FUT is more popular than FUE

[Yiddo]

Just can't get my head around Dr Feller saying their are hardly any decent fue results out there...their are bloody hundreds of them, especially on the European Hairloss forums...just a really odd thing to say.

 

I also believe mickey85 to be an excellent poster, I always enjoy reading what he has to say.

[BaldingBogger]

Mickey85 has been a tremendous asset to the online HT community. He Has always been composed, helpful respectful of others and tremendously informed. Yes sure he probably says a lot of things a pro strip clinic won't like. Tough. It's facts.

 

Despite what Dr feller says he is not an FUE clinic. No one has seen an FUE result in years.

 

To label Mickey an 'Online bully and stalker' is totally bizarre and alarming coming from a recommend Dr.

 

His threads informed many and Dispelled several absurd myths around FUE/FUT comparisons which no Dr certainly not

Dr feller has managed to dispute.

 

Dr feller it sounds harks back for the days when online on certain forums anyone who rocked the boat or ruffled anyone's feathers would be banned from a forum. Things have changed

Now fortunately and improved with far more options in terms of viable clinics and transparency I believe in the online

World.

 

 

Also Funny how Dr Feller is not asking for 'Hairjos' credentials whose profile was created the day of his first

Video and echoes everything he says.

[FUE2014]

I would imagine it is only Dr F in this universe who regards Mickey85 as an online bully. Very strange statement to make and one which I am 100% sure is not shared by any of the moderators.

[HairJo]

I wonder how you know for a fact how far advanced these fue doctors are booked . Do you work for all of them or have you called all of them and they all told you they are booked for 6 months Hmmm.

[Arrie]

Mickey has been helped me a lot and actually in private chats we have both agreed both procedures have their place, which is most of us can agree to. To say hes a stalker or an online bully is harsh... Hes willing to do his research and ask the tough questions that sometimes a new person would be hesitant to ask, I greatly value that! Mick your all good with me buddy...

 

Im sorry but I think personally, Im not a professional in the HT field, that FUE is becoming the standard. Like a previous poster on here stated, go look on the European forums FUE results, there are so many out there its great.

 

If doctors dont want to come on here because they dont want to debate with him (Mickey) then thats fine. If anything, that makes me wonder why they wouldnt... If they are too busy to come one here and debate then they would have to be too busy to come on here and post.

Edited June 17, 2015 by Arrie
spelling, i suck

[Mickey85]

Thanks for the support guys, very much appreciated and touched. Hugs to all(1978Matt included).

[Swooping]

Swooping,

I viewed the youtube link you put up and it does not support your statements. Spencer's view is to favor a HYBRID approach and states clearly that FUE just can't hit the sweat spots of the donor area like strip can. He is correct. If a patient needs a small case when he is young then he would recommend an FUE. I also agree-as long as that case doesn't exceed about 600 grafts so that they can be spread out far enough apart in the donor area as to minimize fibrosis and donor exhaustion. But for megasessions, which is the OVERWHELMING majority of HTs performed in the modern age he still advocates FUT. And rightly so.

 

Then watch again, he clearly states that FUT is going extinct basically (way of the dodo). He also thinks that it's very hard to sell FUT these days. Furthermore he specifically even mentions that no guy under 35 years of age should even think about FUT because of the scar.

 

Joe predicts that on short term FUT will be overthrown by FUE too.

 

This is cold hard reality and I'll repeat again that you see it in the ISHRS census numbers. You clearly see the massive increase from 2011 to 2013. The 2015 results will be out soon.

 

Also you can browse yourself on various inter(national) forums as I said. Just go and count the topics. The overwhelming majority is about FUE. This is reality. But you seem to be blinded by the fact that this is a reality. A reality that is only going to come in stronger as years go by with FUT becoming more and more a minority. Hard data? No, but indicative.

 

Now you can jump up as high as you want, and shout as hard as you want but consumers dictate the market. Keep that in your mind.

 

The fact that FUE is getting more and more popular is clearly a bad thing for you. FUT is getting harder to sell and your FUE prices are not really attractive. Time = money and you spend a whole lot of a more time on a FUE procedure right? You even state it yourself on your site. So you are kinda in a bad spot with how the market moves? At least hell of a lot worse than a few years ago .

 

A few years ago you probably didn't see it coming that FUE would become as big as it is now did you? Heck many doctors thought in the beginning that FUE would only be a temporary hype! And look now, even Hasson & Wong are giving in to FUE now.

 

All in all it's a undeniable fact that FUE is getting bigger and bigger. Does that make it the superior procedure? No, but that's not what I'm arguing here. Apparently the less invasive nature of FUE and the lack of a linear scar is a very important point for many people.

[HairJo]

As long as they know the pros and cons then let them choose whatever procedure they want . Most Dr.s will give the patient what they want money is money so they do the procedure make their money and hope for the best . The doctors gave Michael Jackson what he wanted just to make the money and see how well that worked out for him . Some doctors just give people what they want sometimes it works out but sometimes you go against the experienced advise of your doctor and end up paying the price. Think it through. It's amazing to me that some doctors are just led by what the people want and just do it even though in their mind fut would be better for them but they don't want to lose a single patient so the. just agree what what they want just to get the case. In the end the patient decides but lately how can they make a choice when all they hear is how great fue is and the promise of no scars. They only hear how great the turkish clinics are that's because they have people on line pushing their procedure all day they know how advertising works and how to discredit other procedures and lure you in to their way of thinking these are not everyday people some are but most aren't.

[mav23100gunther]

 

Results are all that matter we all agree so wether we like you or don't is irrespective but show us your results then, silence your critics with actual patients having life changing results via your fue procedures!

 

 

 

I don't believe he is claiming his FUE procedures result in life changing results. I thought he was arguing the opposite, that his life changing results are coming out of FUT?

[hairshopeing]

Exactly!! The other surgeons I mentioned ARE producing them!! IMHO it would be more credible to say look, I only fue for small touch ups a I can't or don't get the results of some of the high level fue surgeons so if it's due your after go to one of them!! But is its strip your after I'm as very capable and produce so examples cases!!

But that what's being said, it's being said that fue as a procedure can't produce these life changing high yielding results, which are on par with most top notch strip surgeries!!this will untrue for some fue practitioners but the ones I have named have mattered this procedure are producing excellent consistent results, so no the procedure hasn't evolved as a procedure but some have excelled in being able to achieve high level consistent results via it for what ever reason!!

obviously if something in any industry seems to be taking over and your company can't for what ever reason then you will try to either up your game or discredit the other thing trying to sell yours as a better product/solution!!

Choice is good, strip can and is good but so is fue in THE RIGHT HANDS!!

[hairshopeing]

Excuse my terrible grammar it's this soddin I phone!! Samsung were right about Apple!!!

It will never take off!!

[JoeTillman]

In the end the patient decides but lately how can they make a choice when all they hear is how great fue is and the promise of no scars. They only hear how great the turkish clinics are that's because they have people on line pushing their procedure all day they know how advertising works and how to discredit other procedures and lure you in to their way of thinking these are not everyday people some are but most aren't.

 

Hairjo,

 

They hear how great Turkish clinics are because some Turkish clinics are pushing out very nice work for a 1/3 of the cost, at most, compared to Western Euorpean and North American clinics. It is a simple lesson in economics. If you offer a product that is even only "almost" as good but for an disproportionate amount of money LESS then it will sell and it will sell well. The degree of shilling found onilne is unfortunate but it is not much different (but still better) than the clinic wars ten years ago.

[JoeTillman]

Since I'm being mentioned as a point of reference I should chime in to clarify my position.

 

First, I know Dr. Feller. I like Dr. Feller. I think Dr. Feller is one of the better hair transplant doctors. But my position is one that I think Dr. Feller may not agree with but I also know he respects that.

 

FUE is growing. It has been for years and it was at the 2013 conference in San Francisco when I saw the real writing on the wall. I knew that FUE was going to get stronger and as early as 2010 I ceased being so negative in general about the subject and started to be more complimentary but with the facts laid out as they existed, and still exist, in that the yield will generally be lower, sometimes by a lot, sometimes not, than when compared to FUSS. And before anyone decides to chime in on this to debate this issue, don't waste your time. It cannot be proven one way or the other and it is something that I believe from having seen, oh, I don't know, thousands of heads AND because I don't have a pro-FUE or pro-FUSS agenda. Being a free agent affords me this freedom.

 

Anyway, the program for the conference showed all of the discussions scheduled and an overwhelming amount of discussions were regarding FUE. 78 were FUE only. 12 were FUSS and those were more like comparisons of FUSS vs. FUE. The only presenters regarding FUSS were the old guard, those that are most established in the industry for their FUSS work and happen to be getting overlooked now in favor of more recognized, modern FUE clinics.

 

The ISHRS ranks have swollen to where membership borders near 1000. This is nearly twice as many people as ten years ago. What I saw at the conference were some familiar faces but the majority were young, new and most likely not performing strip. Statistics quoted at the conference said that on average two new clinics are opening to perform surgical hair restoration, worldwide, every week. It is my opinion that these are not FUSS clinics and as those that perform FUSS switch over 100% or retire, and with the lower overhead and startup costs of FUE, FUSS WILL eventually disappear. The statistics in 2013 were that approximately 1/3 of all procedures in the ISHRS membership were FUE procedures. With the expected rate of adoption, either in existing clinics or new clinics, I predict we'll have FUE at parity with FUSS worldwide by 2017 or 2018 and then FUSS will begin to be the minority procedure with a rapid observable decline by 2020. By then, FUSS will be rarely spoken of.

 

The above, save for my prediction, are facts based on the ISHRS membership sharing their information with little room for debate.

 

This does not mean that Dr. Feller is wrong on his position. I happen to agree with much of what he says. What I do not agree with is that FUE results are rarely good (if he did say that, I didn't read that part). I've seen many many exceptional results and I'm not referring to online only. My recent trip to Turkey and Europe showed me this in addition to the many patients I speak with on a weekly basis. In fact, I've seen great results for a fair amount of time now. When I went to work for Dr. Rahal last year I was given access to a trove of FUE results that are not published that helped to nail the issue shut for me. But I digress.

 

As was said earlier, a hybrid approach is the best way to maximum graft numbers and FUSS alone is the best procedure for many repairs. FUSS is always the most efficient manner in which to get the maximum # of grafts if one had to choose between the two. Technically more can be removed via FUE as one can have their donor zone plucked clean like a Xmas Turkey but one must think of the cosmetic threshold that FUE can easily, and often does, overstep. I'm a walking billboard for the merits of FUSS over FUE as there is no way in Hell that I could have had the repair I had with FUE alone. Not. Going. To. Happen. Ever. Period. I'm stripped out now and I've got about 1500 scalp FUE remaining. Hybrid = good.

 

The reality of FUE vs. FUSS is simple. FUE has gotten to the point that people do not care about the yield disprecancy. A few percentage points of lower yield is preferrable to a strip scar for many, if not most, patients. No amount of debate, no number of videos, no degree of fervor will change this. FUE is not only here, it is growing, and FUSS is leaving and in my opinion it will be relegated to a statistically tiny number of cases where FUSS has the clear advantage and is still practiced by a few FUE doctors that remember how to do it. It is just like the Betamax/VHS wars in the early 1980's. Betamax was the superior technology but the public had access to the lower priced, but not quite as good technology, found in VHS. The rest is history.

Edited June 17, 2015 by JoeTillman

[hairshopeing]

This does not mean that Dr. Feller is wrong on his position. I happen to agree with much of what he says. What I do not agree with is that FUE results are rarely good (if he did say that, I didn't read that part). I've seen many many exceptional results!

 

Agreed!!

[Cant decide]

FUE is a great option for those that are "Stripped out" and want those extra 1000-2000 grafts to complete things. Starting out with FUE is folly IMO unless you have minimal to lightly moderate loss and likely always will.

[Blake Bloxham]

Joe,

 

A few things:

 

1) I think the comments about Turkish FUE need to be supplemented by a BIG asterisk. While there are a FEW solid clinics putting out good results at a much lower price, Dr Karadeniz himself has said the Turkish hair transplant industry is a bit of a minefield. We ourselves have seen some of the highly questionable practices of the technician FUE clinics in Turkey, and I've seen a number of blatantly wrong results coming from clinics where a plastic surgeon literally rents a clinic, puts his name on the door, and hires non-medical staff to perform unsupervised surgery. I don't feel comfortable with members thinking that they can google a Turkish FUE clinic, find the cheapest one, and walk out with results "almost" as good as other places because this just isn't the case. I feel very comfortable recommending the Turkish doctors we've pre-screened. Other than that, I advise patients to be careful, ask a lot of questions, and know precisely what you're paying for.

 

2) Another issue I have with the cost model is that the cost savings aren't as obvious as they may appear. Let me give an example: I recently reviewed the case of a patient who underwent surgery with a technician FUE clinic in Turkey. He was roughly a NW3.5 - 4, and I would say an experienced surgeon would have probably utilized around 3,000 to 4,000 grafts -- either via FUE or FUSS - to restore this patients hair. He underwent an initial 4,200 grafts at the clinic and then wrote that he was going back for another 2,000 more.

 

The Turkish clinic's pricing, let's say, was roughly, $3.50 a graft. So let's say the US/European clinic would have charged $8 for the same procedure.

 

So 6,200 grafts x $3.50 = $21,700

 

On the other hand, 3,200 (I'll average here) x $8 = $25,600

 

So, we are talking about a fairly small difference when comparing the overall amount that was spent on procedures. However, if you compare $3.50 a graft to $8 a graft, it sounds much more dramatic than $21k compared to $25k.

 

And let's consider a few other things in this above scenario too: I'm not trying to offend here, but the Turkish FUE model in these clinics works as such: charge a very low rate per graft; make up for this by hiring technicians to remove as many grafts as possible in one sitting on as many patients a day as possible to make up the cost.

 

Now, I know you have a lot of experience in the industry, but have you ever removed a graft via FUE? Those things are FRAGILE. Even when removed with care and precision. Now, when you're removing 5,000 grafts in one patient and need to have these out, slits made, and placed in one day ... you can bet they aren't being removed with such care.

 

Now, I know this kind of refers back to the point you made above: who cares if the yield is a little less.

 

I won't get into the same debate because I agree with your assessment that it's not really getting us anywhere and for many patients is moot in the face of a strip scar. However, the yield of this type of procedure will absolutely be less. Furthermore, the clinic's profit model essentially counts on it being less. What does yield matter when you will extract the maximum number of grafts and pack as tightly as possible into the smallest space possible? I just can't sign off on this. Grafts are finite and they need to be utilized properly.

 

What's arguably more important, however, is the quality of the donor region after 6,000 grafts are removed. These patients better hope their results are almost "as good," because that donor region is done. No strip, no FUE. Nada. It's a big sheet of scar tissue and nothing that comes out is growing well.

 

Also, the point about yield still doesn't address the appearance of the fully developed grafts. Now, fair warning here, this is something I believe based upon thousands of cases I've reviewed online and in person. I think hairs extracted via FUE are more wiry and kinky when compared to non-FUE extracted grafts. I think there is permanent alteration of the internal portion of the follicle -- which determines the thickness and shape characteristics of the hair -- and the hairs will not match the donor.

 

Again, for some this may not be an issue. But I always think it's worth mentioning.

 

Also, Joe, I think your personal experience and input is very important to this thread, so I wanted to share some of my own:

 

I think I have a unique perspective as someone who has been highly involved in the online and "real world" hair restoration field. Two years ago, when I was still a medical student, I planned on entering the hair transplant world as an FUE-only surgeon. Like Joe said, the start up costs are much more reasonable, you really don't need to hire much staff, and it's absolutely more profitable. Even with graft prices as low as $ 3-5 bucks a pop.

 

I was able to train and learn under someone I've admired for years now, and really got my "hands dirty." I participated in FUSS procedures and FUE procedures performed with a manual punch and forcep delivered grafts. I've seen FUE results from Dr Feller, and also FUE results from patients who had surgery elsewhere -- with both good and bad doctors. After seeing both procedures in real life, seeing both patients in real life, and experiencing first-hand some of the things I've seen disregarded as myths online, I found myself doubting my initial plan. I soon realized I really wanted to be proficient in both techniques. There really is a role for strip, and it's not just for small little "niche" circumstances.

 

Offering a 50 year old NW 6 who wants to get in, bang out the biggest procedure possible, and get back out on the dating scene with a new mop of hair FUE is silly. You're going to get 25% less "UMPH" on this gentleman, make him come in for multiple procedures over several years, and never once hear him say he wishes he could just "retreat" and buzz his head bald -- like we do a lot on here. When I read messages from these guys online, I'm glad I'm learning strip. And I hope I'm young enough to be considered one of the "young guns" you were talking about before!

 

However, I would never doubt FUE is growing dramatically in popularity. Patients always want a less invasive option. No doubt. Like you said before, it doesn't mean it's better, but many don't care. Now, I do think it's a physician's job to still advocate for the best outcome, but it's all about the right procedure for the right patient.

 

But, I'll match your prediction with another: It's 2015, and I have no doubt the ISHRS numbers will have climbed when they come out in October. But, I'm willing to bet that I can come back to the forums in 2025 and have this EXACT same debate. Why? Because there are still patients who will be better suited for strip. And many will realize this and still want it. If I'm the only dude still offering it, I'd be okay with this because I still think it's the right move for a big chunk of patients.

 

Now, what I think will be interesting is seeing how mFUE plays into this mix. Like I've blabbed on about many times before, I think it overcomes some of the issues with traditional FUE but offers the same level of scarring. Frankly, I think this makes much of this debate -- even on a technical level -- moot. We've got some exciting cases coming in for mFUE procedures in the upcoming months, and I'm eager to perform and present these.

 

As usual Joe, thank you for the contributions!

 

And sorry to all for the long post!

[Swooping]

Amen. That is the whole point anyway. The market is driving to FUE. FUT will become a niche, eventually it will die out. People don't care about a small possible trade off in yield variability for the lack of a linear scar and the nature of FUE being less invasive. That's what most want.I think it already is more popular. The hearsay and forums tell a big story and new census results will be out soon.

 

Debating actually about the specific details in the outcome differences overall in a FUT vs FUE scenario is a never ending story. Nobody knows the exact answers, besides that there are so many variables to take in. However many people do have a view that it's marginal, and I think almost all good FUE practitioners will all concur with this view too. And one more time, the overwhelming majority of people will gladly take that marginal difference for the lack of a linear scar. It's really this simple.

 

Btw, Blake trust me in 2025 we won't have any FUT discussion anymore lol . By that year, even before that I think FUT will go the way of the dodo as was said on the baldtruth show. Time will tell eventually, but it's already giving hints!

[1978matt]

I think some of you have got short memories regarding Mickey85. Over the last 2 years he has singled out doctors as lazy, unskilled at FUE, and unethical. (Feller, Lindsey, Keene, Charles, Carmen, SMG, Diep to name but a few, and in general 'North American FUT' doctors). He made a lot of unsubstantiated claims that they know nothing about FUE compared to European counterparts and do not practice it (since proven to be complete fabrication to suit his own personal agenda). Just check out the thread titled 'donor scar options'. Charming stuff.

 

I hope for his sake he has not shared his name and email address too much as pretty much no doctor would risk operating on him for fear of backlash, even the European ones. They probably all know this information anyway or only need to make a single telephone call to obtain it.

[Blake Bloxham]

Swoop,

 

Only time will tell! However, I remember reading the same thing in 2008, 2009, 2010 ... and yet here we are 5,6,7 years later still having the same debate. I'm not saying FUE won't continue to increase in popularity, but there are a set of patients who will still weigh yield and characteristics over the scar and will chose it. To many, it may seem like a silly choice. But this is why I keep going on and on about why I think surgeons should be skilled in both and why the right procedure should still be offered to the right patient.

 

Unless something drastically changes, our surgical options in 2025 will be FUE and strip. The gentleman like I described above will still exist. And the 55 year old, NW 6 who is looking for a quick fix to help him find a new girl is going to want strip.

 

And, again, I don't care. I have no reason to promote one above the other. I could take out a loan tomorrow, open a tech FUE clinic in a state allowing it. I could get online and say my style of FUE has 95% yield -- with no evidence besides my word, throw up 1-2 good cases a month, charge $5 a graft, and live happily. But I don't think it's the right thing to do.

Edited June 17, 2015 by Blake_Bloxham

[KO]

Blake, do you not think Feller calling Mickey85 a "bully" is a personal attack?

[JoeTillman]

Hi Blake,

 

1) I think the comments about Turkish FUE need to be supplemented by a BIG asterisk. While there are a FEW solid clinics putting out good results at a much lower price, Dr Karadeniz himself has said the Turkish hair transplant industry is a bit of a minefield. We ourselves have seen some of the highly questionable practices of the technician FUE clinics in Turkey, and I've seen a number of blatantly wrong results coming from clinics where a plastic surgeon literally rents a clinic, puts his name on the door, and hires non-medical staff to perform unsupervised surgery. I don't feel comfortable with members thinking that they can google a Turkish FUE clinic, find the cheapest one, and walk out with results "almost" as good as other places because this just isn't the case. I feel very comfortable recommending the Turkish doctors we've pre-screened. Other than that, I advise patients to be careful, ask a lot of questions, and know precisely what you're paying for.

 

First, you took my comment way too seriously. "Some" or a "few" doesn't matter, the point is that Turkey has some gems amonst a mine full of coal. And to put an asterik on my comment, the screen you are viewing this on isn't large enough for the asterik it demands! In my video series that I would just LOVE to be able to finish editing this year (sarcasm) I touch on this subject. And in the next several weeks I hope to have something groundbreaking, never before seen, that no one has ever presented regarding this subject. So, just to touch on this, you're right and I was saying the same thing.

 

2) Another issue I have with the cost model is that the cost savings aren't as obvious as they may appear. Let me give an example: I recently reviewed the case of a patient who underwent surgery with a technician FUE clinic in Turkey. He was roughly a NW3.5 - 4, and I would say an experienced surgeon would have probably utilized around 3,000 to 4,000 grafts -- either via FUE or FUSS - to restore this patients hair. He underwent an initial 4,200 grafts at the clinic and then wrote that he was going back for another 2,000 more.

 

The Turkish clinic's pricing, let's say, was roughly, $3.50 a graft. So let's say the US/European clinic would have charged $8 for the same procedure.

 

So 6,200 grafts x $3.50 = $21,700

 

On the other hand, 3,200 (I'll average here) x $8 = $25,600

 

So, we are talking about a fairly small difference when comparing the overall amount that was spent on procedures. However, if you compare $3.50 a graft to $8 a graft, it sounds much more dramatic than $21k compared to $25k.

 

I'm not sure I get your point. You said an experienced surgeon would have moved up to 4000 grafts, he got over that at 4200 grafts but he went back for 2000 more. Who's to say he would not have wanted more with this experienced surgeon as well? Did the patient go back because of hair greed or because of low yield? Regardless, you can't compare the cost of two procedures to one procedure because you're assuming way too much.

 

And let's consider a few other things in this above scenario too: I'm not trying to offend here, but the Turkish FUE model in these clinics works as such: charge a very low rate per graft; make up for this by hiring technicians to remove as many grafts as possible in one sitting on as many patients a day as possible to make up the cost.

 

You assume too much my friend. The thinking is not that deep or structured. First, let me clarify for the readers. Blake is referring to what is known as "technician" clinics where the clinic has no real doctor associated with the procedure aside from drawing a hairline at most. Aside from that the technicians do ALL of the work from extraction to implantation of grafts into incisions that THEY make, not the doctor because the doctor is no where to be found. Blake is not talking about clinics like Karadeniz, Erdogan or Doganay as these doctors have a strong involvement in the procedure. The vast majority of clinics in Turkey are not like the respected clincs I mentioned but are like mills and there is an unofficial estimate of there being nearly 500 of these "clinics" operating in Turkey with half of them being in Istanbul alone. These types of clinics could not care less about doing a few more grafts to compensate for the costs. They care about making money. Why else would many of these tech clinics have one large room with between fifteen and twenty (that's 15 and 20) patients IN A SINGLE DAY?!!?!?!? Mo money, mo money, mo money. Period.

 

Quality clinics like the names I mentioned have a much lower price than Western clinics for one reason. Economics. The economics of this procedure are much different in Turkey, and other parts of the world, compared to what we are used to in the West. Hair restoration is a normal part of life. When I was in Turkey the first night I was at a restaurant with Dr. K and five of the waiters had bad hair transplants. Were they horrible? No, they were ok for 1997 work but the point is that they were all in the same place and were had with waiter incomes. Where has anyone reading this EVER seen so many hair transplant results in a restaurant much less on the WAITERS? Point being, there is no inflating of graft requirements to compensate for anything. It's a money grab for many clinics, nothing more nothing less and when you have a small army of technicians cranking about over a dozen results, and way more, in one day it then makes more sense. The techs are paid peanuts and the owner of the cllinic is still making €30,000 or more every single day.

 

Now, I know you have a lot of experience in the industry, but have you ever removed a graft via FUE? Those things are FRAGILE. Even when removed with care and precision. Now, when you're removing 5,000 grafts in one patient and need to have these out, slits made, and placed in one day ... you can bet they aren't being removed with such care.

 

Yes, I've removed grafts via FUE as well as BHT. I've also cut grafts under microscopes - no thank you:) They are fragile but not so much if you have experience with extracting them. Knowing which hairs are more fragile than others such as Asian vs. Caucasian, etc. but regarless, I'm not debating the issue of fragility or yield. I know grafts are fragile and I know that 5000 grafts would be impossible without some or even a lot of damage to the grafts but that is also why better clinics really don't push out 5000 in a day and instead limit most procedures to about 2500 to 3000 max. Erdogan does this. Karadeniz does this, Lorenzo does this, most everyone with a name does this.

 

Now, I know this kind of refers back to the point you made above: who cares if the yield is a little less.

 

I do but my point was about the market not caring but yes, agreed.

 

What's arguably more important, however, is the quality of the donor region after 6,000 grafts are removed. These patients better hope their results are almost "as good," because that donor region is done. No strip, no FUE. Nada. It's a big sheet of scar tissue and nothing that comes out is growing well.

 

Agreed. If you take out 6000 with strip and you have a bad result you still have at least 2000 to do something with, maybe 3000 before you get into FUE. If you hit that donor with 6000 FUE first then it's time to tap out, you're done.

 

Also, the point about yield still doesn't address the appearance of the fully developed grafts. Now, fair warning here, this is something I believe based upon thousands of cases I've reviewed online and in person. I think hairs extracted via FUE are more wiry and kinky when compared to non-FUE extracted grafts. I think there is permanent alteration of the internal portion of the follicle -- which determines the thickness and shape characteristics of the hair -- and the hairs will not match the donor.

 

I don't see this, in my tens of thousands of cases. Sometimes, yes, but I also see it with FUSS. The cases where I see either are in cases where the growth overall just wasn't that great but the majority of cases that I've seen where the growth was acceptable the characeristics of the hair seemed fine. There are always exceptions but overall I disagree with this particular observation.

 

But, I'll match your prediction with another: It's 2015, and I have no doubt the ISHRS numbers will have climbed when they come out in October. But, I'm willing to bet that I can come back to the forums in 2025 and have this EXACT same debate. Why? Because there are still patients who will be better suited for strip. And many will realize this and still want it. If I'm the only dude still offering it, I'd be okay with this because I still think it's the right move for a big chunk of patients.

 

Fair enough but here's why I disagree. Again, this isn't based on preference, it is based on what I see as the cold hard reality. In 2025 it will be far more difficult to be in a position to offer strip because the opportunities to perform such procedures will be more rare but in order to perform them you'll stilll need the same amount of staff, not to mention space, equipment etc. As an FUE clinic you might have two technicians, three is you're busy. As a FUSS clinic, to do strip where it is worthwhile, say 4000 grafts, you need six technicians. What are you going to do with these additional technicians not performing FUSS procedures? Will they be part time and come in as needed? Are you going to pay for the additional space needed to house the unused microscopes, the unused additional support materials etc.? It goes back to the economics. It is more cost prohibitive to perform FUSS and this becomes an ever harder fact of life when your FUSS procedures are sprinkled in between FUE procedures every once in a while.

 

Now, what I think will be interesting is seeing how mFUE plays into this mix. Like I've blabbed on about many times before, I think it overcomes some of the issues with traditional FUE but offers the same level of scarring. Frankly, I think this makes much of this debate -- even on a technical level -- moot. We've got some exciting cases coming in for mFUE procedures in the upcoming months, and I'm eager to perform and present these.

 

And with that I too am anxious to see the results. I hope you have clean shaven mFUE results to share with properly taken photos. I have my doubts which I won't mention here (unless you want me to) but I'm trying to keep an open mind about it which is all anyone can ask for.

 

Consider my position in all this. My life has been dominated by the shadow of the surgical hair restoration industry, starting with two bad strip procedures at the age of 22/23. Nine years later, as a full blown NW6 with a pluggy hairline and nothing behind it AND two stacked donor scars, I finally got repaired. Not by FUE as it wasn't well known back then but even if it were FUE would not have done much. FUSS was the only option and I would not change that or my experience with Dr. Wong for anything. I then worked for a clinic that eventually became arguably the most famous hair transplant clinic in the world, for eleven years no less and after a short stint with another, just about equally as famous clinic, I'm independent but more importantly I'm a convert which is ironic since FUE is the only thing I could have now if I wanted more work performed (anyone? anyone?). The point is that I have much less to gain from debating in FAVOR of FUE than just about anyone that actually works in this industry because surgically, FUE has done almost zero for me personally and FUSS has saved my life and even given me a new life and a new career. I am in a position where I need absolutely nothing surgically. But I am also in a position where I drink no Kool-aid and I have no financial advantage to saying anything except the absolute truth based on my experience and in that experience, with zero influence from anything but that experience, this is the all encompassing reality, in my opinion.

 

1. FUE has less yield overall compared to FUSS with varying degrees of severity, all things being equal, patients, doctor skills etc.

 

2. Patients do not care. Patients do not want strip once they have a second to realize that there is FUE and I don't have to tell you that the majority of cases you speak to, that are considering you for surgery, have to have the merits of FUSS explained to them, usually more than once and I absolutely guarantee that when strip is pushed too hard on someone that comes to you for FUE you wind up not hearing from them ever again. I guess that this is a fact for most all clinics that offer FUSS to this day, unless the patient found them in the phonebook or a referral and not online. If this wasn't the case, mFUE would not exist, because you are catering to those that do not want a strip scar thus there can be no debate about why strip will disappear. You and Dr. Feller acknowledge this by your own actions, the creation of your mFUE punch.

 

I hope it works out because I believe in options so I look foward to what you and Dr. Feller have to offer.

[mav23100gunther]

Blake, do you not think Feller calling Mickey85 a "bully" is a personal attack?

 

No, it would only be considered a personal attack if one of us or Busa called him a bully

[Blake Bloxham]

Hey Joe,

 

Yes, I was absolutely referring to the technician FUE clinics you referenced above. Thank you for clarifying that further. I'm very excited to see the new videos! Maybe it will help clean up the situation there a bit. And hopefully, with your comments, my initial comment is clearer.

 

I also have to believe that 500 FUE clinics operating on multiple patients per day are skewing the ISHRS data we were discussing above as well.

 

I'm also glad we are on the same page with limited the number of grafts per day. Also, my comments about fragility were in reference to the entire process. This includes what happens to them while they are waiting to be implanted and during the implantation process itself.

 

And yes, I agree, it takes a LOT more overhead to run a strip practice. And yet US and European clinics continue doing it. These are guys who could easily hop on the FUE-only train and make more $ as well, but they don't. I think this is pretty telling, frankly. Like I said above, I think the right way to do things is to offer both.

 

Hmm, I'm actually curious to hear some of the mFUE doubts. It may help us improve the method. However, I don't want to derail the thread. Could you send them to me in a private message? I'm especially curious because you mentioned how well the wounds healed when Dr Wong extracted and sutured up old plugs.

 

I do understand the ability to speak a little more freely without a formal association, but I thought you were still associated with a doctor offering both strip and FUE? Especially in an area dominated by other FUE clinics and patients who want FUE? Did Dr K only pay you once for the business consulting, or is this an ongoing thing?

 

I would say about 30-40% of patients bring up FUE during the initial consultation. Some of them are good candidates and it's discussed further. Some are borderline and all options are discussed. Others have very unrealistic expectations with FUE -- IE "I'm a NW 7 and want 10,000 FUE grafts at once" (this is a real one) and we recommend what we feel is the best option: strip. Sometimes they are clearly uninterested and leave. This is okay. We've made ethical recommendations and don't want to perform a procedure we don't think will reach expectations or push a procedure on a patient. However, I ALWAYS share some version of the following with patients in this situation: you will find a clinic who will do FUE on you; make sure you are aware of what they can achieve, who will be performing the surgery, and go into it with realistic expectations. If you understand the risks and potential benefits (which I outlined before), move forward. Best of luck!" It's my way of saying be careful, but good luck! I've worked for a patient advocate for way too long in this business to say otherwise.

 

However, I think people would be surprised by the consults I speak with daily. I think the breakdown is pretty close to what the ISHRS showed in 2013; about 2/3rd lead with wanting strip or aren't sure but specifically mention strip; about 1/3 are interested in FUE. I also think the number of FUE repair consults I see on a daily basis would surprise a lot of members here, but this is all subjective so I won't go into it.

 

mFUE exists because a growing number of patients want a less invasive option. I have never doubted that FUE is growing in popularity. This is an inevitability of all medical/surgical procedures. A less invasive option comes out and people always want it. Period. Like you said above, it's not always better but this doesn't usually matter. This is the two worlds mFUE attempts to marry: the best results with the best scarring. And I still stand by my statement that we will be having this discussion in 2025 and there will still be a good chunk of patients undergoing strip. Not because they were tricked into it or because the evil "North American FUT doctors" couldn't stand losing their precious baby, but because it will give them the most "bang for their buck" and they don't care about the scar.

 

And, again, I say this as a 28 year old moving from HT surgery fellowship into the "real world" with limitless options. I still think the ability to do both is the right thing to do and there will still be enough patients who will undergo strip to benefit from the increased costs/effort.

[JoeTillman]

Hi Blake,

 

I also have to believe that 500 FUE clinics operating on multiple patients per day are skewing the ISHRS data we were discussing above as well.

 

The Turkish data is insignificant as there are only 26 ISHRS members based in Turkey and I'm positive that in 2013 it was much less. By how much? I don't know but even at 26 members it is statistically insignificant. The stats were based on the then ISHRS membership only.

 

I do understand the ability to speak a little more freely without a formal association, but I thought you were still associated with a doctor offering both strip and FUE? Especially in an area dominated by other FUE clinics and patients who want FUE? Did Dr K only pay you once for the business consulting, or is this an ongoing thing?

 

I am, and I will continue to be as long as the relationship makes sense for us both. Dr. K is but one of maybe three or five doctors in Turkey that offer strip and FUE and I like that he has options for his patients but my freedom comes from not being limited to working with one doctor so I have no company line to push nor do I have the pressure to push a company line. That was my point. I drink water, the occasional beer, and red wine, not Kool-aid:) I will be announcing a new doctor July 1st in addition to Dr. K. so I'll have two doctors I work with that I happen to believe do not only very good work but also have other qualities that I feel set them apart. Yes, Dr. Karadeniz offers both procedures but the 2nd doctor I will be working with does not as he is strictly an FUE doctor.

 

I won't go into another long post because we're agreeing on everything except one point. Where will strip be and where will FUE be in the future? My position is clear so it's not worth debating any longer and I have a butt ton of video to edit:)

[Blake Bloxham]

Yup. Seems like we are basically on the same page. And I didn't think about how few of these clinics would be ISHRS affiliated. You're right about that.

 

I think I may be a little less clear about the affiliations though. If you do have an ongoing financial relationship with these doctors, I think any reader would assume there is some incentive to align with their business model? I think this would be even more true with the FUE-only doctor. How is this different than aligning with strip while you were working with H&W? I understand that you work for/own an organization that consults with the clinics instead of being an actual employee, but I feel like the end results are similar?

 

Maybe I'm just not understanding, but feel free to reply privately or at a more appropriate time if need be.