FUT is more popular than FUE

[mav23100gunther]

A case that will fail happens only if the case has not been selected properly. Otherwise over 95% patients are happy with their FUE result at my clinic. Towards achieving this level of satisfaction we do rigorous counseling and almost 50% patients seeking the procedure are not found fit for the hair transplant and counseled accordingly.

 

The following are the Red Flags-

 

1. Extensive balding coupled with a less than satisfactory donor region- scalp, body.

2. Body dysmorphia

3. Young age group

4. Irrational objectives

5. Uncontrolled diabetes

6. Afro-textured hair with severe hooking of the root.

 

1-5 are the same as any FUT surgeon would keep in mind too.

 

My questions not yet answered:

 

 

1) can the three forces of FUE mentioned by Dr Feller, have you actually succeeded in doing so? 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?

[California]

Honestly, although I appriciate this input, I feel Dr Bhatti has danced around the claims made by Dr Feller, and hasn't really refuted much of anything, specifically disproving the theory that besides the linier scar, FUT is a better procedure than FUE. Still awaiting Dr Bhatti's view on lifetime donar supply, yield, and cherry picking of grafts of FUE as compared to FUT. He also hasn't explicitly stated that he has successfully overcome the three forces. No disrespect to the doctor, but in my opinion he is dancing around the topic rather than addressing it head-on. Sort of like our dear politicians do.

 

Hi Mav23100gunther,

 

I can bet that every single one of Dr. Bhatti's Patients will vouch that he is the most straight forward, honest and humble Surgeon that they have met in their lives. He never shies away from calling a spade a spade. He never sugar coats stuff, telling the Patients what he believes (which might be contradictory to what they might want to hear).

 

Now, going back to the topic at hand, this is an ongoing discussion and not a "one question, one answer" situation. Dr. Bhatti is the only "FUE only" Surgeon on this Forum that has taken this on. So, let's be fair and give credit where ever it is deserved. He has taken the time to share his views and expertise on this very important, sensitive and controversial topic. He has answered the questions that were asked of him.

 

I am sure that he will get to the other answers/details too......

It is just a matter of bandwidth for him. Please note that he performs all his HT procedures himself (2 procedures per day, one big one and one smaller one) and works 6 days a week. As he has mentioned in one of his previous posts, sometimes it is challenging for him to keep up with his email.........there again, he makes it a point to respond to each and every Patient email personally.

 

So, if our Politicians were like Dr. Bhatti, our country would be the Utopia States of America!

 

Best regards,

California

[FUE2014]

That's a fair point California. Not to be unkind Mav23100gunther but given your post count in three months you probably have a bit more capacity to frequent this forum than Dr Bhatti and demanding answers to your questions in the manner above is hardly going to encourage free flowing discussion between doctors.

[mav23100gunther]

That's a fair point California. Not to be unkind Mav23100gunther but given your post count in three months you probably have a bit more capacity to frequent this forum than Dr Bhatti and demanding answers to your questions in the manner above is hardly going to encourage free flowing discussion between doctors.

 

Cali / FUE2014 - all fair points, not trying to be disrespectful to Dr Bhatti at all, and apologies if I came off like that, the politician statement was probably inappropriate. Just trying to say what I feel because I really do want to hear both sides with an objective view so that as an average patient with little real knowledge of this stuff, I myself can make an informed decision.

 

So far all I have really heard to date, is that FUE is performed with extraordinary success in the hands of Dr Bhatti (I never disputed this myself, and know it to be true, just take a look at David's progress to date) and that he made the decision to switch his practice to FUE exclusively. I think he is implicitly stating that the three forces are overcome or mitigated in his own hands due to patient selection/screening, but I am still not hearing whether FUE is a better procedure over FUT when a patient has great donar laxity and qualifies for both (push the linier scar to the side for a moment, because we all know that's a big con to FUT). I'm really hoping to hear more from Dr Bhatti on this. No disrespect at all, promise!

[voxman]

but I am still not hearing whether FUE is a better procedure over FUT when a patient has great donar laxity and qualifies for both (push the linier scar to the side for a moment, because we all know that's a big con to FUT). I'm really hoping to hear more from Dr Bhatti on this. No disrespect at all, promise!

 

You will hear Dr. Bhatti give his opinion based on his experience - I would not expect a declarative statement of the state on the entire industry from either physician. Which is better is always subjective.

 

I would invite you to PM Dr. Bhatti if you are looking for a physicians statement regarding your situation!

[adonix]

Cali / FUE2014 - all fair points, not trying to be disrespectful to Dr Bhatti at all, and apologies if I came off like that, the politician statement was probably inappropriate. Just trying to say what I feel because I really do want to hear both sides with an objective view so that as an average patient with little real knowledge of this stuff, I myself can make an informed decision.

 

So far all I have really heard to date, is that FUE is performed with extraordinary success in the hands of Dr Bhatti (I never disputed this myself, and know it to be true, just take a look at David's progress to date) and that he made the decision to switch his practice to FUE exclusively. I think he is implicitly stating that the three forces are overcome or mitigated in his own hands due to patient selection/screening, but I am still not hearing whether FUE is a better procedure over FUT when a patient has great donar laxity and qualifies for both (push the linier scar to the side for a moment, because we all know that's a big con to FUT). I'm really hoping to hear more from Dr Bhatti on this. No disrespect at all, promise!

 

What is the definition of "better" to you?

 

Yield? I saw more excellent results from dr. Bhatti's FUE than dr. Fellers FUT.

Natural look? Did not see unnatural results from leading FUE surgeons.

Post op care and recovery? Lets not even go there.

Scarring? See above.

 

What is problematic with your posts is that you talk about dr. Feller's FUT as if he did a 5 year study, comparing his patient's pre and post op hair count, quality of hair, etc.

He did not, in fact he has no records to support his claims of "gold standard", "higher yield", etc.

 

Dr. Feller rarely posts pre-op and post op high-definition photos, and he had his share of low yield results and stretched scars.

[mav23100gunther]

What is problematic with your posts is that you talk about dr. Feller's FUT as if he did a 5 year study, comparing his patient's pre and post op hair count, quality of hair, etc.

He did not, in fact he has no records to support his claims of "gold standard", "higher yield", etc.

 

Dr. Feller rarely posts pre-op and post op high-definition photos, and he had his share of low yield results and stretched scars.

 

Hi Adonix,

 

I am not talking about Dr Feller's FUT at all, I am talking about FUT in general, hence why I picked another FUT surgeon for own procedure. My own top 5 list of FUT surgeons are Hasson, Rahal, Shapiro, Konior, & Feriduni. But that's a separate discussion altogether. Dr Feller has made some claims about FUT vs FUE in general, not Dr Feller's FUT vs Dr Bhatti's FUE.

[mav23100gunther]

What is the definition of "better" to you?

 

Yield? I saw more excellent results from dr. Bhatti's FUE than dr. Fellers FUT.

Natural look? Did not see unnatural results from leading FUE surgeons.

Post op care and recovery? Lets not even go there.

Scarring? See above.

 

What is problematic with your posts is that you talk about dr. Feller's FUT as if he did a 5 year study, comparing his patient's pre and post op hair count, quality of hair, etc.

He did not, in fact he has no records to support his claims of "gold standard", "higher yield", etc.

 

Dr. Feller rarely posts pre-op and post op high-definition photos, and he had his share of low yield results and stretched scars.

 

My definition of "better" is which procedure would provide the most hair and aesthetic coverage over the course of an average patients life who needs every single graft available to him, has average scalp laxity, and qualifies equally for both procedures. Let's also say that he is deciding between FUE only or FUT until stripped out, and then switching to FUE once stripped out.

[adonix]

My definition of "better" is which procedure would provide the most hair and aesthetic coverage over the course of an average patients life who needs every single graft available to him, has average scalp laxity, and qualifies equally for both procedures. Let's also say that he is deciding between FUE only or FUT until stripped out, and then switching to FUE once stripped out.

 

I think that is becoming less about the type of surgery and more about your donor and the choice of surgeon.

 

Some FUE surgeons claim 7-7,500 grafts can be extracted from a good donor. FUT surgeons claim they can extract 7-7,500 if there is a good laxity.

 

If FUT was really the "gold standard" then almost every patient would get 90%+ yield, and FUT would have an advantage. However that is simply not true.

[mav23100gunther]

FUT would have an advantage. However that is simply not true.

 

Why is FUT not having an advantage simply not true? How do you know this as fact?

[adonix]

Why is FUT not having an advantage simply not true? How do you know this as fact?

 

Because i dont see any verifiable records of that.

 

I would like to propose to surgeons to do follow ups with patients after 1 or 2 years and measure hair count in transplanted areas.

 

No excuses, make it a part of your practice.

Edited August 8, 2015 by adonix

[mav23100gunther]

Because i dont see any verifiable records of that.

 

So you have verifiable records of FUE having an advantage?

Edited August 8, 2015 by mav23100gunther

[Dr. Alan Feller]

Mav is correct, this is not a Dr. Bhatti vs. Dr. Feller thread. This is an FUT vs. FUE thread- independent of individual practitioners or personalities.

 

I do not even believe that Dr. Bhatti ever intended to participate either as a practitioner nor as a representative of the “FUE side”. Rather it was his own rep who fired him up by telling him mistakenly that I had written something on this thread that I had not. Dr. Bhatti came online and vented his anger in a few posts before he realized I was innocent of the charge made against me. Although I feel his apology could have been more direct, I nevertheless accepted it and let the matter drop so that we could engage in the more important discussion/debate that clearly thousands of people are interested in. To date this thread has over 21,000 views. The topic is obviously a hot one and from the many emails I’ve received it is being viewed and followed literally around the world on a regular basis.

 

When I discuss the limitations of FUE I avoid all reference to individual practitioners, personalities, or even philosophies by boiling down the argument to three basic detrimental forces inherent to the FUE procedure. Either they are there, or they are not. I have made the case that they are there and that they inflict themselves on each and every graft that is removed via FUE. And as such FUE is at a major disadvantage compared to FUT right from the start.

 

It is now up to a practicing FUE advocate to dispute the claim and support it; or, acquiesce and start making some changes.

 

It is unfortunate Dr. Bhatti has withdrawn from the discussion. It is his right and I bare him no ill will for doing it. He is an individual and this is not a court room. However, he is also a self described advocate and defender of FUE and as such his withdrawal from the debate reduces the credibility of the FUE side. But it is not fair to focus on him. The burden does not fall solely on his shoulders. It also falls on the shoulders of each and every practicing FUE practitioner. And to date none of them have showed up. Neither to refute the claims I’ve made, nor to back up their fellow FUE practitioner. And as such, again, this reduces the credibility of their side and bolsters the FUT side. This should be a very important factor to consider for patients who are on the fence of choosing FUE or FUT or nothing.

 

I will create a video that goes through Dr. Bhatti’s comments line by line so that the viewers may quickly and easily hear and understand my response. As an advocate for my side it is my responsibility to demonstrate the failure of the other side to make their point if I can and to support it. As I do this, however, it should be clear that I am not criticizing the man nor the practitioner, but rather the information itself that was presented as the substance and support of the FUE side by it's only representative who showed up.

 

You viewers will be the judge.

 

Dr. Alan Feller

Feller Medical, Pc

[Dr Blake Bloxham]

Hey Adonix,

 

Wanted to share something that may be helpful:

 

Dr Wesley and Dr Beehner, both FUT and FUE surgeons, shared data about the yields and rates over the past few years. In fact, Dr Beehner did this in the exact manner you suggested: by following up with patients who had the procedures and objectively comparing the data.

 

Here's the info. Hope everyone finds it educational:

 

[Wwiizzkkiidd24]

Thats a shame if he has withdrawn himself from the discussion. We all know he's a buzzy man and can understand if he hasn't got the time to reply. but It would if been nice to get more of an understanding of the procedure he practices and if he overcame the 3 forces dr feller has claimed was not possible. Oo well maybe we as patients will never know.

[lileli]

Thats a shame if he has withdrawn himself from the discussion. We all know he's a buzzy man and can understand if he hasn't got the time to reply. but It would if been nice to get more of an understanding of the procedure he practices and if he overcame the 3 forces dr feller has claimed was not possible. Oo well maybe we as patients will never know.

 

 

I think results speak for themselves. While the three forces may be present, it doesn't prevent many doctors from getting excellent results, which does say something.

[lileli]

Hey Adonix,

 

Wanted to share something that may be helpful:

 

Dr Wesley and Dr Beehner, both FUT and FUE surgeons, shared data about the yields and rates over the past few years. In fact, Dr Beehner did this in the exact manner you suggested: by following up with patients who had the procedures and objectively comparing the data.

 

Here's the info. Hope everyone finds it educational:

 

 

 

Thank you for this. As we all know, one or two studies does not establish a strong scientific theory. Multiple peer reviewed studies are needed in order to form a true scientific consensus. Having said that, I think most reasonable people would tell you to go to FUT if your trying to max out the amount of grafts. Ultimately, the customer has to weigh the pros and cons of both.

[Wwiizzkkiidd24]

I think results speak for themselves. While the three forces may be present, it doesn't prevent many doctors from getting excellent results, which does say something.

 

Yeah i guess so but it would have been nice to have it in writing. All it takes is one fue specialist to come and bite the bullet and say how it really is.

[Michael Vories, MD]

This is an interesting thread on extraction methods, but it does need to be pointed out that in considering graft survival the method of implantation also needs to be included. Of course graft survival of FUE grafts is going to be variable when implanted by forceps into pre-made sites. There is no debate that FUE grafts are more fragile than FUT grafts, so it is no surprise that FUE grafts will suffer under the relatively rough placement by forceps. The lack of surrounding tissue makes them much more likely to suffer crush injury, and like desiccation, this is fatal to the tissue.

 

Our experience is that with implanter placement, we obtain equal, if not better, growth rates with FUE grafts compared to FUT placement with forceps. To not include this in this discussion is leaving out a critical component to percentage yield. It is true that using implanter placement is expensive, and involves the physician to be with the patient the entire afternoon during placement. But our experience is it is worth the effort, and should be the standard for FUE surgery.

[adonix]

So you have verifiable records of FUE having an advantage?

 

No, I dont. That is the point. There is a need for more research and more records.

 

Until then, this is all empty talk, or even borderline greed by some surgeons who are worried that their business model is not so appealing anymore, etc.

[Dr. Alan Feller]

Dr. Vories,

 

Since an implanter pen can be used for either procedure in exactly the same way it cannot stand as an advantage for FUE.

 

If, however, it did impart some sort of greater protection for the implantation of injured skeletonized FUE grafts, then this heretofore unknown benefit would apply to an even greater extent to an uninjured FUT graft, thus giving the advantage once again to FUT.

 

I understand that your point in using the pen is that it somehow will compensate for the injured FUE graft. But my point is: isn’t it better to not have the injured graft in the first place?

 

The graft is injured due to varying levels of particular and predictable damage inflicted exclusively during the FUE procedure, namely Torsion, Traction, and Compression. Wouldn’t it be better to just avoid these destructive forces altogether?

 

I look forward to your considered reply and thank you for joining in the discussion.

 

Dr. Feller

[adonix]

Hey Adonix,

 

Wanted to share something that may be helpful:

 

Dr Wesley and Dr Beehner, both FUT and FUE surgeons, shared data about the yields and rates over the past few years. In fact, Dr Beehner did this in the exact manner you suggested: by following up with patients who had the procedures and objectively comparing the data.

 

Here's the info. Hope everyone finds it educational:

 

6 patients, seriously?

 

What if 0.85mm punch is used?

 

Have they used the implanter? How often they do FUE vs FUT?

Edited August 8, 2015 by adonix

[adonix]

Dr. Vories,

 

Since an implanter pen can be used for either procedure in exactly the same way it cannot stand as an advantage for FUE.

 

If, however, it did impart some sort of greater protection for the implantation of injured skeletonized FUE grafts, then this heretofore unknown benefit would apply to an even greater extent to an uninjured FUT graft, thus giving the advantage once again to FUT.

 

I understand that your point in using the pen is that it somehow will compensate for the injured FUE graft. But my point is: isn’t it better to not have the injured graft in the first place?

 

The graft is injured due to varying levels of particular and predictable damage inflicted exclusively during the FUE procedure, namely Torsion, Traction, and Compression. Wouldn’t it be better to just avoid these destructive forces altogether?

 

I look forward to your considered reply and thank you for joining in the discussion.

 

Dr. Feller

 

"injured" "skeletonized" "detrimental forces" "gold standard", such transparent manipulation tactics..

 

Dr. Feller, with all due respect, you think that you are smarter than an average forum visitor. Unfortunately you show time and time again that you are not. Even an average person, able to read between the lines, can see what you are trying to do..

 

Do yourself a favor, lose arrogance, support your claims with evidence, provide top-of-the line care to your patients before and after surgery...

 

Maybe you should follow H&W path, provide high resolution photos, follow up with your patients, etc. and you will not have to worry about the future of your business so much..

[Michael Vories, MD]

I do not think of the FUE graft as "injured," unless an FUT graft is also "injured" during dissection. They do need to be handled carefully, inspected for being intact, and keep moist during the procedure. They are also more subject to desiccation than FUT grafts. The point is not that FUE grafts are superior to FUT grafts, it is that when the procedure is done properly, they are equal in survival to FUT grafts. Obviously studies need to be done to clarify these remarks, and no one should be taking my words as gospel.

 

But I do feel the need to report what I have seen with performing FUE surgery daily, and compared to what I have seen performing FUT surgery for the past decade. I do feel that some the physical forces described occur during FUE surgery, but I do not believe it matters much when it comes to graft survival. When we began FUE procedures, we placed grafts with forceps, and even with experienced placers, the results were indeed variable. However, when we switched to implanter pens, we saw much more consistent results, and in my opinion, slightly better than when we were doing FUT procedures.

 

Finally, when it comes to discussions like these, I believe that a picture is not worth a thousand words, it is more like ten thousand words, and we should let the results speak for themselves.

[wazaam]

Dr Feller & Dr Bloxham (either one will suffice)

I have several questions (requests) that I would like you to respond to. I have asked previously and they have all been ignored. This is the second post and based on your continued contribution to this thread I would very much appreciate of you would take the time to answer.

 

I feel these are reasonable requests that EVERY prospective patient should be considering during a consultation.

 

1. What is the surgical protocol for FUE at Feller/Bloxham

Extractions carried out by;

Extraction Device;

Incisions;

Implantation;

Avg Number of grafts placed in patient per day;

Avg number of patients operated per day;

 

2. Please describe the surgical protocol at the clinic for mFUE (anticipated if more applicable).

 

3. Please post some FUE results from Dr Feller. It was suggested that Dr. Feller carries out 70-80 FUE case per year but I haven't been able to locate any. Please include some larger FUE results 2000-4000 graft cases. If you could just post to this thread that would make it convenient for the many followers.

 

4. What is the pricing structure for mFUE?

 

5. I find it very disconcerting that the patient rep for the clinic Spex clearly disagrees with Dr. Feller's assessment of FUE yield. Dr Feller your response was something along the lines that you don't think much of it?

 

If you could please elaborate on this please. I would think the patient rep and the doctor being represented would share comparable views on the topic. If they didn't then it would be assumed that their relationship wouldn't be mutually beneficial?

 

Maybe Spex could chime in on this as I think several posters have made similar inquires.

 

It is a shame that Dr Bhatti has chosen not to contribute any further.

 

Hopefully Dr. Vories will continue to contribute as he is one of the top FUE surgeons in North America and his opinions and experiences should be considered. His FUE results speak for themselves.