FUT is more popular than FUE

[LondonHTseeker]

I am simply acknowledging the reality of the world we live in today by saying the truth is not always relevant in that no matter how good FUSS may look to a patient they will still choose FUE because of the strip scar. Period. End of discussion. Mic drops, exit stage left.

 

I think a lot who go for FUE may not be aware that going for FUT instead would increase their potential donor grafts by 3000 or more. If they knew this they might see the strip scar a bit differently. It could mean the difference between having closed off temples or receding ones.

[Dr. Alan Feller]

Joe, excellent lecture. I couldn't agree more with you. Strip first and then FUE. Blake, kudos to you for your diagrams and explanation.

 

But I want to clarify something that caught my eye and that of Swoop's as well and that's the change in the donor area after massive FUE. It is true that the angles of the follicles will change, but that really isn't the problem because a skilled FUE practitioner can change his angles easily, just like a billiards player.

 

The problem is WHY the angles changed and lost their uniformity. The reason is that the dermis has been undermined and infiltrated by fibrosis. Whereas before the FUE procedure the dermis was hardy and flexible, thereafter it becomes brittle and stiff and extremely vulnerable to the three detrimental forces unique to FUE: Torsion, Compression, and Traction.

 

When performing FUE a skilled practitioner relies on the resistance of the skin itself to control the application of the punch. But after fibrosis, the characteristics of the donor skin change radically and the skin loses much of it's resistance. The result is Follicular Collapse during an extraction attempt.

 

When the punch is applied, the brittle skin gives way and the punch slams down uncontrollably causing a transection. It's like termites eating the floor. It looks fine, but look out when you take that first step.

 

But even before this can happen, the TORSION force of the punch may have already literally broken the target graft in half for the same reason. That being the skins integrity has been undermined by fibrosis. So when the punch was pushed down over the target graft it forms a seal with the wall of the punch and turns with the punch as one. Since the base of the graft is still attached lower down, only the top twists and SNAP, the graft is in half. Sometimes the center of the graft keeps the graft intact while the outside circumference of the graft had transected. Like a big surface crack wrapping itself around the graft. That graft is toast.

 

And the chances of all of this increase directly with the number of FUE attempts made to get those grafts out. That's why I oppose megasession FUE cases or multiple sessions of FUE.

[JoeTillman]

Joe, excellent lecture. I couldn't agree more with you. Strip first and then FUE.

 

Thank you Dr. Feller but there was much more to my post than the point you highlighted above.

 

I'd like to clarify my position. Strip first, then FUE if you are one that is seeking the absolute maximum amount of hair over a lifetime AND you have zero desire to shave or have a very close hair cut, below a #4 guard. I can barely hit a #3 guard myself but if I wanted to go shorter my donor scar would be clear as day but considering I've got ten thousand grafts you can't really ask for anything better and in fact to get this good would be fortunate for most to say the least.

 

But here's the thing. I don't think anyone should have hair transplant surgery. It means that you always have something no matter how small it is, that is in the back of your mind. It can and does include the following:

 

1. Does anyone see my donor scar?

2. Does anyone see my donor scars from FUE?

3. Does anyone see the overharvested area of low density compared to higher density in the virgin areas?

4. Does my hairline look natural?

5. Is my crown covered?

6. Is my vertex covered?

7. Do I need more hair spray?

8. Do I need more surgery?

9. Is my Propecia still working?

10. Is my penis still working because I'm taking Propecia?

 

So on and so on.

 

The subconcious and concious issues that are floating in our heads become common place and routine but they are there and they would not be there without surgery, FUSS or FUE alike. I don't worry about my hair but at the same time it is still a "thing" that I am aware of. Is this because of my mental scars from my first two botched surgeries and from having a pluggy as Hell hairline throughout my twenties? Maybe, but it's there just the same.

 

If someone is looking to have hair transplant surgery I try to routinely ask them if they have ever shaved their head. If they have not then I encourage them to try because if they like the look it will save them ten to forty thousand dollars. If they don't like the look then they can eliminate that option from their list. If one is going to get a hair transplant and they have taken every step possible to stop their loss and they are having a positive reaction to their efforts then they should evaluate what type of surgery that is best for them. Strip first then FUE is not a reality for many patients and I think in the grand scheme of things this path would be in the minority for most. If they know they are going to potentially wind up as an advanced NW and they do not like how they look with a shaved head then yes, strip first then FUE. If they want the option and think they do look ok with a shaved head but would prefer hair, FUE first all the way. This gives more of an option to tap out if they change their mind as long as the tools used are small enough to avoid the pock mark scarring that can result from larger punches and reckless overharvesting. With FUSS, one procedure is all it takes and there is no turning back. At. All. Ever. No amount of FUE into scar, SMP into scar, pixie dust into scar or a combination approach will ever erase a donor scar so if it can be avoided for most then it will be. This is where I believe that the somewhat lower yield of FUE compared to similar quality strip is irrelevant for most patients.

 

I've said my peace for now so I'm going to try and stay out of this from here on out. My position is clear and I still have a lot of videos to edit before I hop on a plane for Turkey on Monday. I never imagined being my own boss would have me so busy!

[mav23100gunther]

Good stuff Joe - makes a lot of sense

[Sethticles]

If they want the option and think they do look ok with a shaved head but would prefer hair, FUE first all the way. This gives more of an option to tap out if they change their mind

 

Joe Tillman I couldn't agree more with all your comments,

with regards to your quote above, would be hard to say how many people now fall into this category but I suspect this is the majority thinking. Dr Feller is 100% correct for the best hair result strip strip strip til you cannot strip no more, for many of us that feeling in the back of your mind I will be branded for life with no turning back out weighs the actual hair itself. FUE is becoming the more popular choice, FUT is still very popular, but I wonder how men are now starting with FUT compared to starting with FUE.

[Blake Bloxham]

Seth,

 

Yup. And this is why I frequently discuss "the right procedure for the right patient." I've done it a dozen times, but I'll give the example again. Take these two patients:

 

1) A 55 year old guy, recently broke up with his partner of a number of years, NW V for the past 15 years, didn't even consider shaving his head, wants to get in, get as much "umph" in the front as possible, and get back out on the dating scene.

 

2) 30 year old gentleman, started the conversation off saying he's worried about donor scarring, has shaved his head in the past, and isn't talking about how he needs the "wow" restoration but is ready to "test the surgical waters."

 

Patient 1 is a strip patient. The strip scar will never be an issue for him and he wants the most "bang for his buck." This patient isn't going to be well served by 3 FUE procedures with less yield spaced out over 3 years.

 

Patient 2, on the other hand, is an FUE patient. A strip scar may really limit this gentleman's options down the road, and it sounds like he wants to give it a shot, see if it works, and then shave and go on with life if it doesn't -- and many times these patients end up shaving down regardless.

 

Now, these examples are obviously pretty exaggerated, but you get the point. Consent the patients properly, offer the right procedure to the right patient -- another reason why I think it's important to be well versed in both, and transplant some hair!

[Sethticles]

Agree Blake... cheers

[MAGNUMpi]

I'd like to clarify my position. Strip first, then FUE if you are one that is seeking the absolute maximum amount of hair over a lifetime AND you have zero desire to shave or have a very close hair cut, below a #4 guard. I can barely hit a #3 guard myself but if I wanted to go shorter my donor scar would be clear as day but considering I've got ten thousand grafts you can't really ask for anything better and in fact to get this good would be fortunate for most to say the least.

 

But here's the thing. I don't think anyone should have hair transplant surgery. It means that you always have something no matter how small it is, that is in the back of your mind. It can and does include the following:

 

1. Does anyone see my donor scar?

2. Does anyone see my donor scars from FUE?

3. Does anyone see the overharvested area of low density compared to higher density in the virgin areas?

4. Does my hairline look natural?

5. Is my crown covered?

6. Is my vertex covered?

7. Do I need more hair spray?

8. Do I need more surgery?

9. Is my Propecia still working?

10. Is my penis still working because I'm taking Propecia?

 

So on and so on.

 

The subconcious and concious issues that are floating in our heads become common place and routine but they are there and they would not be there without surgery, FUSS or FUE alike. I don't worry about my hair but at the same time it is still a "thing" that I am aware of. Is this because of my mental scars from my first two botched surgeries and from having a pluggy as Hell hairline throughout my twenties? Maybe, but it's there just the same.

 

If someone is looking to have hair transplant surgery I try to routinely ask them if they have ever shaved their head. If they have not then I encourage them to try because if they like the look it will save them ten to forty thousand dollars. If they don't like the look then they can eliminate that option from their list. If one is going to get a hair transplant and they have taken every step possible to stop their loss and they are having a positive reaction to their efforts then they should evaluate what type of surgery that is best for them. Strip first then FUE is not a reality for many patients and I think in the grand scheme of things this path would be in the minority for most. If they know they are going to potentially wind up as an advanced NW and they do not like how they look with a shaved head then yes, strip first then FUE. If they want the option and think they do look ok with a shaved head but would prefer hair, FUE first all the way. This gives more of an option to tap out if they change their mind as long as the tools used are small enough to avoid the pock mark scarring that can result from larger punches and reckless overharvesting. With FUSS, one procedure is all it takes and there is no turning back. At. All. Ever. No amount of FUE into scar, SMP into scar, pixie dust into scar or a combination approach will ever erase a donor scar so if it can be avoided for most then it will be. This is where I believe that the somewhat lower yield of FUE compared to similar quality strip is irrelevant for most patients.

 

BRAVO! Awesome post. Everyone should read this post at least once.

[Blake Bloxham]

Look at us, all getting along! ; ) Hahaha

[frankwhite]

Thank you Dr. Feller but there was much more to my post than the point you highlighted above.

 

I'd like to clarify my position. Strip first, then FUE if you are one that is seeking the absolute maximum amount of hair over a lifetime AND you have zero desire to shave or have a very close hair cut, below a #4 guard. I can barely hit a #3 guard myself but if I wanted to go shorter my donor scar would be clear as day but considering I've got ten thousand grafts you can't really ask for anything better and in fact to get this good would be fortunate for most to say the least.

 

But here's the thing. I don't think anyone should have hair transplant surgery. It means that you always have something no matter how small it is, that is in the back of your mind. It can and does include the following:

 

1. Does anyone see my donor scar?

2. Does anyone see my donor scars from FUE?

3. Does anyone see the overharvested area of low density compared to higher density in the virgin areas?

4. Does my hairline look natural?

5. Is my crown covered?

6. Is my vertex covered?

7. Do I need more hair spray?

8. Do I need more surgery?

9. Is my Propecia still working?

10. Is my penis still working because I'm taking Propecia?

 

So on and so on.

 

The subconcious and concious issues that are floating in our heads become common place and routine but they are there and they would not be there without surgery, FUSS or FUE alike. I don't worry about my hair but at the same time it is still a "thing" that I am aware of. Is this because of my mental scars from my first two botched surgeries and from having a pluggy as Hell hairline throughout my twenties? Maybe, but it's there just the same.

 

If someone is looking to have hair transplant surgery I try to routinely ask them if they have ever shaved their head. If they have not then I encourage them to try because if they like the look it will save them ten to forty thousand dollars. If they don't like the look then they can eliminate that option from their list. If one is going to get a hair transplant and they have taken every step possible to stop their loss and they are having a positive reaction to their efforts then they should evaluate what type of surgery that is best for them. Strip first then FUE is not a reality for many patients and I think in the grand scheme of things this path would be in the minority for most. If they know they are going to potentially wind up as an advanced NW and they do not like how they look with a shaved head then yes, strip first then FUE. If they want the option and think they do look ok with a shaved head but would prefer hair, FUE first all the way. This gives more of an option to tap out if they change their mind as long as the tools used are small enough to avoid the pock mark scarring that can result from larger punches and reckless overharvesting. With FUSS, one procedure is all it takes and there is no turning back. At. All. Ever. No amount of FUE into scar, SMP into scar, pixie dust into scar or a combination approach will ever erase a donor scar so if it can be avoided for most then it will be. This is where I believe that the somewhat lower yield of FUE compared to similar quality strip is irrelevant for most patients.

 

I've said my peace for now so I'm going to try and stay out of this from here on out. My position is clear and I still have a lot of videos to edit before I hop on a plane for Turkey on Monday. I never imagined being my own boss would have me so busy!

 

You, sir, have hit the nail on the head .

Excellent post and excellent advice.

This discussion is now over , there is nothing valid that anyone can add to this IMHO.

[FUE2014]

Good post Joe, that seems to be the reality for most patients now. I asked Stephen (the patient rep) from BHR on another site about the difference in demand between the two procedures and he said :

 

"Certainly we are doing more FUE than in the past when I see the surgeries we book FUE far outnumber Strip.

 

We still offer Strip and based upon some of the above it is the best option for some patients and indeed what they want to opt for but certainly the trend is more towards FUE and I have seen it changing that way and it will continue to do so.

 

Whether a patient is best to have that first is another topic but the trend is certainly there."

[Cant decide]

You, sir, have hit the nail on the head .

Excellent post and excellent advice.

This discussion is now over , there is nothing valid that anyone can add to this IMHO.

 

For advanced NW patents, its strip out and then FUE, that simple IMO. Advanced NW patients have to concede something and that's just the way it is (Slightly wider scar, thiner crown, etc).

[home1212]

Joe is exactly right. The only reason I had to have a corrective procedure recently was because I was naive and uninformed and chose to have a small HT procedure in my early to mid twenties. In my opinion, a reputable doctor today would have sent me away, but unfortunately, I went ahead with the procedure and decades later regretted it as I began to loose alot more hair - basically bald up top except for the plugs at my hairline. So for years I wore my hair in all sorts of creative styles to hide the plugs up front, using hairspray, gels, etc. It was a nightmare! Until I finally had enough grief and chose to have a corrective FUE procedure with Dr. Rahal. Of course, I wasnt going for or expecting a full, thick head of hair, in fact my crown is still very thin - but that doesn't bother me. I was just going for "normal" again. To avoid those odd looks people give you when you first meet and their eyes roll up to your hairline - frightening. In fact, as Joe said, if I could take it all back again, I would have shaved my head in my late 20's or early 30's and forgot about hair altogether. But because I basically "scarred" myself, I had to do a followup procedure with modern techniques to give me some sanity. The necessary 2nd procedure essentially made me forget about my hair again and allowed me focus on the things that make me happy. Good advice Joe, thanks again.

[paddyirishman]

Paddy,

 

You obviously have not been personally and professionally attacked by this person. I have.

 

He is exactly the reason why other doctors will not post on these chat forums. Him specifically, among others. This is not my opinion, this is absolute fact. And he knows it. He believes himself to be a consumer advocate and expert. He is none of these things.

 

Who would you rather hear from: uninformed anonymous guys like him, or doctors who have specialized in HT for years? Even better, doctors with different viewpoints. That's how it used to be on this site before the likes of him showed up. Most of the doctors just tuned out. And who losses? Patients do! You do.

 

Truth is, it's the responsibility of physicians who support this site to set the record straight when it becomes so distorted by people like this. But they won't because they don't want to be personally attacked.

 

To my mind, people become more civil when they know they will stand accountable for their actions. That's why I ask guys like him to reveal themselves. And NONE of them do. Who trusts what a shady person writes? I stand in full view of the world with my personal and professional reputation on the line each time I post, so you can bet it is sincere and supportable. I have no agenda other than to put my best foot forward and deliver the best information that I can.

 

Dr. Feller I do not believe you have been personally and professionally attacked by Mickey. Mickey is entitled to respond to you and ask questions just like other forum members.Other forum members had similar viewpoints.But you seemed to single out Mickey and say he is an online stalker and a bully, if this was the case then someone that acts in this way would surely be banned from the forum? So it is obvious that Mickey is not guilty of being an online stalker or bully, if he is guilty of anything it is that he shares a different point of view than your own,( which is not a sin as we all have different points of view) and adding to this he sometimes asks for evidence on the subject, just like all the evidence that you spoke about not being there?, same thing.

 

Yes I am very interested to hear HT Doctors posting and giving their valuable expertise in FUT and FUE on the forum, and also I am very interested to hear from forum members speaking about FUT and FUE and that's how we all learn from each other when questions are asked and subjects are debated and then facts are asked for.Just like now. Thats what makes a forum. You are the expert,you are the Dr. ,you started the thread, because you are the Dr. you have to be identified. You have no other option. If you say their is a lot of hype surrounding FUE of course you are going to get a big response? So its unusual when a Doctor responds asking for names and addresses to those asking questions on the subject, and those looking for facts,or to become accountable.These forum members don't have to be accountable as they are giving their opinions and asking questions and looking for facts,why? because you are the Doctor and the expert. They demand answers from each other , and ask each other for facts, so why not the expert?

Its you the Doctor who should respond in a professional manner to the subject at hand for yourself first, then the forum members who ask those questions and ask about facts.Thats all Mickey was doing.I would consider Mickey quite civil in his posts.If things got a bit hairy ( you got to laugh ) between posts its not because you were professionally attacked, its because of strong opinions clashing.If anyone was attacked it was Mickey, with what you said. If the likes of Mickey and others like him were not on the forum ,the forum would not be worth having, and vice versa, if you or other Doctors were not here with contributions either it would be less interesting.

 

You mentioned that Doctors don't want to come on the forum because they do not want to be personally attacked, There are doctors who do show patients results, and in turn receive excellent compliments on their work.This is a massive benefit to patients, members, and the Doctors themselves as it gives everyone great hope for the present and future in the HT world.

Doctor you mentioned in the end of your post that you wanted to be sincere, and that you wanted to put your best foot forward. Do you think you could allow yourself an error of judgement , like we all do from time to time, and put your hand up and say you over reacted with your comments regarding a forum member being an online stalker and bully.?

 

All the best Doctor Feller.....................................Paddy.

[HairJo]

well just being on here a short time I've learned a lot about people and this forum it's really not what I expected you get attacked and accused of things not enjoyable at all. I feel like I have to watch everything I say or it will be picked to death by a few people that are obviously anti Dr. Feller . I have never said anything bad about any other doctors and I have met a few that I can slam but that,s not my style . I just report things as I see them and I have my favorites like all of you do so why single me out . I see patients brag about their doctors and experiences with them . Are they ALL BEING ACCUSED LIKE ME . I thought this was a place to give advise and share knowledge. I feel that to remain active on this site then I can't voice my opinion I have to cower down and just agree and praise ALL the Fue doctors in the world and say yes everyone should do Fue then I'd be well liked on this forum . My belief and I stick by it I do believe in Fue for small cases try it out if your graft yield is good and everything looks great then go for a larger session or do a little at a time . I believe in both procedures but like I said it depends on the individual. I personally would take my doctors advise into consideration as to if he thinks I'm a good candidate for Fue and I would try a small area just in case I don't like my results I will still have a good amount of donor for a strip if that's what I need . A lot of people do both procedures to achieve a great final result. I don't think I did anything wrong with my posts and I will continue to give my advise . This thread is getting worn out . I think I'll go on other threads were people really want help and advise genuine people who are grateful for some advise and even compassion this thread is just turning into baby games I'm right .no your right how about we're all right we all have our own opinion and If you want to accuse me of something then go right a head if that's how you get your jollies then say what you want. You can accuse me for everything I'm OK with it you still can't change my opinions I have just as much rights as you do. I'm waiting for my lie detection test I'm sure that will come next

[Mick50]

Hi there I was just wondering if what Dr Feller and Blake are saying is true regarding the negative aspects of mega FUE sessions to cover larger balding areas, how come so many recommended Docs on this site seem to be producing great results not just with one session of FUE but another one a year later to add density to the crown or wherever ,surely the Donor area in the original op cannot have been damaged that much if it provides more grafts .

 

Just to clarify i have no particular drum to beat here I had 4200 FUE grafts done at a budget clinic you can view my pics at just over 5 months if you like ,but I would still advise anyone to go with a recommended Doc, I feel what Dr Feller says seems to make sense but I am genuinely confused about the great results I keep seeing from FUE patients not just on this site but other ones as well. Surely if Dr Fellers claims are true it calls into question the integrity of the likes of Lorenzo, Erdogan etc because the implication is even if you have a mega FUE session with a high skilled Doc you are still going to get a sub-par result and damage to the donor and grafts, surely if these facts ARE true a reputable Doc wouldn't use FUE other than for smaller areas.

Edited June 20, 2015 by Mick50

[HairJo]

like I keep saying try a small area for Fue first you may have grafts that can handle the extraction method and may get good quality grafts then I might consider a larger session down the road . If my hair is fragile or my skin isn't right for an Fue I'd rather not waste what good donor I have left . Try a small session with a reputable FUE doc and see how well you grow if it doesn't look good then you still have enough to do a strip.

[Dr. Alan Feller]

Mick50,

In answer to your questions I will say it again:

 

No matter how good any particular FUE procedure grows, it would have grown better with a strip procedure because the potential for injured and transected grafts is far lower.

 

No matter the size of the FUE case, the equivalent size strip procedure will produce less scar tissue in the donor area.

 

No matter the size of the FUE case, the equivalent size strip procedure will produce less donor damage and diminishment of irreplaceable donor grafts for FUTURE procedures.

 

You have not seen FUE damage first hand and had to operate in it. I have. When these patients gave FUE a try and were devastated by their poor results they realized that their best chance was to go for the gold standard of strip. But by then the donor area was decimated with shock loss and scar tissue.

 

There are many great FUE cases out there. There should be since it's been out there for 14 years. I perform them myself. You make generous mention of the wonderful FUE cases you've seen on this site. But not a word on the failures and unhappy patients who also post on this site. They are here and present, just ignored by the FUE cheerleading squad that resides on this and other sites.

 

The number of FUE cases out there is miniscule compared to successful modern FUT cases. No matter what bluster and supposition you read on chat forums from anonymous posters , FUT (strip) is still king of the HT world. Hands down. No contest. After 14 years FUE has had its chance at parity or domination and has soundly lost.

 

Yes, there are more and more doctors practicing FUE- and therefore patients. This is for several reasons:

1. Catering to the public desire...even if it isn't in their best interest.

2. It is much cheaper, easier, and faster to get into the FUE side of the HT industry.

 

Let me put it this way. When a doctor's secretary says that a patient who had FUT one year ago is coming in, he's unconcerned about the level of growth and the likelihood of patient satisfaction. However, when the patient coming in has had an FUE he is very concerned and curious as to how it grew out and wondering if the patient is happy or unhappy.

 

For the FUE-only clinic, they have no choice because they only had one modality to offer. But the Strip/FUE clinic had two: FUE and the better procedure. If the FUE turned out well he is a hero. If it didn't, he has to live with the fact that he did an FUE when he could have done an FUT which would have significantly increased the chances of success for that first surgery and increased the number of grafts available for a second.

 

Now, let's take this FUE patient. If he were unhappy with his first HT as an FUE, do you really think he will make his second HT an FUE again, if it all? Or would he logically switch to the more reliable strip? And don't you think at that point he wished that he started with an FUT?

 

This is the real world balancing act that is not discussed on these boards that I wish all patients would digest and understand instead of getting lost in wishful thinking and precarious betting with their irreplaceable donor areas.

Edited June 20, 2015 by Dr. Alan Feller

[Michael Vories, MD]

I really do not want to get drawn into this whole debate, but I would like to say that personally I look forward to seeing patients at the 6 month and the one year mark. The issue is not so much did they are did they not reliably grow hair, as I am comfortable with the results we get on a daily basis. What I look forward to is showing the patients their before photos, and seeing how the design fit their overall appearance.

[JoeTillman]

No matter how good any particular FUE procedure grows, it would have grown better with a strip procedure because the potential for injured and transected grafts is far lower.

 

This is an unfair statement. You cannot say that a procedure WILL grow better because of the POTENTIAL for another to not grow as well. A more accurate way to say this would be...

 

"No matter how good any particular FUE procedure grows, it would have potentially grown better with a strip procedure because the potential for injured and transected grafts is far lower"

 

There is a big difference between the two statements.

Edited June 20, 2015 by JoeTillman
spelling

[FUE2014]

......

[fortune11]

This is an unfair statement. You cannot say that a procedure WILL grow better because of the POTENTIAL for another to not grow as well. A more accurate way to say this would be...

 

"No matter how good any particular FUE procedure grows, it would have potentially grown better with a strip procedure because the potential for injured and transected grafts is far lower"

 

There is a big difference between the two statements.

 

Joe -- I recall a very good post on your internet blog (this ~ 4 months ago) , that compared FUE to FUT , and the reasons why FUE was growing had more to do with its commercial viability than hair growth-related merits. In that article you went into great detail about easy it was to setup FUE clinics for relative novices, compared to the more surgically involved FUT setups .

 

Maybe my recollection is only partially correct , or maybe I am mistaken, but I went back and tried to pull that article up but could not find it . Has it been removed ? Thanks .

[JoeTillman]

Joe -- I recall a very good post on your internet blog (this ~ 4 months ago) , that compared FUE to FUT , and the reasons why FUE was growing had more to do with its commercial viability than hair growth-related merits. In that article you went into great detail about easy it was to setup FUE clinics for relative novices, compared to the more surgically involved FUT setups .

 

Maybe my recollection is only partially correct , or maybe I am mistaken, but I went back and tried to pull that article up but could not find it . Has it been removed ? Thanks .

 

Hi Fortune,

 

I remember the information, I don't remember where I posted it but I've discussed the issue on various formats over the past several months. The point was that FUE has grown so fast in the past few years because a few companies have made it easier to get started. Neograft, for instance, has a machine that you can buy for 100,000 (or so) and they have a team that comes to your new "clinic" and they train you and perform the first several procedures on your behalf. Anyone with an MD or DO behind his name, and in some US states neither are required, you can have your very own turn key FUE hair trasnplant clinic in a weekend. There is also the lower overall overhead; smaller facilities, less staff, less equipment and then of course the higher cost per graft. It's simple economics and can be likened to the stock market rule of thumb, "buy low/sell high". It is not just Neograft, however. One need only have a punch in hand and they're off to the races, be it hand held manual or hand held micromotor or Neograft. It doesn't matter, the point is that there is much less overhead with FUE, fewer physical requirements (staff, equipment,square footage) so it is cheaper and faster to get started.

 

FUE is everwhere and it will continue to be so whereas FUSS requires a LOT more prep work to get going. Quality is not expected in these overnight lemonade stands and I do not factor such places into my discussions unless otherwise specifically referenced. I think that when we are all discussing the merits of any procedure we are hopefully assuming the respective procedures in relation to them being performed by higher quality establishments.

 

I'll remind everyone, I agree with Dr. Feller in general. FUE grafts will have a lower overall yield but this is in the grand scheme and is a general reference, not as an absolute on a case to case comparison. Furthermore, I do not believe that FUE cases have the appearance of 40% less yield compared to similar FUSS cases as was stated by Dr. Lindsey. Best strip compared to worst FUE? Absolutely yes, but again, we are assuming higher level quality and ethics, or at least I am anyway so this 40% figure just seems unusual to me.

 

Dr. Feller, et al, have their reasons for making the statements they make and agree or disagree you have to at least respect that much. My position, as already stated, is that I support the general notion that FUSS will have a higher yield but I do not believe this automatically means it is a VISIBLE difference or even one that if IS visible is not easily quantified in percentages. Have I seen disasters wtih FUE? Of course, as have most everyone else here, but let us not forget that the majority of the repair cases we see on these boards are not FUE disasters. They are FUSS disasters and the overwhelming theme has been " I wish I had had FUE". Lower yield be damned, be it 5% lower or 15% lower, patients.don't. care.

 

What's funny about all of this is that I've seen some doctors that were FUSS exclusive at one time and they didn't exactly inspire confidence with their work. Several years later their FUE work is unquestionably much better than any FUSS work they ever performed. Does this mean they just have a natural talent for FUE compared to FUSS? Or does this mean that FUE has better yield? It could be argued either way and it may be a combination of both, on a clinic by clinic basis. The point is, no two procedures will be performed to the same level by the same physician, so how can two procedures be performed to the same level as every other physician? If they were, we wouldn't need the Coalition, the IAHRS, and other organizations that at least help to sort the good from the bad. You could just throw a dart at a phone book and go to anyone that is listed and expect the same result as that from the next guy.

[Mick50]

Fair enough Dr Feller point taken, as I alluded to in my previous post, FUT regarding graft survival and damage to donor area seems to win hands down, I was just genuinely intrigued as to some of the great mega FUE cases I have seen, but sure, there have been a lot of disasters as well, also I have noticed a lot of patients post their FUE results up to say 6 months then stop whether that's because they are not happy with how it developed or because they are just getting on with their life is moot, I certainly will keep posting my results until at least the year mark

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Edited June 20, 2015 by Mick50

[Dr. Alan Feller]

Fair enough Dr Feller point taken, as I alluded to in my previous post, FUT regarding graft survival and damage to donor area seems to win hands down, I was just genuinely intrigued as to some of the great mega FUE cases I have seen, but sure, there have been a lot of disasters as well, also I have noticed a lot of patients post their FUE results up to say 6 months then stop whether that's because they are not happy with how it developed or because they are just getting on with their life is moot, I certainly will keep posting my results until at least the year mark

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You got it Mick. Couldn't have said (written) it better myself. The very best growth to you. I hope you love your transplant and enjoy your new hair. I know EXACTLY how that feels. Feels like a million bucks.

 

Joe,

Nope. Strip grows better than FUE. Period. No parsing of words.

 

Forune, I don't know the article, but what you wrote is dead on right. Thanks for joining the conversation.