FUT is more popular than FUE

[Dr. Alan Feller]

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,

 

Since you and I are having a discussion directly would you please answer my question in your own words when you have the time. Let's agree not to use surrogates. Perhaps you could ask your reps to excuse themselves from this particular discussion.

[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,

Well done! That's exactly the point. It is the very heart and soul, the very core of the topic.

 

I've been down the road of the FUE megasessionist. I was one of its very first practitioners and innovators. I even did the worlds first FUE megasession which was 1000 grafts in a single sitting. That was a lot at the time.

 

It only took a few years to realize that the larger the session got, the more it's results negatively diverged from the equivalent FUT procedure. You see evidence of this to this very day on this very site.

 

Many claim that FUE has advanced in terms of technique and instrumentation. But I challenge that vague claim and boiled the problem down:

 

For FUE to advance new instruments and techniques must be invented to overcome three detrimental forces inherent to FUE: Torsion, Traction, and Compression. Because it is these forces that damage the grafts during extraction and either limit or prohibit their growth after re implantation. There is no practitioner in existence known that has overcome these three detrimental forces.

 

And while there have been some very vocal claims of advancement in FUE, absolutely NONE have been demonstrated by any of it's supporters.

 

FUE megasessions damage the donor area far more severely than FUT. There is no equivalence. And FUE megasseions do not grow as well as FUT megasessions simply because FUE grafts are traumatized far more than FUT grafts during the extraction process.

[PaulB79]

Dr 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 proved why that's a false statement in my post earlier today but you've ignored me.

 

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.

 

You insult the community's intelligence by making these risible excuses. To claim you hadn't read Sethticle's signature, mentioning Dr Bhatti's name, while simultaneously making an allegation that he is a rep is very implausible. You must have spent hours on your threads here and are obviously very emotionally committed to them. I don't believe you formed an opinion about one of your arch enemies here - Sethticles - without reading his signature. You obviously do "care" about it.

 

 

“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?

 

I've explained how we draw the conclusion.

[Dr. Alan Feller]

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?

 

Thank you for watching my video, Dr. Bhatti.

You wrote:

"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."

 

I don't think it is a complication, but rather a direct and predictable consequence of the surgical damage inherent to these aggressive FUE megasessions themselves. Dr. Bhatti, if his recent FUE megasession wasn't what was causing the pain and shock loss he complained of only days postoperatively, then what to your mind did?

 

Wouldn't you agree that the chances of him having the same complaints would be magnitudes lower if he had had an equivalent FUT procedure instead?

 

I see later in your post that you are trying to make a comparison between donor area injury and recipient area injury. But your comparison is not valid and here's why: In the donor area punches are used to literally create holes and large chunks of skin are removed by tearing them out from their bases. In the recipient area tiny slits are created like deep paper cuts. They have almost no dimension and absolutely no skin is avulsed and removed.

 

So for the recipient site: tiny insult, tiny response

for the donor site: large insult, large response

 

The depth of the recipient stab is inconsequential. Think of the simple inoculations we get in our arms when we visit our regular doctor. The needle he uses goes much deeper than any slit recipient site that will ever be made, yet we never notice the scarring or damage from them because they are so tiny. If, however, each time we were inoculated a punch of skin were removed from our arm it would not be long before the skin on our arms were very damaged and become easily visible.

 

So it's not the depth, it's the width of removed tissue that dictates the damage. Thus, this is why I advocate for only 700 grafts of FUE because it is only this amount that, over an entire donor area, insures that the resultant scarring from each hole won't join with the resultant scarring of it's neighbor causing fibrosis and devascularization.

 

Does this make sense now?

[voxman]

Perhaps you could ask your reps to excuse themselves from this particular discussion.

 

When Dr. Bhatti provides me with text to answer a question and requests me to post in his words, I will comply with his wishes.

 

He wishes to answer the question:

 

DOES FUT PROVIDE A GREATER NUMBER OF DONOR GRAFTS THAN FUE?

No It does not!

If we consider the fact that we can harvest up to 40% of the donor scalp over 2-3 sessions using FUE technique, a strip area which would yield an average 2500 grafts will yield around 1200 FUE grafts over 2-3 FUE sessions. So there is an availability of 40% more grafts from the area of the strip as compared to if we were to harvest that area of the strip only over 2-3 sessions (N.B.-not the whole scalp)

A fact that is not known to many people is that the strip scar can actually increase the area of the crown by downward displacement as the skin stretches and moves down somewhat when it is stitched. This area of expansion of the crown may be as great as 40% the area of the strip. The additional grafts that we may have been able to harvest with FUT would be used in the long term to cover this area which has developed not genetically but iatrogenically.

So the increased number of grafts we got by the strip technique is countered by a similar increase in the area of baldness.

Therefore it is an illogical and fallacious presumption that we get more grafts from FUT.

It is false to assume that in FUT we are utilising the extra loose skin in the harvesting. The loose skin is there for a purpose. You need it for neck flexion.

After all you can not offer cosmesis at the cost of body function!

[lileli]

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.

 

Thank you!

[voxman]

As mentioned above, I will relay any text or message Dr. Bhatti asks me to. It is not my place to put words into anyone's mouth. You guys know me.

 

HOWEVER.....

 

I have reviewed all of my posts on this thread and I do not see where I said Dr. Bhatti was disengaging because he was too busy. I actually called for patience in the postings. I advised him business first, forum when he has time.

 

Also Dr. Bhatti was well aware of this thread and has been reviewing it well before any comments were made to his reps. It was not brought to his attention.

 

These off point comments and innuendo only serve to undermine the intent of the thread.

 

Stay the course. I will.

[Dr. Alan Feller]

When Dr. Bhatti provides me with text to answer a question and requests me to post in his words, I will comply with his wishes.

 

He wishes to answer the question:

 

DOES FUT PROVIDE A GREATER NUMBER OF DONOR GRAFTS THAN FUE?

No It does not!

If we consider the fact that we can harvest up to 40% of the donor scalp over 2-3 sessions using FUE technique, a strip area which would yield an average 2500 grafts will yield around 1200 FUE grafts over 2-3 FUE sessions. So there is an availability of 40% more grafts from the area of the strip as compared to if we were to harvest that area of the strip only over 2-3 sessions (N.B.-not the whole scalp)

A fact that is not known to many people is that the strip scar can actually increase the area of the crown by downward displacement as the skin stretches and moves down somewhat when it is stitched. This area of expansion of the crown may be as great as 40% the area of the strip. The additional grafts that we may have been able to harvest with FUT would be used in the long term to cover this area which has developed not genetically but iatrogenically.

So the increased number of grafts we got by the strip technique is countered by a similar increase in the area of baldness.

Therefore it is an illogical and fallacious presumption that we get more grafts from FUT.

It is false to assume that in FUT we are utilising the extra loose skin in the harvesting. The loose skin is there for a purpose. You need it for neck flexion.

After all you can not offer cosmesis at the cost of body function!

 

I'm sorry Voxman, I do not accept those terms. My discussion is with Dr. Bhatti, not you. Respectfully, you are not qualified to be in this conversation and I fail to see why Dr. Bhatti would need you as a buffer.

 

When you answer for him it goes under your alias, and thus his words are almost impossible to find in a search engine. He needs to post under his own name. Now that I think of it, he uses an alias as well. So that's confusing enough. Either he willingly stands accountable for what he writes, or he doesn't.

 

If Dr. Bhatti and I were at a medical meeting and this conversation came up, how do you think it would look if he were to position you between him and everyone else? There is no difference here.

 

I have now asked Dr. Bhatti a very direct question for which I have not received an answer in 48 hours. I have also answered in great detail his second question with no response or rebuttal. Now he wants to skip to yet a third unrelated question. One I didn't even ask.

 

At this point, respectfully, we can begin to conclude that he won't stay on point and is being evasive; or he is incapable of staying on point which is far worse. Either way, it doesn't look good for the FUE megasession side.

 

Dr. Bhatti, clearly you are reading every word of these posts, will you engage in debate or not? If you don't wish too, that's fine by me, but either engage and proceed orderly; or disengage and resign officially.

 

I look forward to your direct response.

 

Thank you.

[Dr. Alan Feller]

By the way, Dr. Bhatti, I do appreciate you at least joining the thread and putting out your thoughts and beliefs for everyone to read as an advocate and defender of FUE megasessions.

 

I will address the points you make that are on topic or are particularly in need of quick answering, but for the other material you are also throwing out there that doesn't seem connected I will address in a video presentation.

 

So please don't think that even a single word you have written or will write be ignored or unaddressed by me.

[Dr. Alan Feller]

As mentioned above, I will relay any text or message Dr. Bhatti asks me to. It is not my place to put words into anyone's mouth. You guys know me.

 

HOWEVER.....

 

I have reviewed all of my posts on this thread and I do not see where I said Dr. Bhatti was disengaging because he was too busy. I actually called for patience in the postings. I advised him business first, forum when he has time.

 

Also Dr. Bhatti was well aware of this thread and has been reviewing it well before any comments were made to his reps. It was not brought to his attention.

 

These off point comments and innuendo only serve to undermine the intent of the thread.

 

Stay the course. I will.

 

Voxman,

Dr. Bhatti did not respond to my question but rather sent you on instead. That seems like disengaging to me. You also wrote:

 

"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."

You advised him to disengage and it's his choice to remain active or not. That also sounds like a declaration of disengagement.

 

 

It's interesting that you say Dr. Bhatti had always been reading this thread. He claimed he only got involved after "well wishers" informed him of the awful things I supposedly wrote about him. His post from August 5th at 10:17am:

 

"As far as reading this thread is concerned, I was pointed out about your comments by some well wishers and therefore I am here. Believe me, I would not have otherwise I seldom have time to go through my own e-mails let alone stalk forum threads."

 

So you say one thing, he says another, and then you both do something else. Just easier and more respectful for you to stop running interference for your doctor and allow he and I have to have a direct discussion. If he needs more time to post, I have no problem with it. There is no time limit here.

[voxman]

Then I will be respectful of all parties and I will gladly disengage.

 

But before I go, let me tell you the truth as it exists in my world.

 

As you quoted me above I advised him that it was his choice - not mine - to continue or not - that is hardly a declaration of disengagement by him. But you are keen it say 'it seems like' or 'it sounds like'.

 

And upon recent review, it appears he is a man of his own mind and will continue. Just not every 5 minutes.

 

And, I am totally unaware of whatever well-wisher advised him of this thread, but it was not me. He first brought it up to me in passing well after he had been reading it. Are you aware of when he logs on and reads internet message boards? I'm not.

 

Believe me or not, that is the truth. See you around the pool.

[Dr. Alan Feller]

Thank you, Voxman. Very gracious.

[adonix]

So dr. Feller, what is the surface area of the mFUE punch?

[fortune11]

Dr Feller --

 

The point about recipient site trauma vs donor site trauma makes a lot of intuitive sense , thank you . How about the point raised by Voxman that repeated FUT strips lead to enlargement of the crown area ?

 

I ask because I have been through multiple strips myself. And while I am satisfied with the growth in the recipient area, I have always had this nagging suspicion that my crown bald spot kept enlarging and " dropping back and lower " with each successive transplant. Now granted , I was not on propecia up until now so that may have just been the natural progression of MPB but I would like to hear from you on this topic.

 

For the record , this continues to be a very useful discussion at least in my mind , and especially for all of those considering their next procedure -- just need to ignore all the posts that do not contribute to advancing an argument (in either direction).

[voxman]

How about the point raised by Voxman that repeated FUT strips lead to enlargement of the crown area ?

 

I know I left the room, but in the interest of clarity - and as explained - that point was raised by Dr. Bhatti himself and simply relayed by me.

[Dr. Alan Feller]

Dr Feller --

 

The point about recipient site trauma vs donor site trauma makes a lot of intuitive sense , thank you . How about the point raised by Voxman that repeated FUT strips lead to enlargement of the crown area ?

 

I ask because I have been through multiple strips myself. And while I am satisfied with the growth in the recipient area, I have always had this nagging suspicion that my crown bald spot kept enlarging and " dropping back and lower " with each successive transplant. Now granted , I was not on propecia up until now so that may have just been the natural progression of MPB but I would like to hear from you on this topic.

 

For the record , this continues to be a very useful discussion at least in my mind , and especially for all of those considering their next procedure -- just need to ignore all the posts that do not contribute to advancing an argument (in either direction).

 

Fortune,

Thank you for your posts and observations. I think you have understood what has been going on all along. I would be happy to address crown balding, but not on this thread or at this time. I want to keep this focused on the debate. And as of now we are waiting for Dr. Bhatti to answer my first question declaratively and in depth. And to respond to my rebuttal of his question that you mentioned here.

 

By the way, I agree with you that the issue brought up by Dr. Bhatti concerning donor extractions and recipient sites is intuitive. Is there any FUE practitioner viewing this who doesn't see it as intuitive that punched donor area extractions are not the equivalent of recipient area site slitting ?

 

Dr. Bhatti, do you have any comments or questions about your confusion in this matter?

 

Thank you Fortune.

[adonix]

Fortune,

Thank you for your posts and observations. I think you have understood what has been going on all along. I would be happy to address crown balding, but not on this thread or at this time. I want to keep this focused on the debate. And as of now we are waiting for Dr. Bhatti to answer my first question declaratively and in depth. And to respond to my rebuttal of his question that you mentioned here.

 

By the way, I agree with you that the issue brought up by Dr. Bhatti concerning donor extractions and recipient sites is intuitive. Is there any FUE practitioner viewing this who doesn't see it as intuitive that punched donor area extractions are not the equivalent of recipient area site slitting ?

 

Dr. Bhatti, do you have any comments or questions about your confusion in this matter?

 

Thank you Fortune.

 

Dr. Feller you are missing the point. The thread is about FUE vs FUT, which includes all aspects of both approaches, including potential stretching of crown. You keep avoiding all negatives about FUT, and keep promising to address them at some other time.

 

Nevertheless, this is the thread and time to address those concerns.

[TakingThePlunge]

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?

 

I want to thank Dr. Feller, Dr. Bhatti, Dr. Vories and Dr. Bloxham for sharing their experience and technical expertise in this discussion.

 

Regardless of how knowledgeable we may be as hair transplant patients, prospective patients and avid participants in this community, in my opinion, those of us that are not medical doctors regularly performing surgical hair restoration should keep an open mind when reading physician contributions. Let's be respectful, listen and learn from both sides of the topic.

 

With that in mind, I'd also like to urge everyone involved in this conversation to stay on topic and refrain from jumping to conclusions when someone does not respond to a given question immediately. Don't forget that this is an international forum. The middle of the afternoon to you may be the middle of the night to someone else. In addition, many of us are juggling multiple jobs, family and trying to sneak in a little leisure time. The doctors involved are all running successful practices that demand a lot of their time. Let's have patience and assume that if a physician has not publicly bowed out of the debate, he will eventually get around to addressing our questions.

 

Regarding the Sethticles concerns, let's all accept the following as truths and move on with no more mention of the topic.

 

1. Sethticles is not a representative of any clinic and has no monetary incentives for sharing his experiences.
   
2. Dr. Feller did not state or imply this at any time.
   

Finally, given that it's unlikely that everyone will come to a consensus and engage in a virtual group hug at the end, it would be nice if this debate had a foreseeable end just as an in-person debate would have. Without such a goal in mind, it could just go on forever and lose value. Perhaps if each side had a short list of questions they'd like the other to address, we could wrap this up once these questions have been answered and rebutted.

 

I also propose to Bill that we take a harder line in terms of moderation moving forward by immediately eliminating any future comments that are off-topic, insulting or irrelevant to the main discussion.

 

Just my opinion guys.

[mav23100gunther]

Dr. Feller you are missing the point. The thread is about FUE vs FUT, which includes all aspects of both approaches, including potential stretching of crown. You keep avoiding all negatives about FUT, and keep promising to address them at some other time.

 

Nevertheless, this is the thread and time to address those concerns.

 

Dr Feller, I absolutely agree with Adonix on this point. Dr Bhatti brought up the stretching of the crown as a disadvantage of electing FUT over FUE, and therefore relevant to this thread. I never even considered this factor before, what are your thoughts?

[tommygun]

David, if you actually believe what you typed in your last post, will you be restoring posts made by Feller that were removed seemingly because of their intent? In this thread, Feller is nothing more than an Internet bully and you just caved.

[TakingThePlunge]

David, if you actually believe what you typed in your last post, will you be restoring posts made by Feller that were removed seemingly because of their intent? In this thread, Feller is nothing more than an Internet bully and you just caved.

 

I honestly don't know what you are mean but this is exactly the type of post that i would suggest be deleted moving forward. This serves no one at this point. Everyone has expressed their opinions about the motivations and behaviors of everyone else involved. Now, how about we refrain from further such personal attacks on all sides and stick to the topic of FUE vs. Strip?

 

How exactly have I "caved" in calling for everyone to stop bickering about off-topic nonsense and engaging in personal attacks?

 

As for restoring deleted posts, I never said such a thing and the answer is no. We deleted the post in question because we deemed it inappropriate and in violation of our Terms of Service.

[tommygun]

Understood. Thank you.

[PaulB79]

Understood. Thank you.

 

way to cave

[delancey]

Dr. Feller,

 

I am also interested in whether a crown can expand from strip surgery. Please, can you elaborate on this point.

 

Thank you in advance.

[tommygun]

way to cave

 

Lol! Just don't want to get BUSA'd