FUT is more popular than FUE

[BaldingBogger]

Bill,

 

The point is that Dr. Feller was saying that bad FUE scarring is a normal occurrence. I offered an opportunity to show these cases as they come in, in real time, as he must be seeing these cases in person else he would not have any legitimate reason to make such a statment. This is what I have been doing to show the mix of cases I get on a daily basis, verified with the newspaper date in the images. These are not "results" as you put it but rather pre-operative photos to show the state of the donor region as the patient comes in. They are not cherry picked, they are not selected. They are what they are, random and mor importnatly, daily.

 

That is the very crux of the argument by Dr. Feller, that there is so much bad scarring from FUE so I have set the stage for him and I to back up at least this part of our respective points with the necessary visual evidence.

 

When he asked me to take up his challenge to disprove the 3 forces I did participate. Now it is his turn to reciprocate.

That would be a gentleman he is.

However, if you wish me to stop posting, I will honor the forum; but with a note of dissent on record.

 

Bill, As far as marketing is concerned, I don't even use a link to my website in my signature block.

 

Also, it is also a fact that I was not too eager to join this thread. You know that.

 

Best wishes.

 

Dr Bhatti, Thank you for your input on this thread and daily cases which are highly relevant IMO in refuting some of Dr Fellers claims. I also recall Dr Feller stating earlier his work frequently consisted of repairing bad FUE work with horrendous scarring.? Its quite telling that he has not offered any real time daily examples like you have. All we have had is hot air.

 

Your posts are also very valuable as it seems to show lots of sub par FUT results coming in for repair. My main problem with the impression coming off these marketing threads is the claims that FUT is a guarantee 'gold standard' result. It is not and is subject to lots of variables (surgeon choice just being one) just like FUE. The difference being after a failed FUT your options are decidedly more limited in your inability to shave down without being 'branded for life' with a linear scar on display.

 

 

This is the truth that the FUT doctors on this thread are not telling prospective patients and very much downplaying from what i can see. And are being just as 'disingenuous' in the same way they label other FUE doctors.

Edited August 26, 2015 by BaldingBogger

[Dr. Alan Feller]

Hi Bill,

 

With regards to the photo challenge;

 

I think Dr Bhatti is actually challenging Dr Feller to show whether his patients actually have the FUE scarring he talks about as if it is common occurrence. .

 

That is not his challenge. His "challenge" is to compare the shear number of patients who have had FUT and seek his "repair" services to the shear number of patients who have had FUE and seek my "repair" services.

 

As I already wrote:

 

1. There are thousands of FUT patients for every one FUE patient so it is absurd by the numbers. To not understand this is to either be disingenuous or suffering from a severe learning disability.

 

2. I nor anybody else offers to repair moth eaten FUE donor areas or failed growth in recipient areas. He's asking for me to present patients who visit me for a repair procedure that isn't performed and one that I don't offer.

 

3. He conflates people visiting him for FUE services who have simply had FUT in the past with patients seeing REPAIR from him. In reality, these patients just want more grafts in their recipient area.

 

4. None of the patients he showed with the Tribune slapped in front of it demonstrated a recipient area "repair" or a donor area "repair". He didn't fill a single scar with FUE, although in two of his photos the patients could have benefited from such FUE repair-which is one thing I believe large FUE is designed for.

 

As far as bad FUE scarring from megasession FUE being a rare occurrence, I can assure you the opposite is true. ALL patients with megasession FUE have massive scar tissue. If the patient was selected properly and had enough donor density then the scarring can be hidden with some hair. But if the patient wasn't filtered properly, as most are not, you are left with a destroyed donor area and very thin hair left, if any , to cover it.

[Dr. Alan Feller]

50,000 views and over 1,000 replies. Another milestone.

 

I think at this point it is fair to say at best FUE is still controversial and FUT retains it's title as king of Hair transplantation

[California]

50,000 views and over 1,000 replies. Another milestone.

 

I think at this point it is fair to say at best FUE is still controversial and FUT retains it's title as king of Hair transplantation

 

Dr. Feller,

 

Congratulations! I know that the "number of views" makes you happy and hence I am happy for you:)

 

In regards to your "victory claims"......again, unsubstantiated, unilateral, one sided, unproven, ambiguous, arguable, debatable and totally biased. That said, if such claims make you happy.....then we are happy for you!

 

 

Best regards,

California

[Melvin- Admin]

50,000 views and over 1,000 replies. Another milestone.

 

I think at this point it is fair to say at best FUE is still controversial and FUT retains it's title as king of Hair transplantation

 

In your opinion

[Dr. Alan Feller]

Dr. Feller,

 

Congratulations! I know that the "number of views" makes you happy and hence I am happy for you:)

 

In regards to your "victory claims"......again, unsubstantiated, unilateral, one sided, unproven, ambiguous, arguable, debatable and totally biased. That said, if such claims make you happy.....then we are happy for you!

 

 

Best regards,

California

 

Unilateral? Nice try, but not so much.

 

After 50,000 views, over 1,000 replies, and one incredibly frightening video by your doctor demonstrating EXACTLY what I'm talking about, I'd say controversial is a fair word to describe FUE.

[HairLostYears]

The Bhatti video, yea...enough to give a transplant neophyte pause. Like Doc was bound and determined to make a scheduled tee time. The corralling of the follicles also reminded me it will be time to rake the leaves again soon enough. (Just jokes!).

 

But...

 

It did not make the prospect of a slice of jerky carved from the back of me any less repulsive in the mind's eye.

 

It just makes me reconsider doing anything. Poor me though, so miserable with my current situation!

 

Part analysis paralysis, I guess. Also part just feeling like I'm <expletive> no matter what.

[Sethticles]

600 of the replies is Feller repeating himself

[FUE2014]

Dr Feller in all honesty (no hyperbole) why do you think no other docs have come on here to support or refute your positions?

[Sethticles]

Dr Feller in all honesty (no hyperbole) why do you think no other docs have come on here to support or refute your positions?

 

Blake has

[gilgamesh]

 

Easy to setup? I don't think so, it will be far from easy. I can't seem to find your "rough" outlines of the method besides that you want a "good" peer reviewed study. That's easy to say.

 

Can you sketch a more detailed study which would answer the FUT vs FUE debate (yield), and would be easy to set up? Pretty impressive if you could make it happen.

 

You already start out well by mentioning the following point;

 

"Objective and unbiased third party.". I think we all know how easy it is to get a double blind peer reviewed study through which suffers from heavy bias. John P. A. Ioannidis has written an excellent piece about this which expands more deeply on all;

 

PLOS Medicine: Why Most Published Research Findings Are False.

Most downloaded paper on PLOS.

 

Anyway how further?

 

Yes, extremely simple. As in, so simple it's laughable. Read my first post. Almost no funding required outside of procedural work and a part time statistician.

 

Think about procedures comparing saline to silicone breast implants as an example to start with. Start with a defined end point. An earlier post of mine on this forum contained some of the rough details. I will elaborate later this week when I have more time.

[gilgamesh]

Sadly, I have no idea if your wish list will happen soon.

 

 

It will once the balance tips too far in one direction or the other, and the economic incentive re-emerges.

[Dr. Alan Feller]

The Bhatti video, yea...enough to give a transplant neophyte pause. Like Doc was bound and determined to make a scheduled tee time. The corralling of the follicles also reminded me it will be time to rake the leaves again soon enough. (Just jokes!).

 

But...

 

It did not make the prospect of a slice of jerky carved from the back of me any less repulsive in the mind's eye.

 

It just makes me reconsider doing anything. Poor me though, so miserable with my current situation!

 

Part analysis paralysis, I guess. Also part just feeling like I'm <expletive> no matter what.

 

You bring up a good point. No surgery is easy to watch. But try to tune out the repulsiveness of the surgery itself to focus on the trauma inflicted on the individual grafts. Now compare that to a linear strip being divided under 8 microscopes at the same time by 8 experienced technicians. No contest, and that's the part of the video I want people to focus on. Other than that, even a video of getting a mole removed is repulsive. I don't hold that against any practitioner, but I do hold what is clearly rough and rushed handling of tissue against them.

[Dr. Alan Feller]

Blake has

 

They don't have to comment. FUT is the gold standard and hasn't been "on trial" for the past 14 years. FUE has and is.

 

Try and make the same thread for FUT and see how far it gets. Think Lead Balloon.

 

The other reason is basically posters like yourself who attack doctors when they post an opinion different from yours. It's not worth it to them.

 

The real question is where are all the FUE doctors to refute my claims? Your doctor got roped in by a stupid mistake he and his rep made. At least Dr. Vories showed up to his credit. But he smartly avoided the real controversy details and backed away.

 

What you don't get, Seth, is there is no debate here. I KNOW the problems of FUE because i've been doing them for 14 years. I'm just very honest and open about it's shortcomings. FUT also has it's shortcomings, and I've written about them for years. But FUT has less than 5% of the shortcomings of FUE and is why it's still king and will remain king until those three detrimental forces of FUE are reduced or eliminated. That is the reality, the rest is just fluff.

[Dr Tejinder Bhatti]

@ Doctor Feller...can you provide examples what you would deem to be the normal scarring & donor area from an FUT procedure of roughly 4000 grafts?

 

@Dr. Bhatti, can you do the same for an FUE procedure.

 

Thanks

 

"gbhscot" I do not feel when you ask such a question you will ever get an honest answer. It is also true that if a hysician were to give an honest answer, you may not believe it!

Therefore, the best way to study the scarring produced by FUE and FUT is to post cases coming to you every single day.

Like for instance this 53 years old patient of March 2015 who received 3200 scalp grafts and 403 beard grafts for the hairline and midscalp and who is here with me today for coverage of his crown area.

You can clearly see the FUE scars. Even if you wear a size #1 trim hair, the scars will not be visible like an FUT scar would.You can also see the beard donor area.

And mind you he has darker skin characteristics. And compare him to my patient of last week whose picture I am again posting to show how a Caucasian scars after an FUE.

Honestly, in my practice, and in that of leading FUE surgeons the world over, I do not see much scarring in FUE as compared to similar subsets who have undergone FUT.

 

Dr Feller's pictures are culled from the internet and this is not a statement on the state of FUE today.

[wylie]

Props to Dr. Feller and Dr. Bhatti for showing up and having this discussion. Most doctors fear tread into any controversial topic. And let's admit it, whether or not we love or hate Trump, we respect he has the cojones to stand up there and speak without a teleprompter. Might be why he is currently obliterating his competition in the polls.

 

This thread is so long already, I only hope fanboys would make their point and then shut up, we don't need more pages of snark and gotcha commentary. It's usually apparent where one stands on the issue after one or two posts. The rest is just you bloviating to yourself.

[voxman]

It will once the balance tips too far in one direction or the other, and the economic incentive re-emerges.

 

Could be 5 years, could be 10.

 

Too bad we can't go to sleep until then. Unfortunately, rust never sleeps.

[HairLostYears]

You bring up a good point. No surgery is easy to watch. But try to tune out the repulsiveness of the surgery itself to focus on the trauma inflicted on the individual grafts. Now compare that to a linear strip being divided under 8 microscopes at the same time by 8 experienced technicians. No contest, and that's the part of the video I want people to focus on. Other than that, even a video of getting a mole removed is repulsive. I don't hold that against any practitioner, but I do hold what is clearly rough and rushed handling of tissue against them.

 

Yea, but it's hard to see big picture through a mind clouded with trepidation.

 

It would have to be through an "arrangement". Have me randomly chloroformed, to wake up 3 days later with a mummied noggin and post-op details taped to my chest. Something along those lines. Don't tell me it's a go though, just dismiss this suggestion and discreetly set the wheels in motion.

 

For real though Doc, it would take a lot to get me into your chair...even though it might be the best course for me.

[Kootrapali]

Wow bhatti Sir

 

You mean to say more than 90 percent (in general) will have these kind of negligible scars ..... ....?????? Or is this a special case? What does your experience say.?

I think this kind of scars tilt the scales quite a bit to the fue way......

[Swooping]

Yes, extremely simple. As in, so simple it's laughable. Read my first post. Almost no funding required outside of procedural work and a part time statistician.

 

Think about procedures comparing saline to silicone breast implants as an example to start with. Start with a defined end point. An earlier post of mine on this forum contained some of the rough details. I will elaborate later this week when I have more time.

 

Looking forward to your elaboration .

[California]

They don't have to comment. FUT is the gold standard and hasn't been "on trial" for the past 14 years. FUE has and is.

 

Try and make the same thread for FUT and see how far it gets. Think Lead Balloon.

 

The other reason is basically posters like yourself who attack doctors when they post an opinion different from yours. It's not worth it to them.

 

The real question is where are all the FUE doctors to refute my claims? Your doctor got roped in by a stupid mistake he and his rep made. At least Dr. Vories showed up to his credit. But he smartly avoided the real controversy details and backed away.

 

What you don't get, Seth, is there is no debate here. I KNOW the problems of FUE because i've been doing them for 14 years. I'm just very honest and open about it's shortcomings. FUT also has it's shortcomings, and I've written about them for years. But FUT has less than 5% of the shortcomings of FUE and is why it's still king and will remain king until those three detrimental forces of FUE are reduced or eliminated. That is the reality, the rest is just fluff.

 

Dr. Feller,

 

You might be a good FUT Surgeon but unfortunately you fall extremely short when it comes to basic courtesy, manners, politeness, professional etiquette, tolerance and human kindness. All through your "super star thread" that makes you "gloat" with pride, you have INSULTED folks that have "dared" to disagree with you. How dare you use the term "stupid mistake" for Dr. Bhatti and his Rep? Do you OWN this forum. Are you the "Supreme ruler" that can get away with anything and everything? Forum ADMINS, requesting you to take appropriate action. BUSA got kicked out for being rude.....can someone go over Dr. Feller's posts and put them through a "rudeness test".

 

Here is one example of Dr. Feller's insulting attacks that too on Mickey85, one of the biggest and most respected contributors on this Forum:

 

Mickey is simply an online bully and stalker. Also known in the parlance of the internet as a "Hater". He doesn't hate everybody, just those who disagree with him.

Sorry Mickey, but doctors are allowed to use this website and share their opinion unmolested by the likes of self appointed know nothing "experts" like yourself. I don't come on here to debate with the likes of you, although you hilariously think I do. I write to bring facts to newbies who don't know any better and might be influenced by you and your kind.

If you fancy yourself a consumer affairs expert and want to hold yourself out to the public as such, then stand accountable for

your words and offer your real name and address. (Post #123)

 

Ironically, recently Dr. Feller (after he realized that Mickey85 was quite knowledgeable in HT) for a change, complimented Mickey85 for his views!

 

Dr. Feller keeps on tooting his horn that "No FUE Surgeon has refuted this claims"....what he does NOT get is that NO ONE WANTS TO GET INSULTED BY HIM! How hard is that to understand? For the longest time, we (Darling Buds/Dr. Bhatti) stayed away from this thread because we knew how Dr. Feller responds to anyone that has the nerve to disagree with him. We just cannot forget our professionalism and etiquettes and respond in kind. We have been extremely tolerant so far and were hoping that the multiple reprimands that Dr. Feller got from the Forum Admins (including deletion of one of his posts) would help.....but unfortunately, it has NOT.

 

I have yet to see an apology from Dr. Feller to all the Forum members that he has insulted and attacked (including Mickey85, of course).

 

Last but not the least......his "FUE bashing" views remind me of a very famous saying in Hindi (Indian).....Naach na jaane, aangan teda (If a person is not a good dancer, he tends to blame the floor for being uneven).

 

Thanks,

California

[Dr Tejinder Bhatti]

That is not his challenge. His "challenge" is to compare the shear number of patients who have had FUT and seek his "repair" services to the shear number of patients who have had FUE and seek my "repair" services.

 

As I already wrote:

 

1. There are thousands of FUT patients for every one FUE patient so it is absurd by the numbers. To not understand this is to either be disingenuous or suffering from a severe learning disability.

 

2. I nor anybody else offers to repair moth eaten FUE donor areas or failed growth in recipient areas. He's asking for me to present patients who visit me for a repair procedure that isn't performed and one that I don't offer.

 

3. He conflates people visiting him for FUE services who have simply had FUT in the past with patients seeing REPAIR from him. In reality, these patients just want more grafts in their recipient area.

 

4. None of the patients he showed with the Tribune slapped in front of it demonstrated a recipient area "repair" or a donor area "repair". He didn't fill a single scar with FUE, although in two of his photos the patients could have benefited from such FUE repair-which is one thing I believe large FUE is designed for.

 

5. As far as bad FUE scarring from megasession FUE being a rare occurrence, I can assure you the opposite is true. ALL patients with megasession FUE have massive scar tissue. If the patient was selected properly and had enough donor density then the scarring can be hidden with some hair. But if the patient wasn't filtered properly, as most are not, you are left with a destroyed donor area and very thin hair left, if any , to cover it.

 

I'll address each point:

 

"1. There are thousands of FUT patients for every one FUE patient so it is absurd by the numbers. To not understand this is to either be disingenuous or suffering from a severe learning disability. "

"Thousands" of FUT to each FUE? From where do you find such a statistic? I have 300 patients per year so if there is a single thousand per every one of my own patients it means that there are 300,000 FUSS cases being performed each year worldwide and that is compared to my clinic alone. To compare it to the HUNDREDS of clinics (per the ISHRS statistics) then I think your statement is contains a slight degree of embellishment, no?

 

2. I nor anybody else offers to repair moth eaten FUE donor areas or failed growth in recipient areas. He's asking for me to present patients who visit me for a repair procedure that isn't performed and one that I don't offer.

No, I'm asking you to present your patients, regardless of their past procedures (if any), to show us how often you have patients that come in that happen to have bad FUE scarring as you claim. So far you have shown zero but instead have to pull images from random internet sources to back up your statement. I on the other hand have shown you my patients with, zero filtration, on a daily basis now.

 

"3. He conflates people visiting him for FUE services who have simply had FUT in the past with patients seeing REPAIR from him. In reality, these patients just want more grafts in their recipient area."

Call it what you will, repair or addition, it is irrelevant. They have come to me and I am sharing their cases for the sake of sharing.

 

"4. None of the patients he showed with the Tribune slapped in front of it demonstrated a recipient area "repair" or a donor area "repair". He didn't fill a single scar with FUE, although in two of his photos the patients could have benefited from such FUE repair-which is one thing I believe large FUE is designed for."

Again, it is to show what kind of patients walk through my doors on a daily basis. You miss the point, sir and instead you are offering excuses and fictitious statistics.

 

"As far as bad FUE scarring from megasession FUE being a rare occurrence, I can assure you the opposite is true. ALL patients with megasession FUE have massive scar tissue. If the patient was selected properly and had enough donor density then the scarring can be hidden with some hair. But if the patient wasn't filtered properly, as most are not, you are left with a destroyed donor area and very thin hair left, if any , to cover it."

It is just as much an issue for the patient to filter the clinic as it is for the clinic to filter the patient, which is why you are seeing the images that you have to search the internet for. Properly performed FUE will leave scarring, of course, just like any time one receives a paper cut or a scalpel cut, but the difference between a good clinic and a bad clinic is tremendous, which is my point to begin with. This issue you call a "confluence of scarring" is the result of larger punches used too close to each other and that is why you have such images to post to begin with.

 

I'll remind you that you have yet to prove that the three "detrimental forces" are in fact detrimental and cannot be overcome. This is your responsibility before it becomes mine to disprove. Until then we have visual evidence to show that your theory, and it is a theory, is wrong.

 

Best regards,

Dr. Tejinder Bhatti

[mav23100gunther]

I'll address each point:

 

"1. There are thousands of FUT patients for every one FUE patient so it is absurd by the numbers. To not understand this is to either be disingenuous or suffering from a severe learning disability. "

"Thousands" of FUT to each FUE? From where do you find such a statistic? I have 300 patients per year so if there is a single thousand per every one of my own patients it means that there are 300,000 FUSS cases being performed each year worldwide and that is compared to my clinic alone. To compare it to the HUNDREDS of clinics (per the ISHRS statistics) then I think your statement is contains a slight degree of embellishment, no?

 

 

 

 

I believe he was referring to FUSS cases that have been performed to date.

[mav23100gunther]

Dr. Feller,

 

You might be a good FUT Surgeon but unfortunately you fall extremely short when it comes to basic courtesy, manners, politeness, professional etiquette, tolerance and human kindness. All through your "super star thread" that makes you "gloat" with pride, you have INSULTED folks that have "dared" to disagree with you. How dare you use the term "stupid mistake" for Dr. Bhatti and his Rep? Do you OWN this forum. Are you the "Supreme ruler" that can get away with anything and everything? Forum ADMINS, requesting you to take appropriate action. BUSA got kicked out for being rude.....can someone go over Dr. Feller's posts and put them through a "rudeness test".

 

Here is one example of Dr. Feller's insulting attacks that too on Mickey85, one of the biggest and most respected contributors on this Forum:

 

Mickey is simply an online bully and stalker. Also known in the parlance of the internet as a "Hater". He doesn't hate everybody, just those who disagree with him.

Sorry Mickey, but doctors are allowed to use this website and share their opinion unmolested by the likes of self appointed know nothing "experts" like yourself. I don't come on here to debate with the likes of you, although you hilariously think I do. I write to bring facts to newbies who don't know any better and might be influenced by you and your kind.

If you fancy yourself a consumer affairs expert and want to hold yourself out to the public as such, then stand accountable for

your words and offer your real name and address. (Post #123)

 

Ironically, recently Dr. Feller (after he realized that Mickey85 was quite knowledgeable in HT) for a change, complimented Mickey85 for his views!

 

Dr. Feller keeps on tooting his horn that "No FUE Surgeon has refuted this claims"....what he does NOT get is that NO ONE WANTS TO GET INSULTED BY HIM! How hard is that to understand? For the longest time, we (Darling Buds/Dr. Bhatti) stayed away from this thread because we knew how Dr. Feller responds to anyone that has the nerve to disagree with him. We just cannot forget our professionalism and etiquettes and respond in kind. We have been extremely tolerant so far and were hoping that the multiple reprimands that Dr. Feller got from the Forum Admins (including deletion of one of his posts) would help.....but unfortunately, it has NOT.

 

I have yet to see an apology from Dr. Feller to all the Forum members that he has insulted and attacked (including Mickey85, of course).

 

Last but not the least......his "FUE bashing" views remind me of a very famous saying in Hindi (Indian).....Naach na jaane, aangan teda (If a person is not a good dancer, he tends to blame the floor for being uneven).

 

Thanks,

California

 

I thought the high points were when he referred to us as peanuts in a peanut gallery and then at one point insinuated a "severe learning disability"

[Dr Blake Bloxham]

Seth,

 

Thanks for the shout out!

 

I wanted to take this opportunity to share something that I've actually posted on the boards a few times before. Seems like a good time to kind of explain my position and and experience with these two procedures.

 

I think I have probably the most unique perspective on this entire "FUT versus FUE" debate because of my work in both the "online world" and "clinical world." For five years, I dealt with the online world of FUE. I answered countless questions about it on the forums; I wrote articles for HTN, HRN, the hair loss learning center, and Q&A blog about FUE; and I really thought I developed a solid understanding of the technique, what it could offer, and where it was headed. And what were my conclusions? I thought the same thing many other members think: FUE is "the future." I thought it was on par with strip and didn't think there were any obvious drawbacks or limitations. This is the persona of FUE online, and it's a powerful one. I was convinced. So much, in fact, that I was initially planning on starting an FUE only practice.

But then I had the opportunity to step out of the online world and into the real clinical world of surgical practice.

 

And here's what I saw:

 

First, I noticed that the post-FUE patients coming through the doors of the clinic were very, very different from what I saw online. And these were people who represented the entire spectrum of FUE patients. Guys who had went to the "top" FUE doctors in the world and those who had gone to technician FUE clinics. And I noticed two things: 1) the results were WILDLY variable. Completely different than what we see here. Some grew okay; others had almost no growth whatsoever; and I honestly never saw anything that I felt resembled a strip post-op. 2) the donor regions of these patients were "different." I couldn't really put my finger on it at the time, but I could almost always notice a general thinning and surgical appearance to the back of the scalp. Obviously I was looking for it, but it was there.

 

Then I was able to actually do both procedures ...

 

I find FUE procedures actually quite fun. There is definitely a learning curve with it, but it is satisfying to really sit down with very simple manual tools and do an FUE procedure. But let me share a few of my observations:

 

1) It is a very slow, gentle, methodical process. Anyone who tries to speed it up to these very rapid levels simply isn't doing the procedure justice. It was never meant for this. And watching these videos of it feels very wrong compared to what I've experienced in real life.

 

2) IT IS HELL ON THE GRAFTS! I'm actually pretty surprised that anyone could sit down and extract FUE grafts and claim they don't go through detrimental forces. Define them however you like. But they absolutely do exist, they are noticeable on each graft you extract, and they absolutely put way too much stress and strain on these tiny, fragile organs (follicles). And saying they can be overcome by little tricks isn't realistic either. The only way to REALLY get around them is to not remove grafts via traditional FUE. Period.

 

3) It's way, way harder to get good FUE grafts out of scalp that's been FUE'd before. The scalp is hardened, difficult to penetrate (even with simple anesthetic needles), and simply doesn't react the way it should. The tactile feedback you get with manual tools is ruined. It randomly collapses and causes immediate transection in some regions, and yet seems to still hold the grafts tighter and increase avulsion and tearing at the same time. The bottom line is that there are changes in the donor region and yield and quality suffers in these scalps.

 

4) During FUE days, I have this strange thought in the back of my mind all day. The grafts are out, they are inspected, and they, theoretically, look okay for implantation. Yet I still have one nagging thought all day: "are these things going to grow?" I can't stop thinking of everything I put those grafts through getting them out. I also think about how bent and skeletonized they looked before implantation, and I just have concern about the quality and quantity of the growth. I don't feel this way on strip days.

 

5) It's a completely blinded procedure. You have to continually test and re-test angles and depths, and even then you're still surprised a good number of times per day. This is why the tissue feedback one gets from going SLOWLY with MANUAL tools is so crucial. I honestly couldn't imagine working at a rate to remove 4,000 of these things in one session; nor would I ever want to take the tactile feedback away from myself with big motorized devices.

 

These issues are "night and day" compared to strip days. The grafts come out perfectly, they look great after microscopic dissection, they are placed in an appropriate time frame, and I feel awesome talking to these patients at the end of the day because I have every reason to believe they are going to grow great.

 

After existing in both these worlds, I can say a few things conclusively:

 

1) The perception of FUE online and the reality of what happens in the OR are two completely different worlds. I've lived in both, and I can honestly say the reality is worlds different than what you read online.

 

2) It's always going to come in behind FUT with respect to quality and quantity of growth. And there is really no controversial theories or debatable points as to why. Follicles are fragile organs; FUE puts them through hell and they are never going to grow as well because of it. There are reasons to go down this route, but saying they are equivalent and that all patients are candidates for FUE simply isn't a reality.

 

3) Pretending like decreased yield with FUE is the only issue at hand isn't correct. Some seem to think that you're just trading slightly lower yield for no strip scar and you can simply correct this by taking more grafts. This isn't true. FUE causes serious changes to the donor area and everything after a big FUE procedure in the donor is a big fat question mark. The last thing in the world I -- as the surgeon -- want is to put the patient in a position where the grafts don't grow but I've screwed up donor. Now this guy has no options. And shaving down to a 1 after this isn't as simple as it sounds either. I've seen this in person as well, and there is still a "surgical" appearance to the back of the scalp. Worse than a bad strip scar? No. But, again, it's an online myth that you can take 4,000 grafts out of the back and then buzz it down to a 1 without noticing the changes.

 

Now, I could go on for pages about all the other issues at hand. And I do understand that the scar and more invasive nature can be a concern for some patients. And I don't want to downplay this either. But these are my very unique observations as someone who was helped run the online world then transitioned into the real world and truly changed my opinion.

 

These are my honest thoughts. I know some may doubt my intentions or feel ulterior motives are at foot, but all I can do is share what I've observed openly and honestly. Take them as you will!