the advance that is slowly being accepted by the community as an alternative to strip scars. As this procedure advances, it will replace FUT as the gold standard in HT's, and in another 10-15 years, people will view FUT in the same fashion as we view mini-grafts and micro-grafts of the 90's (multi-haired grafts being placed all over ones scalp, the standard in the 90's, which gave a wonderfully pluggy appearance to ones hair)

 

There is a dearth of qualified surgeons to practice FUE, or as someone posted because the prices are too high, and these are external factors with no connection to the actual procedure. Over time the prices of FUE will drop as more and more physicians become experienced with the procedure, as many are now in the learning stages of this, while most have opted out.

 

How many doctors in the U.S. practice FUE exclusively? I think I can count the number on one hand. Think about that for a second. The world leader in cosmetic surgery has only a handful of doctors practicing this. Most are unwilling to do the work that FUE involves. I know from experience that Dr. Umar uses a small device that quickly extracts the grafts (a device that fits in the palm of his hand) while I have heard Dr. Bisanga extracts the grafts by hand. If that is true, you can imagine the amount of work involved in the extraction process, and how long it would take to do this procedure. And that is the chief reason no one is eager to practice FUE in this country. (It is arguable which procedure for extraction is better. Some might say by hand, but an extraction device offers uniformity in the procedure, while manual extraction does not, due to stress and fatigue during the process)

 

But technology will change this, and extracting grafts will become easier in the coming years when someone invents a device to safely extract grafts. ARTAS, Neograft, and other devices will either be improved or discarded as technology builds a better mousetrap, and naysayers of FUE will likely be retired and their doors closed for business when FUE becomes mainstream and doctors find practicing the procedure to be as easy as it was doing FUT.

 

It's coming, and given the choice between having a scar and not having a scar, the choice is obvious. Nothing will stop FUE from replacing FUT, but it will take time, training, and options for the HT patient, options simply not available at this time due to so few able to practice this, and due to the difficulty in getting high yields for inexperienced doctors who do not want to get the training and fully invest in this procedure, due to the amount of work required.

 

Wylie,

That is a nice write up, but it is based only on wishful thinking and a hopeful parallel to improvements in production technology, not medical technology. If you replaced the word FUT with "carburetor" and the word FUE with "fuel injector" then you would be correct. But medical improvements are far more resistant.

 

The first myth is that FUE is new. It is not. It is now over 14 years old and still has not caught on. In contrast, FUT was "invented" in the late eighties. Within less than 5 years it swept the globe and put HT on the map. There was no internet back then and yet the ranks of HT doctors who accepted and learned FUT swelled literally into the thousands almost over night. So many doctors readily adopted FUT that the ISHRS was born and had it's first meeting in 1992. I joined in 1993 and watched the industry develop and grow into a juggernaut. FUT has a "rightness" and an "elegance" that FUT simply doesn't possess.

 

With three times the amount of time in existence FUE has still failed to launch as a primary procedure. It is not because FUT doctors are lazy or the procedure is too hard. It's because it doesn't work as well. It has it's place, but not as a primary modality. For all the smoke and mirrors and distorted information put out there by FUE only adherents, that is the reality. It doesn't work as well as FUT.

 

By the way, it is sad that so many non doctors mock FUT as simple or easy. It surely isn't. It is more difficult to perform than any FUE and requires far greater surgical skill, competence, confidence, and the ability to create and work with a team. That reality has gotten lost in the mire of FUE hype and bluster.

 

Wilie, you wrote that between the choice of having a scar and not having a scar the answer is obvious. What you left out was the more primary choice of picking a procedure that gives the greatest chance for growth for the greatest amount of grafts with the least damage to the donor area. The mission, after all, is to cover bald skin. Your choice is not realistic because it comes at too high of a price. A price that is ignored or not mentioned by wishful thinkers and patients who are frightened of the FUT procedure. If you think the doctors who perform the surgery don't want the smallest most invisible scar possible then you have no idea how most surgeons think.

 

FUE is not "coming". It has had 14 years to achieve dominance, and yet to date it hasn't even reached parity. The reason is simple. When it comes right down to it patients want the best growth possible in their recipient areas and are not so concerned about a linear scar that will be easily concealed under the hair. Even with the online scare tactics of FUE-only advocates, patients still know intuitively that the more hideous scars are outliers, not the norm. As this scare tactic is exposed for what it is and the chances of scarring put back into proper perspective FUE will lose more ground to FUT.

 

FUE hype is always based on the claim that it is a NEW procedure. But it has now been around 3 times as long as FUT was when FUT took over the world. People are getting wise and realizing that it isn't "new". Knowing this is inevitable, FUE only adherents try to claim or imply they have NEW FUE technology. But that's not true either.

 

FUT will continue to grow as FUE continues to sputter along. It will not completely die out because it does have it's place, but not first place.

 

PAX FUT !

 

Strip scars:

 

Edited August 23, 2015 by Dr. Alan Feller

[hairshopeing]

In America yes!!! Until the law changes and allows techs to extract! The rest of the world, no!! Fue is already more popular, can I ask Dr feller, if strip surgery is sooooooo popular and sooooooo consistent, why have tried to invent an alternative? If a strip scar is so little of an issue ( in your world anyway) and so easy to disguise and your so busy why fix something that ain't broke?? Well, ain't broke in your eyes anyway?? Why cause more donor damage with say hundreds of punches for mfue? Because each punch scars right? Each punch causes fibrosis to its surrounding areas right? So the punches aren't linear, there spread out through out the donor area safe zone, each one another puncture to the skin which causes scarring and damage underneath the skin in surrounding areas right?? Seems strange to approach this in a way when strip causes so little damage, easily hidden scar, high yield?

 

Fue is already more popular globally and will continue to grow, remember fue is usually more than double strip in terms of cost, and people expect quality for their money and if you choose right you will get quality, if you chose cheaply for fue then you MAY luck out, but probably will get sub par results!

BUY CHEAP, BUY TWICE!!

[Mickey85]

Dr Feller, what FUE tools have come out in the last 14 years have impressed you the most?

[Dr. Alan Feller]

In America yes!!! Until the law changes and allows techs to extract! The rest of the world, no!! Fue is already more popular, can I ask Dr feller, if strip surgery is sooooooo popular and sooooooo consistent, why have tried to invent an alternative? If a strip scar is so little of an issue ( in your world anyway) and so easy to disguise and your so busy why fix something that ain't broke?? Well, ain't broke in your eyes anyway?? Why cause more donor damage with say hundreds of punches for mfue? Because each punch scars right? Each punch causes fibrosis to its surrounding areas right? So the punches aren't linear, there spread out through out the donor area safe zone, each one another puncture to the skin which causes scarring and damage underneath the skin in surrounding areas right?? Seems strange to approach this in a way when strip causes so little damage, easily hidden scar, high yield?

 

Fue is already more popular globally and will continue to grow, remember fue is usually more than double strip in terms of cost, and people expect quality for their money and if you choose right you will get quality, if you chose cheaply for fue then you MAY luck out, but probably will get sub par results!

BUY CHEAP, BUY TWICE!!

 

Can you and your ilk possibly tone down the childish nastiness and "gotcha" language? Would you speak to someone like that in person? I should hope not. If you weren't so intent on "winning points" you might learn something that will change your world view. Show respect and I will entertain your questions. You are free to not like what I have to say, but I speak from experience and authority that you do not possess. Like it or not, that's the case. I'm not the evil villain spinning my mustache in my cape and top hat. I am trying to help you and everyone by giving you information you can't possibly have and so many doctors refuse to offer.

 

It is human nature to try and find better ways to do things. Not because what we are already doing is bad, but because improvements are simply better. However, not every effort at improvement is going to succeed. FUE is a great example of that. FUT is not "broken" but it can be improved. The primary improvement WOULD be to minimize or eliminate the scar. I agree with this. But only if this can be done without creating even more negatives like greater scar tissue damage throughout the donor area and decreased growth yields as a result of extraction damage.

 

FUE is an alternative procedure but NOT a substitute for FUT. It has it's place in small procedures and in patients who don't have the donor characteristics for FUT. This is why I actually invented instruments and protocols for FUE. It's why I studied the procedure and boiled it's negatives down to three fundamental shortfalls.

 

I see FUE is a patch. You may put one or two or even three on a pair of torn pants, but you wouldn't realistically make an entire pair of pants out of patches.

Edited August 23, 2015 by Dr. Alan Feller
spelling errors

[Dr. Alan Feller]

Dr Feller, what FUE tools have come out in the last 14 years have impressed you the most?

 

Mickey,

Let me answer your question with a question:

 

What FUE instruments have come out in the past 14 years that to your mind reduce any or all of the three detrimental forces of FUE: Traction, Torsion, Compression ?

 

This may be the most on-point and important discussion to date on this thread or any other concerning "advancements" in FUE technology.

 

I thank you for asking this question and look forward to your considered response.

[Mickey85]

Mickey,

Let me answer your question with a question:

 

What FUE instruments have come out in the past 14 years that to your mind reduce any or all of the three detrimental forces of FUE: Traction, Torsion, Compression ?

 

This may be the most on-point and important discussion to date on this thread or any other concerning "advancements" in FUE technology.

 

I thank you for asking this question and look forward to your considered response.

 

Fair question.

 

I have not used any of those tools(I'm no tech or surgeon ) but I will lay down my opinions on the main FUE tools:

 

Neograft: I think the suction aspect of the device is much too violent personally from the videos I have seen. I could certainly see this part of the device shearing the follicle from the scalp potentially causing damage to the dermal papilla. The graft canister being supplied a constant volume of air could cause drying of the grafts and desiccation.

 

ARTAS: From what I have seen I think the punching process is much too swift(compression?). From the results I have seen I don't think it has lived up to it's claims of such high yields so I question the devices ability to detect and work around the grafts angles and depth.

 

The Harris SAFE system uses a blunt punch which looks like it can actually create moe tension on the graft, rather than punching through it with as few oscillations as possible. This is what you would call torsion? I have seen some good results from the SAFE system but have sadly seen more unsuccessful ones.

 

CIT/Versi manual sharp tip punch in my view looks like it reduces those three elements you speak of the most. Being a sharp tipped punch and manual, the surgeon can control the oscillations and use as few turns as possible because of its sharpness. I would imagine it would reduce compression apon the punching of the graft too, due to the razor sharp edge. The traction aspect you speak of has more to do with the actual pulling of the graft out of the scalp than the punch itself. I have seen surgeon's use different techniques. i do agree that when I see surgeon's 'yanking' the graft our and seeing the scalp pull up, it does make me think there is a possibility of damage to the graft. I have seen some surgeons like Lorenzo used the two forcep method where one forcep holds the graft whilst the other pulls tension on the area behind the graft, sliding it out in a gentle manner.

 

This is just what I have seen. Do any of these tools eliminate all chances of graft damage? Probably not. But I think the CIT/Versi handle with a sharp punch gives the best chance. What do you think Doctor?

[Swooping]

There are always advances in the HT industry. FUE is the advance that is slowly being accepted by the community as an alternative to strip scars. As this procedure advances, it will replace FUT as the gold standard in HT's, and in another 10-15 years, people will view FUT in the same fashion as we view mini-grafts and micro-grafts of the 90's (multi-haired grafts being placed all over ones scalp, the standard in the 90's, which gave a wonderfully pluggy appearance to ones hair)

$$$

 

Exactly well said, nice post. In 10-15 years FUT will be just about extinct indeed. I would bet my money over this any moment. From the moment on FUE was bound to overtake FUT. The numbers tell everything from the ISHRS as well as the whole online community.

 

I also like how you mention that this will only stimulate more innovation and competition. Which is what we all want. But FUT won't have a place in the near future. It's already decreasing every day.

[hairshopeing]

Dr feller

 

I think if you speak to people in a certain way then expect them to speak back in the same manner!! Fair?? You have been very discurtious to several people in this thread, me not being one of them because you ignored all my questions!!

 

I'm not trying to score points, and you are by no means a villen, in fact I praised you attempting a new procedure in your mfue thread as I believe choice is always best! And do I hope it takes off,absolutely I do!! It would give a great choice to an existing pool of patients with differing, needs, goals and expectations!! But I merely pointed out the one of the many negatives you have pointed out on fue WILL still be present in mfue, hardly being rude or scoring points!

 

So I will very polietly again ask you and not to trip you up or score points and would appreciate you answering this question PLEASE

 

If the 3 forces you mention make fue unable to produce high level 85-90% yield and fue decimates donor areas making each procedure more difficult then the last

 

How do the likes of lorenzo, erdogan, maras,feriduni produce the results they do??

 

Particularly lorenzo who I believe documents better than any fue or strip surgeon out there?

 

He shows multiple surgeries on the same patients,6000 grafts with donors at .5 mm in HD video, wet,dry,combed,messy!!!

 

How is he doing this?? Multiple surgeries on the same patient?? Hundreds of examples just on the Internet alone!!!

 

How has he overcome the issues which you believe are detrimental to fue??

 

Seriously Dr feller iv asked this about 5 times now and you have chosen to ignore it, if we can be civil and agree to disagree then great but I'm genuinely interested on your opinion on this! !

 

Thanks in advance

[Dr. Alan Feller]

Fair question.

 

I have not used any of those tools(I'm no tech or surgeon ) but I will lay down my opinions on the main FUE tools:

 

Neograft: I think the suction aspect of the device is much too violent personally from the videos I have seen. I could certainly see this part of the device shearing the follicle from the scalp potentially causing damage to the dermal papilla. The graft canister being supplied a constant volume of air could cause drying of the grafts and desiccation.

 

ARTAS: From what I have seen I think the punching process is much too swift(compression?). From the results I have seen I don't think it has lived up to it's claims of such high yields so I question the devices ability to detect and work around the grafts angles and depth.

 

The Harris SAFE system uses a blunt punch which looks like it can actually create moe tension on the graft, rather than punching through it with as few oscillations as possible. This is what you would call torsion? I have seen some good results from the SAFE system but have sadly seen more unsuccessful ones.

 

CIT/Versi manual sharp tip punch in my view looks like it reduces those three elements you speak of the most. Being a sharp tipped punch and manual, the surgeon can control the oscillations and use as few turns as possible because of its sharpness. I would imagine it would reduce compression apon the punching of the graft too, due to the razor sharp edge. The traction aspect you speak of has more to do with the actual pulling of the graft out of the scalp than the punch itself. I have seen surgeon's use different techniques. i do agree that when I see surgeon's 'yanking' the graft our and seeing the scalp pull up, it does make me think there is a possibility of damage to the graft. I have seen some surgeons like Lorenzo used the two forcep method where one forcep holds the graft whilst the other pulls tension on the area behind the graft, sliding it out in a gentle manner.

 

This is just what I have seen. Do any of these tools eliminate all chances of graft damage? Probably not. But I think the CIT/Versi handle with a sharp punch gives the best chance. What do you think Doctor?

 

WELL DONE! WELL DONE!!!

 

Even though you are not actually performing the procedure I can see that you have conceptualized them enough to understand the forces in play. Very impressive for a non-practitioner indeed.

 

Let me go down your list:

Neograft: Agree on every word. I'll also add that it is marketed as a 'turn key" system to allow non HT specialists to get into the field without all that pesky training, experience, and need to create, pay, and train a staff of technicians. I have seen this device in action and was appalled by it. Only Dr. Bhatti's recent video made me gasp more since seeing the Neograft in action.

Neograft does not address the three detrimental forces.

 

ARTAS: Agree on every word. However, your use of the word "compression" isn't the same as mine. But, you do bring up a force exclusive to ARTAS that I had not identified which is indeed a compressive force that bends the follicle as the cutting surface descends into the skin creating the perfect set up for a side shear. The ARTAS only scores the graft. Why do you need to spend a hundred grand or more when you can do it more gently and swiftly with a manual punch for fifty bucks? An experienced HT practitioner competent in manual FUE has no use for such a machine.

ARTAS does not address the three detrimental forces.

 

The compression force that I refer to is the squeeze on the graft applied with the forceps in preparation to pull the graft free from the lower dermis. The greater the pull, the greater the compression force.

 

Harris Safe system: Agree on every word. But I will add that it does help control side shearing, but at the cost of greater torsional damage. I actually experimented with duller punches for the same reason he did, which was a good idea, but in the end it didn't really help in most patients.

SAFE system does not address the three detrimental forces.

 

I never used the CIT punch, but I think I saw a comparison between it and one of my punches and it was found to be even sharper. Well, if that's true then it's a damn sharp punch. And as Rassman discussed 13 years ago a very sharp punch is a requirement for FUE for the reasons you cited. Less torsion. But it has no effect on the needed compressive force of the forceps nor the traction force required to tear it free. So this could be considered an improvement, but sharp punches are hardly an advance. Nevertheless, I agree with the benefits of a sharper punch over a duller punch. Especially if we incorporate your definition of compression (which we need to rename to include in the list of FUE detrimental forces. I'll leave it to you to name it and we'll use your terminology moving forward).

 

Dr. Lorenzo is the only FUE-only doctor I have met and not had an argument/debate with. Despite the hideously inaccurate things mentioned on his website, he himself in person was very candid and accurate about the differences between FUE and FUT. Actually, I found him to be breath of very fresh air. He is also the only FUE doctor other than myself who came up with what could be called a refinement in FUE technique. His method or "tricks" as he calls them allow for a better distribution of force during the "delivery" process of FUE. It is well thought out and has actual practical application. In short, it works and is an "advance" in my book. HOWEVER, while his forceps compression force is reduced in this manner, it has almost no effect on the traction force. I say almost because it does force the doctor to be more patient to allow the graft to break free at its own pace thus reducing to some extent the traction damage-but not force. These tricks have no effect at all on the torsion force at all. It is a "trick" that allows the practitioner to extract faster with less damage, and that's good. Unfortunately, even these tricks still do not elevate FUE to the level of FUT in reliability and consistency. But at least it's better than ripping them out wholesale without regard for compression damage in the name of speed. I have utilized this technique myself since meeting with Dr. Lorenzo to speed up my own procedures, but still chide at the traction and torsion damage. An advantageous trade off though.

 

My punch and my perforation technique are the only true "advances" that I know of that actually address any or all of the three main detrimental forces. And they are simple. Not hundreds of thousands of dollars and very common sense.

 

My punch is called a "relieved" punch which means it gets wider as the graft moves past the cutting surface into the punch. This makes it harder for a seal to be formed and thus weakens the cohesion between the graft and the punch. So when the punch is turned the graft won't turn as much with it. This relieves Torsional damage. But even with this advance, torsional damage is still a force to be reckoned with. Just look at the amount of decapitations or "capping" that occurs during all FUE procedures. This is an immediate transection that is a direct result of torsion force and still happens with my punch, albeit to a lesser degree.

 

A sharper punch like the CIT you described also reduces torsion because of the fewer turns necessary and the less twisting required to work the edge down to the 3 mm point.

 

Then there is my perforation technique. Which is simply a needle pushed to the bottom of the graft before it is pulled to reduce the strength of the tissue and thus the traction force necessary to tear it free.

 

See the animation and demonstration in the links.(I"ll put these in later)

 

http://fellermedicaldata.com/fellermedical/video%20for%20site/FUE/animation/fueanimation.gif

 

The problems with my techniques is that they don't speed up the procedure. Putting my punch on a motor does. So I built one and marketed it. But over time I found I could do a better and faster job manually.

 

We need a completely new way to look at the problem. But I'm about out of ideas. But if you or anyone else can come up with a way to reduce the three detrimental forces AND speed the process up you will be an overnight hero and multibillionaire.

 

You have some homework now, Mickey. You need to come up with a term other than "compression" to describe what happens when the punch pushes down the graft while still in the skin that causes it to bend thus allowing a greater chance of shear damage.

Edited August 23, 2015 by Dr. Alan Feller

[Swooping]

WELL DONE! WELL DONE!!!

 

Dr. Lorenzo is the only FUE-only doctor I have met and not had an argument/debate with. Despite the hideously inaccurate things mentioned on his website, he himself in person was very candid and accurate about the differences between FUE and FUT. Actually, I found him to be breath of very fresh air. He is also the only FUE doctor other than myself who came up with what could be called a refinement in FUE technique. His method or "tricks" as he calls them allow for a better distribution of force during the "delivery" process of FUE. It is well thought out and has actual practical application. In short, it works and is an "advance" in my book. HOWEVER, while his forceps compression force is reduced in this manner, it has almost no effect on the traction force. I say almost because it does force the doctor to be more patient to allow the graft to break free at its own pace thus reducing to some extent the traction damage-but not force. These tricks have no effect at all on the torsion force at all. It is a "trick" that allows the practitioner to extract faster with less damage, and that's good. Unfortunately, even these tricks still do not elevate FUE to the level of FUT in reliability and consistency. But at least it's better than ripping them out wholesale without regard for compression damage in the name of speed. I have utilized this technique myself since meeting with Dr. Lorenzo to speed up my own procedures, but still chide at the traction and torsion damage. An advantageous trade off though.

 

That's interesting Dr. Feller that he falsely then misleads patients on his website while mentioning other things to you in person. I'm going to call him this week about this and will report back. Curious anyway what his standpoint is and I want to hear it from him. I would assume he stands for what is presented on his website;

 

 

One of the most vital aspects of this technique is the quality of the units which are removed. We have found from our studies in previous years that the quality and strength of the grafts removed are better than those extracted by the strip method. The follicular units are much cleaner when removed one by one then by separating them under the microscope. This also helps to reduce wounding to the recipient area. Our surgeons have presented these studies in various seminars on hair transplants.

 

Source: http://www.injertocapilar.com/English/differences_fue-strip.htm

Edited August 23, 2015 by Swooping

[Dr. Alan Feller]

Dr feller

 

I think if you speak to people in a certain way then expect them to speak back in the same manner!! Fair?? You have been very discurtious to several people in this thread, me not being one of them because you ignored all my questions!!

 

I'm not trying to score points, and you are by no means a villen, in fact I praised you attempting a new procedure in your mfue thread as I believe choice is always best! And do I hope it takes off,absolutely I do!! It would give a great choice to an existing pool of patients with differing, needs, goals and expectations!! But I merely pointed out the one of the many negatives you have pointed out on fue WILL still be present in mfue, hardly being rude or scoring points!

 

So I will very polietly again ask you and not to trip you up or score points and would appreciate you answering this question PLEASE

 

If the 3 forces you mention make fue unable to produce high level 85-90% yield and fue decimates donor areas making each procedure more difficult then the last

 

How do the likes of lorenzo, erdogan, maras,feriduni produce the results they do??

 

Particularly lorenzo who I believe documents better than any fue or strip surgeon out there?

 

He shows multiple surgeries on the same patients,6000 grafts with donors at .5 mm in HD video, wet,dry,combed,messy!!!

 

How is he doing this?? Multiple surgeries on the same patient?? Hundreds of examples just on the Internet alone!!!

 

How has he overcome the issues which you believe are detrimental to fue??

 

Seriously Dr feller iv asked this about 5 times now and you have chosen to ignore it, if we can be civil and agree to disagree then great but I'm genuinely interested on your opinion on this! !

 

Thanks in advance

 

I cannot and will not comment on individual doctors and their patients. And you shouldn't either. Who is going to be more willing to post results and keep posting results: happy patients or unhappy patients? Trust me, it's happy patients by a wide margin. But the unhappy patient numbers are rising in direct proportion to the number of clinics offering FUE-only techniques. It's just that FUE-only advocates completely ignore the failures.

 

I will only specifically comment on the techniques and instruments utilized. This way personalities and feelings are not hurt. That said I will say that every doctor you mentioned, including me, has had publicized poor results with FUE, and these results are a direct result of FUE injury. Your view of FUE is limited to the very very narrow window of chat sites. I see them all the time in my office and know what the problems are.

 

The laws of physics are the same in every doctor's office. All you have to do is understand what they are doing and why and all the subjectivity goes out the window. But almost none of them are willing to be transparent. I am. Lorenzo is, even Dr. Bhatti is to his credit. But how did that work out for him? I'm sorry to keep seeming like I am picking on him, but it's not him that I have an issue with, I've never met him, it's his technique. And while I would definitely sit with him at a meeting and have a beer, I wouldn't let him near my head with his technique. I don't care how many before/after photos I am shown.

 

Look at the latest Bhatti video of how he extracts grafts. Now compare to the Lorenzo video or my video? Which is more brutal? Which is more gentile? Which is faster? Which is slower?

 

If online photos and results could be objectified we could use it as a gauge. But it's not that simple. Clinics will only put up successes (except for me. I've put up duds for years in the name education and reality and it never hurt my business). Most patients who are disappointed in their results are not going to relive that disappointment by posting them. Some do as a relief valve, or call for support or even as a "get even hit thread" against the doctor. But most just want to move on with their lives.

 

So point to before/after photos all you like. They are not valid as a gauge. There are hundreds of old style plug results that produced just as beautiful before/after photos but i wouldn't have this procedure performed on me. There are also some awesome before/after photos of scalp reductions. But again, no way for me. And let's talk flap procedures. Miraculous results in before/after photos. Would you allow that technique to be performed on your head? How about a loved one?

 

I hope you get my point. Read Micky's latest conversation with me on this thread. It is the most on point read in this thread, or any other FUE vs. FUT thread.

[Dr. Alan Feller]

That's interesting Dr. Feller that he falsely then misleads patients on his website while mentioning other things to you in person. I'm going to call him this week about this and will report back. Curious anyway what his standpoint is and I want to hear it from him. I would assume he stands for what is presented on his website;

 

 

 

 

Source: differences_fue-strip

 

I wouldn't be surprised at all if after your discussion he removes the sensational scare tactic pages from his site. It's beneath him.

 

I just clicked the link you included in your post and am shocked by that quote you put up. I couldn't believe it was accurately quoted. But it is. I am genuinely shocked by these claims. Do you believe these claims to be true? Does anybody reading this thread?

[newbie33]

You are free to not like what I have to say, but I speak from experience and authority that you do not possess. Like it or not, that's the case. I'm not the evil villain spinning my mustache in my cape and top hat. I am trying to help you and everyone by giving you information you can't possibly have and so many doctors refuse to offer. .

 

I have actually found some hidden camera footage of Dr Feller. GOTCHA FELLER!

 

[hairshopeing]

Dr feller

 

Thanks for responding, I appreciate it!

 

Although you chose not to answer the question or maybe don't know the answer that's fine!

 

Iv read micros post above, iv read almost every thread in this site in the last 4 years including his very in depth nd informative one on fue!! Trust me when I tell you I researched before and after my own fue ht!!

 

I agree that Dr's like lorenzo will have sub par results with fue,absolutely!!! All Dr's do!! But does hassan and wong, koniour,rhal,yourself have these same failures using strip? Absolute they do! ! That's my point no procedure is guaranteed success,that is a fact!!

 

We both agree that too many poor fue results are out there due to incapable,inexperienced practioners out there! If you choose poorly you will more than likely have a poor result! In both fue and strip surgeries!! Had you come on here and said there are a handful of surgeons producing high level results via fue similar to the best strip surgeries but generally strip yields better results then I would agree! Strip is more consistent with yield,but fue in right hands CAN and DOES match strip in the right hands of a proven experienced Dr! !

 

Iv had fue,am I glad I did,100% yes! I don't wish I'd gone strip, matt,Irish sailor,Chrisdav who all went strip and we're rightly very happy don't wish they had fue and I don't blame them,their results are great!!! And I know some of the above are your patients so qdos for that!!!

 

Just if I was a newbie reading this thread,especially the early part of it,it would frighten the life out of me getting fue as I would be sure it would fail and ruin my donor area,which isn't fair to people researching, it should be more of a you can get great results but all to often there not so great if you choose poorly!!!

 

And I'm glad your debating with mickey on here now as he is a very knowledgeable guy regarding hair transplantation and I look forward to continuing to see how this thread develops!!