Dr. Alan Feller Posted August 13, 2015 Author Share Posted August 13, 2015 Dr. Feller, Then you surely must find this website to be unethical since it recommends FUE only surgeons who do perform mega sessions and claim to get consistent good results. If they didn't get consistent good results, how could they be recommended? No, I don't think this site is unethical. Nor do I think it's unethical for a licensed physician to practice megasession FUE. It only becomes an issue of ethics if the FUE megasessionist does not provide their potential patient with all the facts so as to be providing Informed Consent. That burden falls to the doctors themselves, not this site. Despite how my critics repeatedly and falsely claim I am anti-FUE, I am not. It has it's place. As such there should be a pool of screened practitioners of FUE just as there is for FUT. From there people can look at the work these practitioners post and then decide who they may want to explore further for their FUE. I Link to comment Share on other sites More sharing options...
Senior Member lileli Posted August 13, 2015 Senior Member Share Posted August 13, 2015 No, I don't think this site is unethical. Nor do I think it's unethical for a licensed physician to practice megasession FUE. It only becomes an issue of ethics if the FUE megasessionist does not provide their potential patient with all the facts so as to be providing Informed Consent. That burden falls to the doctors themselves, not this site. Despite how my critics repeatedly and falsely claim I am anti-FUE, I am not. It has it's place. As such there should be a pool of screened practitioners of FUE just as there is for FUT. From there people can look at the work these practitioners post and then decide who they may want to explore further for their FUE. I I understand. Thank you. As someone who did all about fut vs fue, I may have picked fut if things were laid out like this. Link to comment Share on other sites More sharing options...
Senior Member Matt27 Posted August 13, 2015 Senior Member Share Posted August 13, 2015 Surely this debate is pointless? All this rant for rant people will get what THEY want anyway. I would still choose FUE even if the yield was 50% success compared to 98% for FUT. it's all about the scar and having to have your hair longer unless you want to see the line. So would I. Seriously... FUT sucks. Chances are my crown will start to go and then what... rock the Hugh Laurie hairstyle? No thanks. Link to comment Share on other sites More sharing options...
Dr. Alan Feller Posted August 13, 2015 Author Share Posted August 13, 2015 people who are satisfied w 50% yield to avoid a scar better be sure that their hair loss will not progress beyond a NW2 or 3 , or better hope that their "fall back " clean head shaven look won't become hopelessly outdated in 10 years time. Probably the weakest point of the so called FUE "fall back" is that MOST people simply don't look good with their head shaved. Very very few people who visit my practice can pull it off. Thanks for the participation Fortune, you make very valid points and good observations. We need more thinkers like yourself. Link to comment Share on other sites More sharing options...
Senior Member Matt27 Posted August 13, 2015 Senior Member Share Posted August 13, 2015 IMO... most guys do look good with a shaved head if they have a hairline. There are exceptions, generally if the man's head is too small. I used to shave my head as a NW2 and the cosmetic difference between NW2 and NW3/3A when shaved is massive. Nevermind the difference between NW4/5 and NW2. Link to comment Share on other sites More sharing options...
Dr. Alan Feller Posted August 13, 2015 Author Share Posted August 13, 2015 I understand. Thank you. As someone who did all about fut vs fue, I may have picked fut if things were laid out like this. Thank you. I have heard this from several other posters as well. You now know the purpose of my FUE posts. Link to comment Share on other sites More sharing options...
Dr. Alan Feller Posted August 13, 2015 Author Share Posted August 13, 2015 So would I. Seriously... FUT sucks. Chances are my crown will start to go and then what... rock the Hugh Laurie hairstyle? No thanks. Wow! Another one. Link to comment Share on other sites More sharing options...
Regular Member adonix Posted August 13, 2015 Regular Member Share Posted August 13, 2015 Wow! Another one. Dr. Feller if one has FUE and decides to go for FUT for the 2nd surgery, what are the implications? Not a "gotcha" question, since this is something you could advise based on your experience. Please forget FUT vs. FUE camps for a second. Link to comment Share on other sites More sharing options...
Senior Member Matt27 Posted August 13, 2015 Senior Member Share Posted August 13, 2015 Wow! Another one. I don't understand what's so surprising about it. The ability to shave down without a strip scar is a necessity for many of us. I have been shaving my sides and back with a #1 guard since I was 16 years old. Link to comment Share on other sites More sharing options...
Dr. Alan Feller Posted August 13, 2015 Author Share Posted August 13, 2015 Dr. Feller if one has FUE and decides to go for FUT for the 2nd surgery, what are the implications? Not a "gotcha" question, since this is something you could advise based on your experience. Please forget FUT vs. FUE camps for a second. I am in both camps. And I have performed many FUT procedures on patients who have had FUE prior. Here are my observations: If the patient had FUE in the first surgery, particularly greater than 500-700 FUE, then the implications for a second via FUT are decreased yield. This would be due not only to absence of the follicles that were obviously extracted in the first surgery, but also to the fibrosis and shock loss of the hairs BETWEEN those original FUE extraction sites due to FUE trauma. Many of the remaining hairs would also be partially traumatized decreasing their chance of surviving an FUT procedure. It would be harder to numb the skin and the bleeding would be greater. This is because along with fibrosis comes an over compensation on the part of the body by increasing the amount of blood vessels and nerves in the damaged skin of the donor area. It would be harder to dissect under the microscope because the ubiquitous fibrosis will have infiltrated the entire strip disrupting the normally parallel orientation of the follicles. Also, the resistance of the skin will now be more variable making it yet again more difficult to cut as the blade may now shoot through the tissue instead of a slow and controlled glide. Finally, there will be more postoperative pain as those extra nerve ending fire. I've seen all of this many many times and have read the accounts of other patients who have also reported all of this online. I remember speaking with Dr. Hasson about this years ago and his words were "FUE destroys the donor area. Absolutely destroys it and makes a mess". I can confirm that observation word for word. Link to comment Share on other sites More sharing options...
Bill - Seemiller Posted August 13, 2015 Share Posted August 13, 2015 Dr. Bhatti,I'm sorry sir, but quitting in the middle of a debate is conceding defeat. Dr. Feller, I realize that this post is several pages back but I just wanted to chime in here. While your statement may be true, I do not believe that Dr. Bhatti is quitting in the middle of any debate. This "debate" is ongoing and in actuality has no end. I truly appreciate and respect Dr. Bhatti for coming on here and sharing his point of view, which in essence is contributing to an ongoing debate, not quitting before the end - since it never ends. To Everyone, I commend both Dr. Feller and Dr. Bhatti for sharing two different points of view. Ultimately, both of them are sharing your input based on their own experience. Personally, I believe the three forces constantly discussed here do exist but I also believe that some surgeons have been able to either get around or overcome them. In other words, I don't think these forces are always as detrimental as Dr. Feller makes them out to be. At the end of the day, it's one physician's experience against anothers. Assuming both are being honest, one could suggest that Dr. Bhatti has found a way to overcome these negative forces while Dr. Feller has not. On the other hand, if Dr. Bhatti has found a way to overcome these forces (assuming they are being understood correctly), he should do his best to demonstrate this to his physician colleagues, perhaps at the annual ISHRS meetings. He should also do his best to make his case in the court of public opinion (namely patients) to demonstrate this online. I would suggest educational videos that showcase an actual procedure with a detailed description of the extraction process that also shows each graft after harvesting and how it's placed into recipient sites (which also ultimately impacts growth yield). At the end of the day, I think this perpetual online debate is healthy and provides patients with a lot of information. Does it end the debate? No. Will Dr. Feller or Dr. Bhatti folding and agreeing with the other (which I don't believe will ever happen) end the debate? No, because other physicians continue to see things differently. Frankly, unless there is a scientific approach to FUE and a universal understanding of the procedure and how to overcome its hurdles, I believe the debate will continue for years to come. In the meantime, I thank you for everyone's contribution and look forward to reading additional input, hopefully that includes other physicians' opinions as well. Best wishes, Bill Link to comment Share on other sites More sharing options...
Bill - Seemiller Posted August 13, 2015 Share Posted August 13, 2015 Dear Dr Feller, I think it has everything to do with this topic. The last I heard, this was a two way debate over both the advantages and disadvantages of both procedures. You have made some claims as to what you believe are advantages of FUT over FUE, and seem to be putting the burden on Dr Bhatti to refute those. Dr Bhatti made a point as what he believes to be a disadvantage of electing FUT over FUE, that being the stretching of the crown/vertex area when you get a strip taken. I feel strongly that just as if you expect him to come out and refute your claims, it is not unreasonable to ask you to come out and refute his claims. With the greatest of respect sir, this is is not the Dr Feller show, and just because you don't believe that Dr Bhatti has succeeded in refuting anything you have stated, doesn't mean you shouldn't also attempt to refute all the claims made by him. I would try create another thread, but last time I tried to do that Bill shut me down and insisted we continue this debate on this thread. Bill, thoughts? Mav, I don't see any reason to shut this topic down as members are welcome and encouraged to continue sharing their opinion, as long as they do it respectfully. Topics are only closed when there are continued problems with members violating our terms of use. In this case, while there are some strong and heated opinions, I think the overall tone is educational and one can learn a lot by the comments each member shares, in particular, Dr. Feller and Dr. Bhatti. Frankly, I find it very interesting the two very different opinions of the procedure based on physician experience and frankly, I wish more physicians would get involved. The only problem I have is that on occasion, members get so heated with their opinion that they respond a bit defensively. Your conclusion seems to be to create a new topic to do what...discuss the same topic? What would be the point of that since the result will end up being the same with the same points shared again and again? Instead, let's keep this topic open and encourage members to be respectful when sharing their opinion. The end result will educational for everyone. Best wishes, Bill Link to comment Share on other sites More sharing options...
Bill - Seemiller Posted August 13, 2015 Share Posted August 13, 2015 How? Where? Absolutely nothing has progressed since the introduction of FUE in 2001. Dr. Feller, I have to disagree. There have been a number of improvements and enhancements to the procedure and its tools since its inception in 2001. More importantly, physicians have gotten better at actually performing the procedure which is evidenced by the results. Sometimes a particular tool or innovation isn't proof of progress. In some cases, it's that the actual results themselves that have improved, which is what really matters anyway. There are some surgeons still using manual punches and doing excellent work, moreso than those using newer, more "innovative" tools. But if you want to read more about some of the actual innovations that have demonstrated progress, I encourage you to read the following editorial content which has been updated in the last year. Be sure to click on links in the actual content as well which provides even more information. Follicular Unit Extraction - What Is It? The History of FUE Manual Versus Motorized Tools Sharp Versus Blunt Punches Automated FUE Hair Transplant Powered SAFE Scribe ARTAS Hair Transplant NeoGraft Hair Transplant uGraft Hair Transplant Other Popular FUE Extraction Devices FUE Implantation Methods and Devices The Evolution of FUE and Its Tools (Note that the "Feller Punch" is mentioned and discussed in this article and is certainly evidence of progress and innovation to the procedure.) Keep in mind that I'm not suggesting that all of the above devices and methods are evidence of increasing efficacy, but it does show progress which is what we are talking about. I know what you are going to say. But none of the above methods or tools overcome the three detrimental forces placed on the follicular unit during extraction. Whether that's true or not, that doesn't define progress. It also doesn't mean that results haven't improved. There are pros and cons to each extraction and implantation device and much of what occurs during a procedure including its success is largely due to the experience and skill of the surgeon using each tool. That said, given the vastly increased number of tools and method available, I do believe FUE has progressed and improved since its inception and results I've seen by many physicians recommended by this community is evidence of that. Best wishes, Bill Link to comment Share on other sites More sharing options...
Regular Member Eurofue Posted August 13, 2015 Regular Member Share Posted August 13, 2015 (edited) people who are satisfied w 50% yield to avoid a scar better be sure that their hair loss will not progress beyond a NW2 or 3 , or better hope that their "fall back " clean head shaven look won't become hopelessly outdated in 10 years time. I said "I WOULD BE HAPPY" with 50% compared to FUT the truth is that it's not that poor of a result and the use of body hair could surely make up the difference in yield between the both of them to be use as a filler. But all failing you haven't lost the backup of buzzing hair short. Some people I can see on here are happy to show their scar with short hair. I would definately not ever do that with a dirty great line sitting on the back it looks awful! ^which is the reason people are HAPPY to sacrifice grafts. We all know the success rate is not as good....we just don't care. Slightly less hair transplant success rate vs scar........no brainier for most people. Edited August 13, 2015 by Eurofue Link to comment Share on other sites More sharing options...
Senior Member delancey Posted August 13, 2015 Senior Member Share Posted August 13, 2015 Probably the weakest point of the so called FUE "fall back" is that MOST people simply don't look good with their head shaved. Very very few people who visit my practice can pull it off. Thanks for the participation Fortune, you make very valid points and good observations. We need more thinkers like yourself. While I agree that most people cannot pull off a completely shaved look, a buzz cut will always look better than long hair on the sides revealing a horseshoe pattern on top. FUE offers patients the option to sport a shorter hairstyle just in case things don't turn out well. I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own. Link to comment Share on other sites More sharing options...
Senior Member lileli Posted August 13, 2015 Senior Member Share Posted August 13, 2015 (edited) Even if we had scienctific studies they would be very limited since every doctor does fue a little differently. Hair transplant surgery seems to be as much art as it is science. Edited August 13, 2015 by lileli Link to comment Share on other sites More sharing options...
Regular Member Eurofue Posted August 13, 2015 Regular Member Share Posted August 13, 2015 So Dr Bhatti can paint the Mona Lisa but Dr Feller can only draw stick men in the world of FUE Link to comment Share on other sites More sharing options...
Senior Member mav23100gunther Posted August 13, 2015 Senior Member Share Posted August 13, 2015 Mav, I don't see any reason to shut this topic down as members are welcome and encouraged to continue sharing their opinion, as long as they do it respectfully. Topics are only closed when there are continued problems with members violating our terms of use. In this case, while there are some strong and heated opinions, I think the overall tone is educational and one can learn a lot by the comments each member shares, in particular, Dr. Feller and Dr. Bhatti. Frankly, I find it very interesting the two very different opinions of the procedure based on physician experience and frankly, I wish more physicians would get involved. The only problem I have is that on occasion, members get so heated with their opinion that they respond a bit defensively. Your conclusion seems to be to create a new topic to do what...discuss the same topic? What would be the point of that since the result will end up being the same with the same points shared again and again? Instead, let's keep this topic open and encourage members to be respectful when sharing their opinion. The end result will educational for everyone. Best wishes, Bill Hi Bill, It wasn't my conclusion, it was Dr feller who refuses to discuss the potential of the crown stretching on this thread. He asked that a new thread be created to discuss that. So Dr Feller, can you please provide your thoughts on what Dr Bhatti claimed about the crown area stretching with strips? Link to comment Share on other sites More sharing options...
Senior Member mav23100gunther Posted August 13, 2015 Senior Member Share Posted August 13, 2015 I said "I WOULD BE HAPPY" with 50% compared to FUT the truth is that it's not that poor of a result and the use of body hair could surely make up the difference in yield between the both of them to be use as a filler. But all failing you haven't lost the backup of buzzing hair short. Some people I can see on here are happy to show their scar with short hair. I would definately not ever do that with a dirty great line sitting on the back it looks awful! ^which is the reason people are HAPPY to sacrifice grafts. We all know the success rate is not as good....we just don't care. Slightly less hair transplant success rate vs scar........no brainier for most people. If you are bankng on body hair to compensate for losing 50% of potential grafts, then you are gravely mistaken. The growth rate is not the same and I keep hearing that you that's it's basically like having pupes on your head. If body hear was really that viable, then having to ever buzz down when all else fails would be a non-factor for folks no? Link to comment Share on other sites More sharing options...
Dr Blake Bloxham Posted August 13, 2015 Share Posted August 13, 2015 Mav, Agree with your assessment of BHT. This isn't a viable option for the vast majority of patients, and the growth rate (30-40% with everything averaged) isn't worth the potential scarring in most cases. Dr. Blake Bloxham is recommended by the Hair Transplant Network. Hair restoration physician - Feller and Bloxham Hair Transplantation Previously "Future_HT_Doc" or "Blake_Bloxham" - forum co-moderator and editorial assistant for the Hair Transplant Network, Hair Restoration Network, Hair Loss Q&A blog, and Hair Loss Learning Center. Click here to read my previous answers to hair loss and hair restoration questions, editorials, commentaries, and educational articles. Now practicing hair transplant surgery with Coalition hair restoration physician Dr Alan Feller at our New York practice: Feller and Bloxham Hair Transplantation. Please note: my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician. Link to comment Share on other sites More sharing options...
Regular Member Eurofue Posted August 13, 2015 Regular Member Share Posted August 13, 2015 If you are bankng on body hair to compensate for losing 50% of potential grafts, then you are gravely mistaken. The growth rate is not the same and I keep hearing that you that's it's basically like having pupes on your head. If body hear was really that viable, then having to ever buzz down when all else fails would be a non-factor for folks no? I'm guessing you didn't fully read what I wrote. "The truth is that's it's not that poor a result" What is the difference in yield generally 10% ? I realise there can be failures so I'm not talking about those. Just a rule of thumb or mean value Link to comment Share on other sites More sharing options...
Senior Member lileli Posted August 13, 2015 Senior Member Share Posted August 13, 2015 If you are bankng on body hair to compensate for losing 50% of potential grafts, then you are gravely mistaken. The growth rate is not the same and I keep hearing that you that's it's basically like having pupes on your head. If body hear was really that viable, then having to ever buzz down when all else fails would be a non-factor for folks no? Not every surgeon offers it as an option s many people don't know its an option. Link to comment Share on other sites More sharing options...
Dr. Alan Feller Posted August 13, 2015 Author Share Posted August 13, 2015 (edited) Hi Bill, It wasn't my conclusion, it was Dr feller who refuses to discuss the potential of the crown stretching on this thread. He asked that a new thread be created to discuss that. So Dr a Feller, can you please provide your thoughts on what Dr Bhatti claimed about the crown area stretching with strips? Mav, I already answered this question, but I'll do so again. The issue of so-called "crown stretching" is a non-existent phenomenon. It was a distraction invented by Dr. Bhatti to find something, anything, to throw at FUT to discredit it on this thread. Have you ever seen any posts online of patients discussing this or even complaining about it? None. I've never had a patient of mine nor anybody else's come to my office and complain of "crown stretch". And the reasons are obvious. Let's say Dr. Bhatti's numbers are correct (although I have no idea where he got them from). Then you are looking at about a 5mm "stretch" in the skin from the donor scar all the way up to the crown. This 5mm will be distributed throughout the scalp and not result in 5 mm of displacement several inches away. Dr. Bhatti's diagram was incorrect and disingenuous because he treated the donor in his diagram like a bed sheet. A one inch pull on one end results in a one inch pull on the other end. The difference is, the skin is attached to the skull all along its length and it stretches so pulling on one end does not easily translate to the other end. Think of a rubber band bonded to the surface of a table at several points. Then pull on one end. See how well it translates to the other. Not well, thankfully. Another disingenuous thing about his diagram is that in the "after" diagram there is no hair on the patient. The whole idea of the surgery was to put hair on the top of the head and it is in absence in his after diagram. So let's say the guy is a stage 7 as depicted in the diagram. Do you think it matters if he has an extra 5mm of crown from stretch (if that's really happening) if the front half of his head went from cue ball to puffy hair? Of course not. Again, Dr. Bhatti just put this out there to present some sort of equivalence in detriment between FUT and FUE and avoid answering my questions. Did he really stop performing FUT due to this heretofore unheard of complaint or phenomenon? Was the dreaded "crown stretch" something he discussed with his patients during his past life as an eeeevil FUT surgeon and included in his informed consent? I highly doubt it. Or did he just invent it for the purposes of this thread? He was trying to find an equivalent negative in FUT to compare with the very real detriments of FUE that I have been discussing in great detail and without any substantive opposition on his part. And he failed because the three detrimental forces of FUE are real and I have been describing and discussing them for 14 years. They also explain the very real complaints by very real patients online as to why most FUE results are inferior to their equivalent FUT counterparts. The only stretching going on here is with the truth. Edited August 13, 2015 by Dr. Alan Feller Link to comment Share on other sites More sharing options...
Senior Member hairshopeing Posted August 13, 2015 Senior Member Share Posted August 13, 2015 Dr feller a subtle but noticeable change as now MOST fue results aren't as good as strip!! Before it was ALL now it's most the truth is actually SOME! Also intestine that Dr hassan said to you fue destroys the donor area! As I belive if I'm not mistaken that it's now offered by Dr hassan and there is a current fue patient blogging on this site and another for Dr wong! Also still no answer to the reasons lorenzo erdogan feriduni Marras reddy are showcasing and have been for years excellent fue results with patients receiving several passes with extensive loss prior to the procedures! How are they doing it? Please tell us all in the peanut galley! Also like to see some new results from yourself in the same type of demonstration these Dr's do, HD pictures,all angles,hair line exposed combed back! Thanks in advance! Link to comment Share on other sites More sharing options...
Senior Member Yonex Posted August 13, 2015 Senior Member Share Posted August 13, 2015 I think both techniques have their place in the right hands However looking through the 'patient posted results' on this forum I have noticed the following: Dr Bhatti's FUE results seem hit and miss to me, some good , some poor and then a fair amount of patients stop posting for one reason or another, so we can only speculate wheter results have been good or bad here Dr Fellars FUE, I can't find any Now, for FUE and Strip patient posted results from other recommended doctors I would say there are way more dissatisfied FUE patients than strip ones Again this is just my own conclusion from what I've seen on this site in the patient posted section So I would conclude from this that strip is more consistent than FUE Link to comment Share on other sites More sharing options...
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