FUT is more popular than FUE

[PaulB79]

Bill's mFUE questions:

 

1. Approximately how large are the mini-strips that are being harvested? How wide and how long?

 

It depends. Don't you love that answer? I never specified a size of the punch grafts we take with the elliptical punch because it's not round, so the only way to fairly compare it to a round punch would be to compute the surface area. I don't know if anyone here has ever tried to calculate the surface area of an ellipse -- I hadn't -- but it's not fun.

 

The circular punches range in size. Just like traditional FUE punches do. They are several millimeters in diameter. We are still trying different ones to find that "sweet spot" where we maximize grafts and minimize scarring. Dr Lindsey found his initially, but then he started experimenting with the elliptical punches more.

 

However, we are using round punches for the two larger mFUE procedures we have coming up.

 

2. How will these wounds be closed? Will sutures or staples be used?

 

Initially, we used staples and Dr Lindsey used sutures. What we found was that the scarring we got from the staple punctures was actually more significant that the mFUE scar, so we're going to use sutures for the time being. However, there are still numerous ways to close the sites and we will see what is best in time. For now, it seems like sutures.

 

3. How far apart will each mini-strip be taken from one another?

 

It depends on how many we take. They are still very small, so they really don't have to be very far apart. The beauty of the mFUE graft size, however, is that they will be more spread out which means less connection of subdermal scarring under the scalp. This is confluence of scar tissue is what causes issues during secondary procedures in traditional FUE procedures.

 

However, I think the absolutely minimum distance we would leave between each punch site would be the width of the punch IE: punch of X mm, then a space of X mm, then another punch of X mm.

 

4. Is there any formula or science to the strategic placement of the strips?

 

We're designing a grid to mark out the donor region. This will help us do several things: 1) place the punches appropriate distances apart; 2) designate the areas of virgin scalp we did not harvest from so we can use this during future procedures; 3) allow us to figure out EXACTLY how we will close the punch sites (vertical, horizontal, at a 45 degree angle, etc) so the scarring blends with the natural direction of the hairs and is minimized.

 

5. While a single linear scar is eliminated during mFUE, wouldn't a bunch of mini linear scars replace a single large one?

 

It's diffuse, non-linear scarring throughout the donor the same as we see in FUE. See below:

 

6. Do you have any photos to date that you can show of the donor area immediately after surgery and/or when it's completely healed/matured?

 

Yes:

 

Here is an example of the wounds closed right after

 

 

This comes from Dr Lindsey. Generally, the punches would be more spread out, but he was doing this for a specific reason in this case (scar repair via mFUE).

 

Here is an example of them healing:

 

 

And here are some matured results:

 

 

 

 

 

Skip to 3:19 in this video to see Dr Lindsey comb through the patient's post mFUE donor shaved to a 2:

 

 

Skip to 3:42 in this video to watch Dr. Lindsey remove an mFUE graft and discuss the procedure as he does so:

 

 

Another procedural mFUE video from Dr Lindsey:

 

 

Note: he's using the largest elliptical punch we considered in these videos.

 

Hello People. I've been lurking for a while and figure it's time to post as I have a question.

 

Dr Bloxham,

 

Isn't it a bit disingenuous to describe the mFUE scarring depicted above as equal to FUE scarring? The mFUE donor scars are clearly bigger than individual FUE donor scars!

 

Thank you.

 

Paul

[Dr. Alan Feller]

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.

 

.

 

So you believe that damage during dissection of FUT grafts is the same as that for FUE grafts in terms of severity and number of grafts affected?

[PaulB79]

EDIT: OK so Dr Bloxham has just deleted his above reply. Anyway, I still think the mFUE donor scars are slightly bigger. With longer hair I guess it wouldn't matter but for shaving down close I think FUE wins. Just my opinion.

Edited August 8, 2015 by PaulB79

[adonix]

 

Originally Posted by DrBlakeBloxham

Bill's mFUE questions:

 

1. Approximately how large are the mini-strips that are being harvested? How wide and how long?

 

It depends. Don't you love that answer? I never specified a size of the punch grafts we take with the elliptical punch because it's not round, so the only way to fairly compare it to a round punch would be to compute the surface area. I don't know if anyone here has ever tried to calculate the surface area of an ellipse -- I hadn't -- but it's not fun.

 

The circular punches range in size. Just like traditional FUE punches do. They are several millimeters in diameter. We are still trying different ones to find that "sweet spot" where we maximize grafts and minimize scarring. Dr Lindsey found his initially, but then he started experimenting with the elliptical punches more.

 

However, we are using round punches for the two larger mFUE procedures we have coming up.

 

What kind of excuse is that, "it is not round"? How about you provide width of the punch and height at the largest point? Most of people know how to calculate the surface area of an ellipse and will be glad to help you.

 

The fact that you had not bothered to calculate the surface area of the punch you use is very troubling to me - if you dont know the surface area, how can you:

 

1. estimate the potential damage it would do to patients donor?

2. predict scarring?

3. claim the scarring will be comparable to traditional FUE?

 

Weird..

[TakingThePlunge]

...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. Feller,

In all fairness, I have to say that the issue of what you may or may not have said that led to this issue most likely started with my reply to tommygun's post.

 

Originally Posted by tommygun

Sethicles reps an FUE doc??? Oh, how the turn tables! Seth, why has he not posted in these threads?

 

 

As far as I am aware, Sethticles is not a paid representative of any clinic but I've messaged him about this for clarification. If someone has proof that this is the case, please notify me.

 

Like everyone else, I'm really looking forward to this discussion taking on a more educational and less confrontational tone on all sides. But, at the risk of taking this discussion off topic again, I feel the need to clarify this.

 

As far as I had understood it, Sethticles was not a rep so I wanted to determine where that idea come from. I messaged Sethticles and, as I mentioned to Blake also, I messaged Dr. Bhatti asking if Sethticles was a rep and, if so, to please place a disclosure in his forum signature. The response from both parties was that he is a happy patient, nothing more.

 

As to where the idea may have come from, I have to admit that a couple of your comments, whether intentional or not, did paint that picture for me and it appears I'm not alone in that regard.

 

I have a question for you HTsoon. Do you think Sethicles has monetary incentives?

 

He is a representative for a a physician practicing FUE. Do you think he has monetary incentives?

 

To me the word "rep" connotes some form of compensation whether monetary or otherwise. I've seen some dispute that idea and, of course, it may be open to interpretation. However, the question is also raised as to whether or not he may have monetary incentives.

 

Lastly, though you don't mention Dr. Bhatti's name specifically, everyone knows who his doctor is and that he is an outspoken (perhaps overzealous) supporter. Thus, I don't know what other FUE surgeon he might be repping.

 

I present this not to challenge you on it but I don't see any other interpretation and I'd like to know if you can see how I and others may have drawn this conclusion.

Edited August 9, 2015 by David - Moderator
Fixed Typo

[Dr. Alan Feller]

David,

 

First of all there is absolutely no question as to what I did or didn't write so please don't make it out to seem subjective. I did not write what California nor Dr. Bhatti claimed I did which set them off. They made a mistake and chose to double down and attack me rather than saying whoops and apologizing.

 

 

"Lastly, though you don't mention Dr. Bhatti's name specifically, everyone knows who his doctor is and that he is an outspoken (perhaps overzealous) supporter. Thus, I don't know what other FUE surgeon he might be repping."

 

 

While you may be acutely aware that Seth is a patient of Dr. Bhatti, I was not. I don’t read and frequent this site as you do. I had no idea who Dr. Bhatti was until he and California attacked me out of the blue, much less what Sethicles specific past included. I had no idea who California was either Yes, I can now read that Dr. Bhatti is in Seth's signature line, but I had no idea of this at the time. You made a wrong assumption, and so did they.

 

When I brought up that Seth was a rep for an FUE doctor it was in the context of responding to a scathing and inappropriate post by HTsoon. It had nothing to do with Dr. Bhatti nor anyone else. This is plain to anybody who takes the time to read it, which nobody has. That question I asked to HTsooner that you quoted here had nothing to do with Dr. Bhatti or any other doctor

in existence.

 

To me Seth has come across as a rep for an FUE doctor or the FUE industry in general since the very second post of this thread. And clearly many others thought this too long before I ever did to the point that Bill told me he had even investigated Seth for it in the past. So my belief that he was a rep for an FUE doctor is valid, but I never said who he was a rep for because I didn’t know, didn’t care, and it was not important to the point I was making to HTsooner.

 

 

“I present this not to challenge you on it but I don't see any other interpretation and I'd like to know if you can see how I and others may have drawn this conclusion.”

 

If I had written that Seth was a rep for Dr. Bhatti I might see how you could draw your conclusion. But since I never did, then NO, I can’t see how you and others may have drawn this wrong conclusion. I also don't see how false assumptions made by anybody should become my burden to disprove.

 

The reality of this false charge against me should be confirmed by a moderator, and I would suggest a post be inserted after California and Dr. Bhatti's original posts that states that their charge against me was unverifiable and fallacious. They clearly won't do the honorable thing and remove the false statements themselves. Would you make that post, David?

Edited August 9, 2015 by Dr. Alan Feller

[PaulB79]

Dr. Feller,

 

If in the future, you suspect someone in particular covertly representing a clinic (recommended here or not), please send me a private email and we will investigate this. We have investigated "Sethicles" and while he may speak boldly about Dr. Bhatti, I see no evidence that he is employed or represents him or the clinic in any way. Furthermore, I removed one of your posts that he is somehow "profiteering" for Dr. Bhatti as this is inappropriate.

 

 

 

Dr Feller

 

There definitely is a question as to what you wrote because Bill deleted one of your posts about Sethticles. So unless anyone saved it we now have to rely on the memories of those who read it. It's very hard to believe you weren't implying Sethicles was a representative for Dr Bhatti. I question your honesty for now claiming otherwise.

 

Paul

[FUE2014]

In another life Dr Feller would have made a brilliant attorney, he is so belligerent!

[Mikey1970]

In my opinion anything contentious should be resolved verbally (preferably face to face but phone at a minimum), not in writing & certainly not on a public forum...

[mav23100gunther]

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.

 

Then why did you make an explicit statement that FUT having an advantage is simply not true? you just admitted you have no records to prove either side, so for you it's simply unknown, therefore FUT having an advantage could be true, no?

Edited August 9, 2015 by mav23100gunther

[voxman]

Dr. Bhatti is on a Break in India and has asked me to post his rely to Dr. Feller's post.

 

"Dr Feller, I have stated what I had to state. So no, I do not agree.

The above forces you cite do not apply to my cases any more than the numerous bad strip results that are frequently posted here represent in any way your stated practice skills."

To the questions posted by lone parties, if time permits I can reply to them through private message. Otherwise there will be too much of cross talk."

 

 

Dr. Bhatti has not disengaged as Dr. Feller erroneously stated he did - but I have counseled Dr. Bhatti to get on with his business as usual. It's his choice if he decides to remain active on this thread.

[mav23100gunther]

"

Dr. Feller, with all due respect, you think that you are smarter than an average forum visitor. ..

 

Actually he is smarter than the average forum visitor. He is a qualified doctor with a PHD! what are you?

[Dr Tejinder Bhatti]

Dr. Bhatti is on a Break in India and has asked me to post his rely to Dr. Feller's post.

 

"Dr Feller, I have stated what I had to state. So no, I do not agree.

The above forces you cite do not apply to my cases any more than the numerous bad strip results that are frequently posted here represent in any way your stated practice skills."

To the questions posted by lone parties, if time permits I can reply to them through private message. Otherwise there will be too much of cross talk."

 

 

Dr. Bhatti has not disengaged as Dr. Feller erroneously stated he did - but I have counseled Dr. Bhatti to get on with his business as usual. It's his choice if he decides to remain active on this thread.

On a weekend break with a weak net connection. I wish to remain a part of the discussion. Voxman has posted on my behalf.

[PaulB79]

Dr Feller

 

Your silence is deafening.

 

Paul

[mav23100gunther]

On a weekend break with a weak net connection. I wish to remain a part of the discussion. Voxman has posted on my behalf.

 

Thanks Dr Bhatti,

 

Looking forward to hearing your view on the following questions:

 

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?

[Dr Tejinder Bhatti]

Thanks Dr Bhatti,

 

Looking forward to hearing your view on the following questions:

 

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?

 

DOES FUE DAMAGE THE DONOR AREA MORE THAN FUT?

 

I would like to refer esteemed members of the patient community to the following video-

 

 

 

The doctor would like us to believe that CPR4 has pain and numbness in the donor area due to this being a complication of megasessions done using the FUE technique.

This is so far from the truth.

Most FUE sessions cannot harvest in excess of 4000 scalp grafts ( 4000 x 2.3 follicles) in the first session. Given the safe scalp donor in most people is 22 x 6 cms ( 132 sq cm), it comes to making 30 incisions per sq cm (4000/132) in the safe zone of the donor scalp.

Now, also consider the fact that the same doctor advocates upto 55 slits per sq cm in the recipient area while performing FUT.

The depth of each donor scalp recipient incision while harvesting a graft is the depth the punch goes under the skin- a mere 2.0-3.0 mm whereas the depth of the recipient incision is always the length of the follicle- 4 mm. Almost twice as deep!

Is the donor incision more harmful to the blood supply and the nerve supply than the incisions the doctor makes in the recipient area that are double as dense as double as deep?

As a corollary, should not all patients of hair transplant- whether done by an FUT surgeon or an FUE surgeon have unmitigating pain in their recipient area due to serious damage to blood and nerve supply?

 

Doctor, why does this not happen?

 

Why do you advocate only 700 FUE grafts procedure in FUE that comes to 5 incisions per sq cm (700/ 132 ) of half the depth when you advocate 55 incisions in the recipient area of greater depth?

[adonix]

Then why did you make an explicit statement that FUT having an advantage is simply not true? you just admitted you have no records to prove either side, so for you it's simply unknown, therefore FUT having an advantage could be true, no?

 

No, i just said that there is no proof to say that either FUE or FUT have advantage.

[adonix]

Actually he is smarter than the average forum visitor. He is a qualified doctor with a PHD! what are you?

 

Based on his posts - he is not.

 

What am I? Well that is a good question, lets say I am more educated than dr. Feller, for starts. But then again, education means nothing if one allows ego to take over.

[hairshopeing]

Let's get real here Dr feller

You have continually been asked to post fue results that you so often still perform with high success! You have failed to do so because it's pretty obvious they don't exist! Now if you had come out and said fue is in your opinion a slightly inferior procedure for xyz reasons but still in the right Dr's hands produces dome great results but you personally prefer strip as you get better results with it then you would of kept some credebility here, but you didn't! You absolutely slated fue and it's success rates using ridiculous terms like a donor area that looks like it's been blasted by a shotgun, ripping and tearing out follicles! Maybe that's your fue protocol! Who knows no one ever sees any results!!

The real reason your so anti fue is because in America it Is illegal to allow a tech to extract the graft so it means you would have to do all the punches yourself it's that simple! You cannot allow what happens in Europe to be done in your clinic and because of that you cannot compete in this fue market or get results like the other well established fue Dr's! ! Hard work extracting 3000 grafts eh@ hey iv got a good idea what if we extract several at one time with a bigger punch? Sure the scars will be bigger and need stitches but that's got to be more appealing then one big strip one what that may or may not stretch!! So we can get our 1500 fue with a couple if 100 punches as we have to do them all ourselves! !

Also I'd ask you to put a compilation together of all your fue and strip results posted on this forum in the last 2 years and put them with say Dr erdogans fue results that he has posted in the last 2 years and allow everyone to see what he is producing against what you are producing in terms of rdsults being shown and quality in terms of yield and naturalness!! Because the 3 factors you continually mention which stops any fue case being a success are clearly over come in the skilled hands or Dr erdogan and his techs!!! Let's see the numbers, let's see the results! ! I'm pretty sure if the law changed about tech extractions where your bed you'd ship in a load of experienced techs and be doing fue primarily but for now you can't do that or compete in the fue market place which is why you have been so dismissive of it as a procedure! ! You should of just shown what you were good at, nit dismissed something your not good at but others are!! You would of kept some credibility!!!

Oh and look forward to them results comparisons! ;

[Yiddo]

I think Dr Feller probably has many examples of his fue work, but probably only small numbered cases. Surely there won't be any large fue cases, because that's the whole point of this discussion isn't it?

[Dr. Alan Feller]

Dr. Bhatti,

First I want to thank you for engaging in this discussion. You are the very first and only to do so to date. So your participation is noted and appreciated.

 

I want to get into the points you made in your previous posts. But I want to proceed step by step so that these posts don't become ridiculously long and filled with multiple topics. I want to focus our discussion if that is ok with you.

 

I read your comments and would like to ask you simply:

 

Are you agreeing that the three detrimental forces of FUE (Torsion, Traction, Compression) exist in your opinion and are present during each of your FUE procedures?

 

Thank you.

Dr. Feller

 

Dr. Bhatti,

I am so glad you are staying in the discussion. Your representative said you were too busy to engage and that you shouldn't engage. I"m glad this is not the case.

 

If you are on break for the weekend then by all means go and enjoy your time off. The discussion does not have a time limit.

 

i will answer your question about CPR4 in my next post. However, there is still a question on the table that you haven't answered yet and it may be best if you and I proceed one question at a time for each other so the viewers don't get confused and we don't get off on tangents.

 

But for now since you are on break I will answer your question before you have answered mine, and look forward to your answer when you rejoin us.

 

Fair enough?

[Dr. Alan Feller]

Since this is a moderated site I would ask David to act as the moderator for this discussion and try to help keep it on track by making sure that both participants, and any other practitioners who care to join in, stay on track and actually answer the questions.

 

For example, i asked Dr. Bhatti a specific question. He did not answer it but instead asked me a different question. If this is to work both sides must first answer the other's question before we move on. Make sense?

[Dr Tejinder Bhatti]

Dr. Bhatti is on a Break in India and has asked me to post his rely to Dr. Feller's post.

 

"Dr Feller, I have stated what I had to state. So no, I do not agree.

The above forces you cite do not apply to my cases any more than the numerous bad strip results that are frequently posted here represent in any way your stated practice skills."

To the questions posted by lone parties, if time permits I can reply to them through private message. Otherwise there will be too much of cross talk."

 

 

Dr. Bhatti has not disengaged as Dr. Feller erroneously stated he did - but I have counseled Dr. Bhatti to get on with his business as usual. It's his choice if he decides to remain active on this thread.

 

Dear Dr Feller,

 

Thank you for your kind thought.

I do intend to stay on course and believe me I will not stray.

Voxman posted the reply on my behalf already.

The question to you is part of the discussion on the FUE donor area-if it is any worse than in FUT.

So in all fairness may I have your reply!

And I sincerely hope you are enjoying your weekend.

 

Regards,

[HairJo]

I agree I would like to see these questions answered so we all get a better understanding about the FUE procedure and to explain how the all these thousands of hairs are removed with no damage to them.

[Dr. Alan Feller]

I think Dr Feller probably has many examples of his fue work, but probably only small numbered cases. Surely there won't be any large fue cases, because that's the whole point of this discussion isn't it?

 

Yiddo,

You nailed it on the head. I was going to say exactly that in my upcoming video. But since you bring it up I will go into it now. Amazing how nobody mentioned it until you did just now, isn't it?!

 

I performed FUE megasessions over ten years ago. That's why I manufactured manual and powered tools for the FUE industry. Patented them. I did the first live workshop at an ISHRS meeting performing the procedure in front of hundreds of doctors. I gave the first video presentation to doctors and the first to post video online how it was performed. I performed the first FUE megasession and put the results online. Back then a thousand grafts in one sitting was unheard of. But that was a megasession back then.

 

In the beginning I felt nothing could stop FUE. So I started to increase the size of the procedures, just as I had ten years earlier for FUT. Difference was, that while FUT results got better and better as I got more aggressive, FUE results got worse and worse. And then I noticed the donor scarring and fibrosis and came to the conclusion I was killing donor area and that the FUE scarring, although more difficult for the casual viewer to see, was actually worse than the FUT scar. Because while the FUT scar may be more noticeable, at least it spared the hair and skin above and below it. Large numbers of FUE scar just decimated the entire donor area. Also, even the worst FUT scar can easily be covered by surrounding hair. In contrast, FUE donor areas get thinned out massively, which will only look worse as the patient ages due to senile alopecia, which just means our hair naturally thins as we get older.

 

Then I began to perform second passes for FUE and noticed how much the donor area skin had changed. More painful both during anesthesia and after the surgery. More brittle. And sheets and sheets of fibrosis. Devascularization everywhere. Nobody was mentioning this anywhere online nor in our industry publications. I had a discussion with Dr. Hasson to ask if he had noticed this on any patients of his who had FUE in the past and I didn't even have to finish my sentence. He had seen it multiple times and said " it absolutely destroys the donor area, Alan". I will never forget those words of confirmation. Every doctor I discussed this observation with had also noticed it. And all FUE doctors I have ever spoken to acknowledge the problem except for one, and he doesn't post on this site.

 

After a while, i found that even sessions of 1500 graft FUEs were not looking nearly as good as their FUT counter parts. The larger the FUE case, the greater the deviation from FUT results. You still see evidence of this today on this very site.

 

I performed multi thousand graft megasessions on many patients ten years ago. Some looked fantastic, but most did not. I performed the same exact surgery on all of them. If I could get one patient to grow well, then I should have been able to get them all to grow well. But that was not the case. Most did not grow as well as FUT and it didn't take long to realize it was because of the damage done to the graft inherent to the FUE procedure itself.

 

It comes down to the tolerance of the follicular unit to endure the three detrimental forces of FUE, and it is impossible to predict whose follicular units have such tolerance before a procedure. So thus, every FUE case is a roll of the dice. The bigger the case, the bigger the bet.

 

FUT does not subject grafts to FUE forces and so the chances of growth are much higher and much more consistent.

 

Thank you for finally stating the obvious Yiddo and for joining in.

Edited August 9, 2015 by David - Moderator