FUT is more popular than FUE

[Mick50]

Getting back to the original title of this thread 'FUT is more popular than FUE' if anyone cares to checkout the threads posted by patients on this website say for the last 5 years I think the FUE cases come out on top although most of them are in Europe and Asia it must be said ,

maybe the title of this thread should read 'FUT is more popular than FUE in the USA'

[Dr Tejinder Bhatti]

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.

 

My basic training is as a plastic & reconstructive surgeon and I wandered all over the United States from 1997-2001 trying to learn the pearls of cosmetic plastic surgery for which I visited Drs Sherrel J Aston and Daniel Baker in their Manhattan hospital, Dr Ian Jackson of Detroit to learn how to manipulate the skull, Dr Bhangoo in Buffalo to learn all the tucks I needed to learn and last but not the least I spent time with DrsTessler and Aronovitz in Southfiled, Michigan to learn the tricks of FUT hair transplant surgery.

I never knew all the principles of nips and tucks that I would learn would come to naught and have no meaning and set me thinking after your sweeping statement that skin does not stretch, Dr Feller.

Well, how does facelift, necklift, tummy tuck, body lift, and even scalp reduction work then?

Well if crowns won't stretch , can you please throw some wisdom on why they do not in light of above accepted principles of plastic surgery!

[Dr. Alan Feller]

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

 

Yes. You got it !

 

You don't see my FUE results online because they are not megasessions and not as interesting to look at or report on. Successful strip cases are much more satisfying to post, but people have grown bored with seeing FUT results. Like I wrote in the first post of this thread: FUT doctors make getting good results seem as exciting as a trip to Pittsburgh. After all, how many before/after pictures can you look at before they all begin to look the same?! 17 years ago ultra refined dense pack procedures were new. They were the excitement of the day, and thus the procedure became standard. The same is not happening with FUE after 14 years.

 

 

Most of my FUE procedures are filler or repair work, like the one I did this past Tuesday. But if you could go back ten years you would have seen about 50 of my patients online at any one given time. Large cases, too. Lots of FUE and FUT momentum. But I learned that FUE just did not fare as well as FUT patients in the end. So I decided that if a patient was a candidate for an FUT case when large numbers were concerned, then that's really what he should have.

 

I'm glad you're seeing the real story now and did it through your own research. The truth is, the difference between FUE and FUT is even greater than what you have found or could find online.

 

Thank you very much for taking the time and participating. It counts very much.

Edited August 13, 2015 by Dr. Alan Feller

[Dr. Alan Feller]

Getting back to the original title of this thread 'FUT is more popular than FUE' if anyone cares to checkout the threads posted by patients on this website say for the last 5 years I think the FUE cases come out on top although most of them are in Europe and Asia it must be said ,

maybe the title of this thread should read 'FUT is more popular than FUE in the USA'

 

Mick,

I think it's fair to claim that FUE appears to be more popular outside of the United States. But I think it only appears that way.

 

If you look at the number of FUE only clinics and compare to either FUT only clinics or FUT/FUE clinics you will see there are very few more now than there were five years ago. I would venture to say no more than a dozen. If you look at the ISHRS listing of doctors the number European and Asian clinics in total exceed this number by orders of magnitude.

 

So who is performing all this demographic changing FUE? Unless we believe that all the FUT clinics and the few FUE/FUT clinics have stopped working for the past five years we can not conclude that FUE has even matched, much less exceeded FUT or FUT/FUE.

 

In the United States there are only three stand alone FUE only clinics that I am aware of. There may be a few more, but they are not established players. But even if they were the number of patients they would be doing still couldn't compete with the number being turned out by established FUT clinics across America.

 

The reason is obvious. FUE is simply not as reliable or as good as FUT due to inherent trauma associated with the FUE procedure as I have exhaustively outlined on this thread alone.

 

Laymen want what they want. Who doesn't want a cut-free or scar-free surgery? I know I would. But FUE is not either of these things despite the blatant innuendo and often time outright lie that it is. It is also not more "advanced" than FUT simply because it came out later in time. It is an ALTERNATIVE to FUT, not a substitute. And this alternative has additional risks and consequences that patients need to know about. Not only should it's drawbacks be clearly outlined in black and white before procedures, but also needs to be accepted and understood within the online HT culture. To date, the culture is hostile and intolerant of being told the realities of FUE. But slowly but surly people are becoming convinced and are starting to question their original belief about what FUE and FUT are.

 

That's the point of this chat site. If it were all agreement and high fives, what would be the point?

[Dr. Alan Feller]

My basic training is as a plastic & reconstructive surgeon and I wandered all over the United States from 1997-2001 trying to learn the pearls of cosmetic plastic surgery for which I visited Drs Sherrel J Aston and Daniel Baker in their Manhattan hospital, Dr Ian Jackson of Detroit to learn how to manipulate the skull, Dr Bhangoo in Buffalo to learn all the tucks I needed to learn and last but not the least I spent time with DrsTessler and Aronovitz in Southfiled, Michigan to learn the tricks of FUT hair transplant surgery.

I never knew all the principles of nips and tucks that I would learn would come to naught and have no meaning and set me thinking after your sweeping statement that skin does not stretch, Dr Feller.

Well, how does facelift, necklift, tummy tuck, body lift, and even scalp reduction work then?

Well if crowns won't stretch , can you please throw some wisdom on why they do not in light of above accepted principles of plastic surgery!

 

Dr. Bhatti, I gave you several chances to engage me in debate and you refused to do so. You quit. I'm a "stone" remember? So instead of trying to engage me to win points in a contest you started but refused to finish, why don't you spend at least some of your online time addressing the viewers and posters of this site? I am not the only person reading this thread as evidenced by the 1000 or more hits it is getting every DAY.

 

Several very vehement FUE only posters have changed their position since the start of this thread. Perhaps your views are beginning to soften as well.

[Bill - Seemiller]

Dr. Feller, Dr. Bhatti and All,

 

I know this is a highly popular topic but I hope you will go back and read and respond to the posts I made on page 64. I'd really like input on the comments I made and links I shared regarding the advancements to FUE over the last decade plus.

 

Best,

 

Bill

[Melvin- Admin]

Dr. Bhatti, I gave you several chances to engage me in debate and you refused to do so. You quit. I'm a "stone" remember? So instead of trying to engage me to win points in a contest you started but refused to finish, why don't you spend at least some of your online time addressing the viewers and posters of this site? I am not the only person reading this thread as evidenced by the 1000 or more hits it is getting every DAY.

 

Several very vehement FUE only posters have changed their position since the start of this thread. Perhaps your views are beginning to soften as well.

 

Way to avoid the question Dr. Feller, instead of answering the question you've ever so cleverly tapped around it like a world class lawyer, in regards to the crown stretching you said Dr. Bhatti was disingenuous in his remarks, you said you've never had a patient who's crown stretched, you never answered whether or not this could happen. Very clever Dr. Feller, I'm seriously impressed with how crafty you are, I really mean it when I say you'd make a good lawyer, instead of answering the question outright like you've so vehemently have demanded Dr. Bhatti do, you've then again shifted focus on his presentation of the question i.e the diagram at an attempt to shift the readers focus away from your answer which wasn't an answer at all. I look forward to Dr. Bhatti engaging with you more. For those who've changed their opinions on FUE I seriously hope they do their own research before jumping to conclusions based on one doctors opinion.

[adonix]

 

Dr Fellars FUE, I can't find any

 

 

 

Here is one of dr. Feller's FUE cases (~2000 grafts in total, much larger than 700 grafts he claims as acceptable)

 

http://www.hairtransplantnetwork.com/blog/journal.asp?CopyID=5942&WebID=1787&ProcID=4023

[adonix]

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.

 

Noted and thanks.

 

Just like every other patient, I am only interested in getting the best result possible with minimum risks.

 

A friend of mine had FUT. His scar is ~2mm at most, meaning fantastic by FUT standards. However he cuts his hair very short and when I first saw it (I did not know he had a HT, nor much about HTs at the time), it looked scary. I thought he had a brain surgery.

 

I am of opinion that if a reputable surgeon is chosen with a proven track record, FUE can provide similar results to FUT. Are there risks? Of course, but I personally see more risks with FUT. If I can get 6-7000 grafts with FUE, good enough for me + I can still cut my hair very short.

[Dr. Alan Feller]

Repeat

[Dr. Alan Feller]

Here is one of dr. Feller's FUE cases (~2000 grafts in total, much larger than 700 grafts he claims as acceptable)

 

Hair Restoration Websites

 

Adonix,

 

That patient of mine from five years ago is exactly the reason why I identified and try to minimize the three detrimental forces of FUE.

 

Look at the post op photo of that case. Absolutely beautiful. Looks no different than my typical dense FUT cases. But the growth was easily only about 50%. Why?

 

I removed the grafts with the greatest of care. By 2010 I already had 9 years of FUE experience under my belt. I had even created my own tools and protocols and was included in Unger/Shaprio's HT text specifically for FUE. I showed Dr. Unger himself how to remove his first FUE. I had given lectures and demonstrations at ISHRS meetings and for other doctors in my clinic and theirs. By all accounts I knew what I was doing. So why the poor results?

 

The answer had to be damage during the extractions themselves OR his particular physiology. The so-called "X" factor. Assuming it was somehow my fault I just offered him another surgery for free to fill it in and thicken it up. He accepted. But this time I decided to use a larger punch. I think I went from a .9mm punch to 1.0mm punch. Or, I decided not to do any trimming of the grafts once removed from the donor area as I usually did. Or maybe both. I'm not sure because it was five years ago, but the idea was to not do the exact same thing I had during the first surgery. If you read the link to the website he even mentions my change of strategy for him.

 

And even after a second beautiful procedure his results still weren't on par with FUT. But, he was sure the second procedure grew better than the first. So that helped to confirm that indeed the FUE was too harsh on the grafts causing a lower yield. Less trauma on the grafts during round two and thus better yield.

 

I never did see the final results of the second surgery-but obviously he still wasn't happy. By then he wanted to try his luck with another surgeon, and I don't blame him.

 

Unfortunately, he only posted as far as 4 months after his surgery with my friend Dr. Rahal- who himself did his first FUE in my office. Then the patient stopped posting. So perhaps he finally grew well and moved on; or, his results were no better than mine and he just gave up. I should think, however, that he would have posted a triumphant conclusion if that was the case. But I don't know.

 

Throughout this whole situation I couldn't help but thinking that if he had FUT he would have been "one and done". Also though, could another FUE doctor do a better job than I? If so, how? What could I have done differently. I honestly could not say.

 

But I know for a fact that nobody else could do anything differently either. Not then and not now. And that is part of the point I am trying to make in these FUE posts. If someone claims they can do a better job than I did on this patient through the use of better instruments or technique then it is their obligation to prove how and with what. But to date nobody has.

 

To improve his yield on the second round I reduced the detrimental FUE forces by increasing the size of the punch, leaving more bulk around the grafts, and slowing down the extraction process considerably. And it worked. So how in the world can the FUE-only megasessionist do better by decreasing the size of the punch, stripping the bulk away down to skeletonization, and speeding up the extraction process?

 

The answer is, they can't. Luckily, SOME patients have very tolerant grafts and fortunately there are some very dedicated and skilled FUE practitioners out there. When those two combine you get some VERY impressive results. But no matter how good or bad those FUE results are, for the reasons stated above, FUT would have looked better and with far less risk. But MOST FUE practitioners are not that dedicated nor gifted. Instead, they will sacrifice their patient's donor area by 50% to get enough grafts out to complete the case. The patient of course would have absolutely no idea how much of their donor area was sacrificed. But I do, because I've seen these patients in my office.

 

They may have been given a thousand grafts, but the entire donor area had been extracted from leaving a fibrotic mess. It is the "success to failure" ratio that counts.

 

Am I the only doctor on here with FUE patients that have grown poorly? I think not. There are some doctors very very close to this thread who have more than one RECENT patient right now showing their poor FUE results and sharing their disappointment. Difference is, I don't claim FUE has been perfected and that therefore failure was due to the stars or that it was the patient's physiology that was at fault.

 

I am one of the only capable and experienced FUE doctors to admit openly that there are basic detriments inherent to the procedure of FUE and therefore should not be offered as a substitute for strip. I am also a capable and experienced FUT surgeon so I am not dependent on a single modality for my livelihood and can be more transparent than those who do rely on just one modality.

 

Look at that patient you posted of mine and ask yourself if this result is exclusive to Dr. Feller or to all FUE practitioners.

__________________

Feller Medical, PC

Great Neck, NY

 

Dr. Alan Feller is a member of the Coalition of Independent Hair Restoration Physicians

 

Providing FUT, FUE, and mFUE

[lileli]

So some people have more delicate grafts than others. Is there anyway to determine that beforehand?

[Dr. Alan Feller]

So some people have more delicate grafts than others. Is there anyway to determine that beforehand?

 

Wouldn't that be nice ! Do that and you are an instant multi-millionaire!

 

Dr. Rassman came up with the "FOX test" wherein he picks a random area to extract from and gauges the difficulty or success of the extraction. Problem with it is that one or even five random areas may not be representative of all the grafts. So to me it serves no purpose. I've had plenty of patients who would have failed a FOX test but went on to have excellent FUE procedures and result. Conversely, I've had FOX positive guys who had terrible FUE procedures that had to be stopped.

 

By the way, to get as close to what you asked as I can I do test runs on my patients scalp during the procedure. If at anytime I feel the success to failure ratio is lower than 70% I stop the case. That is also in my informed consent form that the patient reads, acknowledges, and signs before we do a procedure. If we are going to take a risk, I want the patient to KNOW what's going on and what we will do if things are going south. Problem with many FUE only doctors is they don't want to give up the case so they push through it anyway with Success to Failure ratios of even lower than 70%.

[Michael Vories, MD]

As long as the grafts were inspected and transection was minimized, then in my experience traumatic placement was most likely the cause of your poor FUE results. The grafts are very fragile, and can not be roughed up with forceps placement.

[Dr. Alan Feller]

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

 

Bill,

I viewed the links and had read them before.

 

The only novel device that address the three main detrimental forces are the Feller Punches. The only unique technique to address the Traction force and Compression force is my Perforation Technique. And even with that said, neither has succeeded in overcoming the detrimental forces. They have helped, but not to the point where FUE could now be seen as a substitute for FUT.

 

The other "advances" just make the job easier and faster for the doctor at the expense of donor area. No diminution in any of the three detrimental forces is embodied in any of the other inventions.

 

Also, most of these "technologies" are ten years old already. Nothing new. So what is new to the FUE megasessionist today that didn't exist ten years ago? NOTHING.

 

When you are evaluating a technology just ask if it decreases any of the three detrimental forces. If it doesn't, then it is contributing very little to the advancement of the FUE field. But the invention that ultimately does significantly diminish any or all of the three forces will be worth millions. Perhaps billions. But to date none exist and no FUE instrument billionaires.

[Dr. Alan Feller]

As long as the grafts were inspected and transection was minimized, then in my experience traumatic placement was most likely the cause of your poor FUE results. The grafts are very fragile, and can not be roughed up with forceps placement.

 

Dr. Vories, that is not likely to be the case.

 

The cause of the poor results was in the extraction of the grafts - that is the most obvious weak link in the FUE extraction chain and the only variable I changed.

 

In the case of my patient with the 50% growth he grew better after his second procedure than his first yet the placing was exactly the same by the same people and the same instruments.

 

I don't care for implanter pens as they are bulky, cumbersome, slow, and expose the graft to too much downward compression force. Since it is essentially a needle on a handle the needle will dull rather quickly in fibrotic skin. Worst of all, doctors are sterilizing them instead of disposing of them which is fine if it is a regular surgical instrument. But these things have lumens which can't be scrubbed prior to sterilization and may have tissue and debris within. Lumened instruments like needles should always be disposed of, not reused. I throw all my FUE punches away for the same reason.

[1978matt]

I watched those videos and heard NOTHING that contradicted Dr Feller. To summarise into bullet points what Dr Ron said in the interview:

 

 

• 
  
• Some doctors are doing good FUE.
  
• FUE had similar early problems to when FUT first introduced.
  
• FUE grafts are weaker.
  
• Doctors [at the FUE Mediterranean Conference] where there showing techniques they use to 'try' to get similar growth to FUT.
  
• Disagreed with Dr Lindsey suggestion that on average, FUE results '40% less full' than FUT. Felt it was nearer 20%.
  
• FUE grafts are more fragile than FUT grafts.
  
• A lot of steps needed to get 80-90% FUE graft survival.
  
• FUE grafts weak.
  
• Good FUE can have a very close growth rate (compared to strip) at least 80% of the time.
  
• Increased risk of lesser growth with FUE.
  
• FUT still 'has the edge' over FUE.
  
• Isn't sure yet exactly how many grafts you can get using FUE exclusively.
  
• Believes doing FUT first then FUE gets more overall grafts.
  
• Lorenzo/Koray showing consistent results in 5-6,000 range.
  
• Doesn't yet know how consistent the 8,9,10,000 graft cases can be.
  
• Said that there are not enough cases in this range yet to know how consistent they are.
  

 

 

Yes I actually made the same point, but my post was deleted because I used his initials to identify him. Well worth checking out those videos, Dr Shapiro is more supportive of Dr Bhatti than Dr Feller.

[Eurofue]

I'm guessing if people are getting better results with the same techniques from 10 years ago they fall into the category my mother always used to tell me "practice makes perfect"

[Michael Vories, MD]

Dr. Feller-

 

Implanter pen needles are disposable, and should never be used on separate patients. I know of no physician who reuses implanter needles. If this is the case, they are using them incorrectly.

[Dr. Alan Feller]

I'm guessing if people are getting better results with the same techniques from 10 years ago they fall into the category my mother always used to tell me "practice makes perfect"

 

So how many doctors have 10 years of FUE experience?

Anyone on this thread?

[Eurofue]

So how many doctors have 10 years of FUE experience?

Anyone on this thread?

 

Who said 10 years experience I was referring to what you said in a previous post about the technique being 10 years old

[hairshopeing]

Hi matt

Saying the above condradicts NOTHING Dr feller has said isn't right if you can show me where on this thread he said that good fue results are close to strip and that 80% of the time in very close to strip yield in the right hands that Koran and lorenzo are producing consistent 5000 _6000 graft procedures and that several steps are needed for 80-90% yield is in this thread I'd be interested because I dint remember reading that anywhere on this thread had Dr feller said the above I dint think this would of been a problem as most of that I'd probably correct but from what iv read none of them statements were made!!

 

Congrats on your outcome by the way great transformation one of the best I've seen by strip or fue!! You chose well koniour is indeed one of the best!!☺

[hairshopeing]

Hi matt

How can you say nothing of the above contradicts what Dr feller said can u show me on this thread where he said that fue yield close to strip yield in the right hands 80% of the time and Koran and lorenzo are consistent with there results upto 5000 6000 grafts or that several steps are needed to get 80-90% yield by fue??

 

If he had said the above I think most would agree with it myself included but he hasn't! Unless iv missed it!

[hairshopeing]

Sorry didn't think the first post went through got a notification saying it was duplicate!

[hairshopeing]

Koray not Koran bloody pre txt