FUT is more popular than FUE

[mav23100gunther]

What comments are you referring to? Which page?

 

Dr Feller, I think it's the part in bold that rubbed folks the wrong way.

 

"If you want FUE because you desire a particular hair style then do so. But do so with the knowledge that you are using a procedure that does not work as well and produces far more scaring than FUT. Furthermore acknowledge that you will have fewer donor grafts in the future as a direct result of the FUE. Acknowledge all this and go and have your FUE. It's your head, not mine.

"

 

Bill, appreciate your comments, but reading through the thread, I have to admit Dr Feller was just being a straight shooter. I personally appreciate his honesty and say it like it is mentality. Got to appreciate his passion for the topic. At the same time, if others are complaining and finding his comments disrespectful, then can't argue with that perception.

 

Hopefully we can move past this tit for tat nonsense, and I really hope Dr Bhatti engages Dr Feller in a healthy debate on the topic.

[Melvin- Admin]

HT,

 

I disagree that decreased elasticity in FUT is akin to subdermal scarring in FUE. If you lose elasticity during multiple FUT procedures, you could theoretically risk scar stretching. Elasticity is actually a multifactorial issue and more complicated that you're discussing here, but I digress. Regardless of what happens with the scar, the tissue around it is unchanged. That means all this tissue is still available for extraction. This includes taking it via FUE or mFUE. With subdermal scarring, however, you actually decrease the yield you can take during subsequent procedures. As you can see, two very different issues.

 

And all the "FOX" test does is check for angulation. Even if you "pass," you still put torsion strain, compression strain, avulsion strain, and risk dehydration and non-growth post-implantation secondary to skeletonization. Like I said before, transection is the least of FUE's problems.

 

I'd rather risk low growth or no growth than having a widened strip scar, when the scalp is no longer elastic the wound will be very difficult to close, this will dramatically increase the chance of shock loss to te donor region, sometimes the hair grows back and sometimes it doesn't, so like I said previously you're exchanging one problem (being bald) for any even bigger problem becoming disfigured. Here is what could occur

It's like getting on propecia to stop hairloss but then becoming impotent for the rest of your life, you basically solved one problem but created another far worse problem. That's my opinion others may disagree and I respect that.

[KO]

 

Hi KO,

 

With all due respect, calling Seth a "SHILL" would be unfair, unethical and wrong. He has documented his HT journey with Dr. Bhatti on this Forum and I don't think there is any room (whether you like Seth or not) to deny the fact that he is a genuine Dr. Bhatti Patient. Now, let me share with you the definition of the term "SHILL": an accomplice of a confidence trickster or swindler who poses as a genuine customer to entice or encourage others.

 

I know that you are a fair person and hope that you would agree with me that Seth and/or any other Dr. Bhatti Patients who express their satisfaction with the service and results that they got from Dr. Bhatti/Darling Buds India, are NOT "shills". "Super happy Patients" ......maybe......but definitely NOT shills!

 

 

I am curious to know, why are you defending Sethticles? You represent a clinic, and your job is to help the patients cosmetic problems, not fighting his battles on an online forum, which should be of no relevance to the clinic as it does not concern Dr. Bhatti. Unless of course you benefit from his promotional behavior...

 

I stand by what I said. When a poster asks about Erdogan, Sethticles tells him to go to Bhatti, when one asks about Hasson, Sethticles tells him to go to Bhatti. So yes, he is a shill and a troll.

 

Your clinic has a number of representatives in employment, I do wonder why you need volunteers as well?

[Bill - Seemiller]

Dr. Feller,

 

I wrote to you earlier today on this topic and then again tonight. I do not know which page my comments are on but I also sent you a private email that contains most of the same comments. Yet I have yet to see a response from either privately or publicly. You read and respond to everyone else on this topic so I would also appreciate it if you find, read and respond to mine.

 

California,

 

While Sethiclea may not be an online rep for Dr. Bhatti, if he is recommending Dr. Bhatti on every topic like KO said even when other highly reputable surgeons are being discussed, he is acting out of line and by default, his posts looks bad for Dr, Bhatti. While this isn't Dr. Bhatti's direct responsibility, you may want to have a talk with him and as Dr. Bhatti's patient and encourage him to tone it down. At best, he is clearly overzealous.

 

Best wishes,

 

Bill

[fortune11]

I have been following this thread and it is fascinating . I mean how many threads on any forum in the world on any topic have a veteran medical practitioner engage in passioned and open discussion like this ? While it is always good to maintain a courteous environment , If some feathers get ruffled , so be it .

 

And I have to agree w KO's recent post. In general it is better to see doctors (and their official reps) defend their logic and techniques and not some perceived slight to one of their patients. We are all adults here and should be able to take care of ourselves.

 

I personally would love to hear the other side of the argument from another medical practitioner , maybe Dr Bhatti can help us with that.

[Sethticles]

for those who think im a troll or shill or overzealous or a rep thanks your opinion, its water off a ducks back, i have called much worse things in my life, remember this is social media, people have an opinion, people share personal experiences, so to put this matter straight here is a list of members who have personally contacted me over the past couple years thanking me for my personal experiences and views,

 

Mickey85

Raj_Jayukdht

jobegood1

athlete22

Mash

augustya

manish1990

mikeey

sam6398

hairhair9000

arsenal009

empirestate

vicky2387

CalvinJR

 

not to mention the online friendships i have made through these messages.

 

further more i have an excellent Dr patient relationship with Dr Bhatti, i see him more as a good friend than my HT surgeon, so much so he came on here defending me, for me that shows respect and caring that he has for his patients,

[FUE2014]

I have been following this thread and it is fascinating . I mean how many threads on any forum in the world on any topic have a veteran medical practitioner engage in passioned and open discussion like this ?

 

How many threads does one doctor get to monopolise to such an extent while promoting their practice? Let's be frank, Dr Feller has got A LOT of exposure so far from these FUE bashing threads, and why would other docs want to come on here and risk getting into a slanging match with him?

[Dr Tejinder Bhatti]

Pure fue docs have had the opportunity to come on here from the start,let's hope we finally get a good debate underway.

I have had both and both are great procedures in great hands. But there are far too many docs out there not sharing all the flaws with both types .

 

Dear Dr Feller,

 

I appreciate your starting this thread, and as Bill suggested and many members wish, there should be a healthy discussion about the drawbacks and benefits of FUT methods- Strip and FUE.

We are both working in the best interests of potential clients seeking a surgical hair restoration by providing them evidence based informed consent about the procedure without inordinate personal bias.

As a background I would like to mention that I practised FUT rather successfully till 2010 following which, encouraged with my 3 year courtship with the FUE procedure, I took the decision to practise 100% FUE - it seemed to work very well in my hands and felt to me the right way to do FUT; and above all my patients goaded me with their utmost happiness with the results. A trained cosmetic surgeon, today I perform only FUE hair transplant and do not offer any other treatment in my clinic be it SMP, Lasers, etc. Like you, surgical hair restoration is my forte, and therefore I respect some of your impassioned threads.

There is nothing personal here and what might have been said by you or by me or by anyone else at the spur of the moment should not come in the way of future healthy arguments about the 2 methods in the armamentarium today. Since English is not my first language (it is my third language after Hindi and Punjabi) I would request you to bear with me if some statements seemed overly offensive. They were not meant to be.

Best wishes.

[Yiddo]

How many threads does one doctor get to monopolise to such an extent while promoting their practice? Let's be frank, Dr Feller has got A LOT of exposure so far from these FUE bashing threads, and why would other docs want to come on here and risk getting into a slanging match with him?

 

I have to agree..im just a normal poster considering a ht, and I'm totaly confused about everything. There's a doctor writing how wrong it is to have large fue procedures, and yet all I'm seeing on every forum is large fue procedures.

 

From just observing through this thread, I haven't been impressed with Dr Feller's way of getting his point across, I personally wouldn't even consider going to him, even if he was the greatest surgeon on the planet.

 

Without meaning any offence to either dr feller or dr bloxham, all I can take from this is two doctors pushing something, and in my opinion, in quite an arrogant manor.

 

Sorry just my opinion and I'm just a nobody.

[Dr Blake Bloxham]

HTsoon,

 

Again, I must disagree. Tension on the wound or elasticity has nothing to do with donor shock loss. This has much more to do with either damage or overwhelming the blood supply. And, again, both are more common in FUE. But permanent donor shock loss is very uncommon in hair transplant surgery in general. So this shouldn't be a big concern for either FUT or FUE.

 

But I get what you're saying overall, and I don't inherently disagree with it. All I'm saying is that patients need to be presented with all the facts before they make a decision. This is the definition of informed consent. And it's every physician's responsibility to provide informed consent to patients. Once they are fully aware, they are free to pursue a procedure. I don't see anything controversial in this. But remember, all the facts must be presented to really make it informed consent. And we can't get upset with the objective facts.

 

This is fair, right?

[Mick50]

Hi Yiddo, nobody is a 'nobody' regarding this matter we as patients if you like are the life-blood of this discussion, just because 'I' for example have no medical training and am not particularly academically inclined I like to think I have a solid native intelligence and can smell a rat as well as the next guy

[Dr Blake Bloxham]

Yiddo,

 

It looks like you're researching and considering a large FUE procedure in Turkey. So I understand that a lot of what we're saying conflicts with your research. This is obviously a bit jarring, but it's actually a good thing. Integrate the information we're providing into your research. Ask the Turkish FUE clinics about it. See what they say. After you get the entirety of the information on hair transplant surgery, review it and make an informed decision.

 

That's all anyone is trying to do here. No personal slights or subjectivity intended. Just sharing information that really hasn't been out there before. Read it, digest it, and then use it to help guide your decision. Even if you don't agree, at least you're now aware and are more capable of making the best decision for you.

 

I really do wish you the best of luck. If you do have any questions as to why this information conflicts with what you've read on other forums, feel free to send me a private message or email at any time. I'm happy to discuss anything we've shared here, objective information about FUE, etc.

 

Hope this helps!

[Yiddo]

Hi Dr Bloxham

 

Thanks for the response..yeah your pretty spot on, it does suddenly make me question what I've been researching, as I said it's all a bit confusing.

[Dr Blake Bloxham]

Yiddo,

 

It absolutely can be confusing. But you're doing the right thing: using this site as a resource. Take your time. Review all the information you can -- pros of FUE, cons of FUE, pros of FUT, cons of FUT, preventive treatments, potential future treatments -- and then use the entirety to make an informed decision.

 

And if you do have any specific questions, you really can email or message me. I'll give you the facts. Even the good stuff about FUE! Haha. The same goes for the moderators or any of the senior members. They've all been through it and they're here to help.

 

Despite some of the discussion from time to time, we're all on the same team!

[Yiddo]

Thanks Dr Bloxham

 

I will take you up on that offer.

 

Thanks for replying to me.

[Yiddo]

Thanks Dr Bloxham

 

I will take you up on that offer.

 

Thanks for replying to me.

[Melvin- Admin]

HTsoon,

 

Again, I must disagree. Tension on the wound or elasticity has nothing to do with donor shock loss. This has much more to do with either damage or overwhelming the blood supply. And, again, both are more common in FUE. But permanent donor shock loss is very uncommon in hair transplant surgery in general. So this shouldn't be a big concern for either FUT or FUE.

 

But I get what you're saying overall, and I don't inherently disagree with it. All I'm saying is that patients need to be presented with all the facts before they make a decision. This is the definition of informed consent. And it's every physician's responsibility to provide informed consent to patients. Once they are fully aware, they are free to pursue a procedure. I don't see anything controversial in this. But remember, all the facts must be presented to really make it informed consent. And we can't get upset with the objective facts.

 

This is fair, right?

 

Absolutely, I agree Dr. Bloxham that is fair, it's been a very interesting discussion, and although we may not agree on hair restoration philosophy, i'm glad we can see where we're coming from;)

[mav23100gunther]

Dear Dr Feller,

 

I appreciate your starting this thread, and as Bill suggested and many members wish, there should be a healthy discussion about the drawbacks and benefits of FUT methods- Strip and FUE.

We are both working in the best interests of potential clients seeking a surgical hair restoration by providing them evidence based informed consent about the procedure without inordinate personal bias.

As a background I would like to mention that I practised FUT rather successfully till 2010 following which, encouraged with my 3 year courtship with the FUE procedure, I took the decision to practise 100% FUE - it seemed to work very well in my hands and felt to me the right way to do FUT; and above all my patients goaded me with their utmost happiness with the results. A trained cosmetic surgeon, today I perform only FUE hair transplant and do not offer any other treatment in my clinic be it SMP, Lasers, etc. Like you, surgical hair restoration is my forte, and therefore I respect some of your impassioned threads.

There is nothing personal here and what might have been said by you or by me or by anyone else at the spur of the moment should not come in the way of future healthy arguments about the 2 methods in the armamentarium today. Since English is not my first language (it is my third language after Hindi and Punjabi) I would request you to bear with me if some statements seemed overly offensive. They were not meant to be.

Best wishes.

 

Dear Dr Bhatti,

 

With all due respect sir, I must admit I am dissapointed by your post above. Although sincer, you still have not disputed any of the statements made by Dr Feller on his view of FUT being a better procedure than FUE. You mentioned previously that you disagree with some of his statements, please can you ellaborate on why you feel that way, i.e. 1) can the three forces of FUE mentioned by Dr Feller be overcome 2) Does FUT really provide a greater number of lifetime donor grafts compared with FUE 3) Is the transection rate on FUE higher than that of FUT 4) Does FUE damage the donor region more than FUT 5) Is cherry picking for FUE really a myth as you still can't really identify singles from doubles?

 

Honestly, the fact that neither yourself nor any other FUE surgeon is coming out and disputing the facts laid out by Dr Feller is just adding credibility to what he has stated, and for someone like myself, I really have no option but to trust what he states. So far, the only pro to selecting FUE over FUT is the lack of that linier scar, is that really the only one?

 

Please please please can you make good on your promise and engage in an intellectual debate. Looking forward to hearing your views.

Edited August 6, 2015 by mav23100gunther

[Dr Tejinder Bhatti]

With winds of change sweeping the field of hair-restoration surgery, it had been postulated in 2011 that FUE shall be done in a majority of cases requiring surgical hair restoration in the immediate near future even in the USA. (ISHRS paper, ISHRS Meeting at Anchorage, 2011). With most centers in the world and esp. in countries outside of the USA offering only FUE as preferred modality of surgical hair restoration, we have reached a long way much sooner than was predicted.

 

FUE is a procedure which requires utmost concentration, skill, devotion mostly on the part of the physician, and, often overlooked, on the type of harvesting instrumentation that the physician chooses to use. However, though the technique is being hyped as a panacea for scarring in hair restoration, the mindless way FUE is being adopted and practiced has raised serious, legitimate concerns in the international hair-restoration community. It is alarming that, at my center in India, I continue to receive an ever growing number of cases of poor hair transplants done by primary surgeons without adequate concept and training in hair transplant. So is the case the world over. This has alarmed the patient community and physicians alike.

 

However, to blame the procedure across the board is unfair.

James Harris, Alen Feller, Lorenzo, Patrick Mwamba, and Lars Heitmann have done considerable work using this technique and have perfected individual methods of harvesting to perfection. FUE under high magnification, the use of motorised machine utilising the dull punch of Jim Harris, Feller’s ingenuous powered extraction tool, the unique and path-breaking ‘expanding needle concept’, Patrick & Lars’ laboriously pain-staking but perfect manual extraction method, Lorenzo’s refinements in FUE graft placement and my clinic’s ‘Rapid FUE harvest’ and ‘Golden Harvest’ techniques are increasingly making FUE technique more popular amongst surgeons and patients alike. The efforts of these FUE surgeons have so enriched the present day FUE technique that the method is on the threshold of being accepted as the foremost method of hair transplant today.

 

We have centers around the world today which are replicating successful cases one after the other- it is not by mere fluke that a center will produce consistently satisfactory and pleasing FUE results.

 

This is possible only when centers have successfully overcome the 3 forces that Dr Feller talks about. Are all centers producing consistently good results?- NO! But so is the case with FUT! There are far more FUT complications floating around than FUE even today.

 

The rash of bad cases at this phase of FUE's evolution is natural. When a technique grows in popularity, there will be complications, and they will be even more when the learning curve is rather steep- FUE takes time to learn. I learnt FUT in 2 months. It took me 2 years to master FUE. That is the one single factor which dissuades FUT surgeons going the whole hog in adapting this technique in their practice when they have very comfortable FUT practises up and running.

 

Did FUT not have complications in its inception stage? Of course it had.

Edited August 6, 2015 by David - Moderator

[Bill - Seemiller]

Dr. Bhatti,

 

Thanks for chiming in with your initial thoughts. I hope this will be the beginning of an intellectual discussion and debate that is both educational and respectful. In your opinion, how have you either overcome or been able to work around the extraneous forces that Dr. Feller stated are placed on the follicle during the harvesting process. What improvements to the FUE technique do you feel have been made over the last 5 to 10 years or since its inception? What do you feel is the success rate versus the failure rate of FUE in your hands at your clinic? I think answering these questions will provide a good starting point for debate and discussion.

 

I look forward to your response.

 

Bill

[hairthere]

"Did FUT not have complications in its inception stage? Of course it had."

 

The difference is that there were no alternatives available at the inception stage. You pretty much had to be a guinea pig.

[Wwiizzkkiidd24]

All i want to know and im sure most future patients wnat to know is the yeild you could achieve. I said a while back i cant remember if it was this thread or another thread that the docs ive contacted took pride in saying they achieve 90% yield some say even more but i cant remember wich one it was dr feller on dr bloxham said no thats not possible its more like 80%.

 

I myslef would like clarification on this being a future patient and looking to go down the fue route. If it is true it might make me change my mind on fue because i wouldnt want to be chucking 20-25% of my grafts away and i dont think im the only one that doesnt.

 

So if dr bahtti could answer that ot if any other fue specailist wnats to get involved to clear that up would be appreciated.

 

Thanks.

[Melvin- Admin]

 

FUE is a procedure which requires utmost rash of bad cases at this phase of FUE's evolution is natural. When a technique grows in popularity, there will be complications, and they will be even more when the learning curve is rather steep- FUE takes time to learn. I learnt FUT in 2 months. It took me 2 years to master FUE. That is the one single factor which dissuades FUT surgeons going the whole hog in adapting this technique in their practice when they have very comfortable FUT practises up and running.

 

Did FUT not have complications in its inception stage? Of course it had.

 

True FUE has a high learning curve, physicians say they would make twice as much doing FUE, but if their results are not good than they'll lose business that's why a lot of physicians stick with FUT, similar to plastic surgeons performing open rhinoplasty as opposed to closed rhinoplasty, I see it like the switch from microgafts to follicular units, a natural progression, although I do think there will always be a place for FUT, with advances in instrumentation the transection rates will decrease.

 

Dr. Bhatti, what are your thoughts on subdermal scarring is it really impacting the yield as much as some say? They say growth may be almost 0% what are your thoughts?

[irishsailor]

I respect Dr bhatti giving his experience , I'm still none the wiser. Yes the tide is changing and more people want fue, but does that mean a doc should give someone a procedure based on what they want rather than what's best for the patient?

Both surgeries have there pro's and con's but we still haven't had a pure fue surgeon explain the flaws in fue, we have heard bits but not all .

 

I wish people would stop referring to FUT as strip though. It's all FUT!!

 

The types of surgery we have are based on how we extract the donar, which is FUE and STRIP.

[Melvin- Admin]

All i want to know and im sure most future patients wnat to know is the yeild you could achieve. I said a while back i cant remember if it was this thread or another thread that the docs ive contacted took pride in saying they achieve 90% yield some say even more but i cant remember wich one it was dr feller on dr bloxham said no thats not possible its more like 80%.

 

I myslef would like clarification on this being a future patient and looking to go down the fue route. If it is true it might make me change my mind on fue because i wouldnt want to be chucking 20-25% of my grafts away and i dont think im the only one that doesnt.

 

So if dr bahtti could answer that ot if any other fue specailist wnats to get involved to clear that up would be appreciated.

 

Thanks.

 

According to the chart on pubmed transection rate for FUT is between 1-2% for FUE between 5-10%, so one could say an inexperienced FUE physician could be having 10% transection where a quality physician could be yielding 5% transaction, a difference of 3-4%. Personally, I think it depends on the skill of the physician you choose, like Dr. Bhattti said if the results were that poor he wouldn't be consistently getting good yield and growth.