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Personally, I’d still very much like to know the bases for Dr. Bhatti’s assertion that “speed is the singlemost essential factor which gives FUE in general and FUE megasessions in particular a higher yield almost comparable to FUT.” (Post #825, p. 83 of this thread.) Dr. Bhatti made that assertion in response to questions and concerns raised about the original version of the video he posted showing his FUE technique.

 

When I questioned that assertion, which to me seemed counterintuitive (post #831, p. 83), Dr. Bhatti sent me an unsolicited message assuring me that he would publicly answer those questions in detail. That was on August 17th.

 

The only reason I could think of for scoring (with a motorized punch) and extracting thousands of grafts at the breakneck speed demonstrated in Dr. Bhatti’s original, unedited video, would be to allow the clinic to churn out multiple FUE cases per day. Good for the clinic’s bottom line. Not so good, it would seem, for maximizing each patient’s yield.

 

If preventing desiccation of the grafts were the objective of the speed approach demonstrated, it seems that this could be achieved with other strategies that would allow for a more measured pace of scoring, extraction, and implantation and a more careful and gentle handling of delicate FUE grafts. For example, grafts could be scored, extracted, and implanted in batches of, say, 600. In other words, carefully score and carefully extract 600 grafts (depositing them into an appropriate holding solution as they are extracted), sort them, implant them, then repeat this process with additional batches of 600 grafts until the total target number for the restoration had been extracted and implanted.

 

If necessary, extreme megasession FUE cases could be executed over consecutive days or perhaps with an intervening day between surgical days to give the patient’s donor a day of rest between “assault” days. The “batch” approach to scoring, extraction, and implantation (described above) could still be employed, perhaps with somewhat larger batch numbers but which still would allow for more measured, careful, and gentle scoring, extraction, and implantation of these delicate, stripped down FUE grafts.

 

Of course, these protocols likely would decrease the number of patients that could be worked on or completed per day, particularly if the “batch” approach were employed, which would require the surgeon to be present and participating during much or all of the surgery. But if the goal is to maximize FUE yield for each patient . . . . .

 

Am I missing something? Dr. Bhatti?

 

Again, I pose these questions in the interest of education, my own and that of other members interested in the science, art, and technique of hair restoration. I am neither pro nor anti FUE nor pro or anti FUT (or mFUE). I am pro exceptional hair restoration.

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Barbaric? What are you talking about? Have you ever seen a C-section before? Or maybe Open heart surgery? Brain surgery to cut out tumors? If you think an elective FUT strip procedure is barbaric, the

40K a year? If you could make 200k a year, I would betcha you would go for it. I could be wrong, and if I am then you are a better human than I am. Bottom line is supply and demand. Price is set by ho

" I would betcha you would go for it. I could be wrong, and if I am then you are a better human than I am."   I hate when people say this. You know as well as he does that he absolutely woul

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I agree, the negativity has gone too far and I’m sure the posting history will show where the negativity is coming from.

 

I will remind everyone that the video was not removed. The video remains on Youtube, untouched, and in five postings by Dr. Feller.

 

Mr. Bill, you said the following,

 

“I've already acknowledged that I haven't followed the debate closely over the last week or so. If discussion of the video is dead, that's fine. But I wanted to make it clear that I never advocated for the removal or editing of the original video. I am a firm believer that apart from minor revisions for spelling or grammar, members should stand behind their posts and do minimal editing."

 

I did not suggest Mr. Bill that you advocate my actions. I stated earlier that you gave me permission. Do I misunderstand the word? I know the word “permission” to mean being allowed something. Does the word “permission” mean endorse or support? Indeed, you advised me and I chose to do what I thought would be acceptable. Dr. Feller has the original video posted five times so I did not believe it to be an issue and I do not understand why it is so controversial if the original is intact here and on my You Tube channel. I agree posts should remain with minor revisions for spelling or grammar and should not be removed but recent history suggests otherwise. My post was untouched but the video was edited over seventy pages ago and a private email exchange, that supports my original position still and shared without my permission, and I am being attacked for changing something that still exists in it’s original form with five copies and over 450 views. Dr. Feller even claimed that the embedding feature had been disabled when it clearly has not. Yet when another physician wishes to have his entire post removed it is done so without incident.

 

Mr. Mav23100gunther,

 

I believe this email trail, which was posted without my authorization, shows what I said from the beginning. I wished to concentrate on the extraction and I believe the circle of focus helps to do this. If you watch the edited version you will also see that from the 2:00 point to the 2:29 point there is no circle focus effect. You can also see that I have each sequence labeled for clarity and I have also included information about the forceps. They are the CIT forceps, which prevent crushing contrary to Dr. Feller’s claims. I’ve said this before.

 

I am of the belief that this obsession with the video is another effort to detract from the lack of evidence to support Dr. Feller’s claims. He says the detriment nature of the three forces he lists are fact but the only fact is that they are his theory. He has no proof that these forces are so detrimental that they cannot be overcome, which is required in science and medicine before a challenge to refute can be made. I also believe this is a ruse to reduce the credibility of FUE in support of his new procedure which supposedly solves problems that none of you knew existed.

 

I have some questions that I would like asked.

 

1. What is the size of the punch for mFUE?

2. How long has mFUE been in development?

3. Did Dr. Blake work on the development of mFUE while he was under your tutelage?

4. Did Dr. Blake know he would have a financial benefit from the development of mFUE or anything related to your practice?

 

Mr. Mavgunther21300, I believe you asked earlier why mFUE was of any concern regarding this thread. I had elected to not continue with this line of thinking as I felt the thread was finally retiring but since it is now revived I will tell you why I was discussing this. I believe it was compulsory for the professional relationship between Dr. Feller and Dr. Blake to be revealed to the community from the beginning, which according to Dr. Blake was two years ago. Dr. Feller is a competitor, not necessarily to me, but to many doctors in North America and particularly in New York and many of them are paying members of this website. For there to be a moderator of a forum that influences the surgical decision of many many people with his “opinion” while simultaneously being influenced by a a paying member that is a competitor, with financial gain either directly or assumed from the relationship, is a conflict of interest.

 

Harvard Medical School states…

 

"Research that involves human study participants or samples is subjected to higher scrutiny with respect to the potential for financial conflicts of interest. This is because the ramifications of bias in clinical research are more immediate and directly impact the safety and welfare of clinical research participants. This rule guards against bias, or the appearance of bias, that might occur if a faculty member conducted clinical research in which she or he had a financial stake in the outcome or allegiance to the funding company. Such a conflict might cause the faculty member to alter his or her study design, conduct, or reporting of the research in some way, whether consciously or unconsciously, or it may cause the public to lose trust in the reliability of the research outcomes. "

 

In a case such as Feller/Bloxham the “study participants” are you, the forum members. The “funding company” is Dr. Feller and the “faculty” is Dr. Blake.

 

In some cases some financial associations are acceptable but in every case the relationship must be disclosed, much like how representative on the forums must disclose their relationship with the clinic they work for, which was what Dr. Feller was accusing my patient Sethicles of being. In short, Dr. Blake was working/training with Dr. Feller and developing a new technique for two years with the intent of profit once training was completed and a partnership was formed. It is my opinion, based on statements and timelines shared that this is the entire reason for Dr. Blakes admitted transition from believing in FUE to being a naysayer. It is also the reason for the re-emergence of Dr. Feller after a year and a half and these threads designed to discredit FUE and deliver mFUE as the solution to the problem that cannot be proven to exist outside of Dr. Feller’s hands.

 

 

Good day.

 

Thank you for your response Dr Bhatti. As always, you are a gentleman sir! I definitely appriciate your point of view, and although I still don't like the manner in which the video was edited and happen to agree with Dr Feller's statements on this, I think you have made your position and intention clear, and forum members can make up their own minds. At the same time, I also don't appriciate Dr Feller's tone, so thank you for keeping your's professional and cordial.

 

I also understand and appriciate your point on conflict of interest, but I still don't see the conspiricy theory . I thought it was well known that Dr Blake was performing his internship/residency with Dr Feller. I never got the impression that he was ever trying to sell Dr Feller abit for a brief couple of months when he made his anouncement and continued on as moderator. Anyway, not my place to comment on this, sounds more like a matter for Bill to address with you.

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I agree, the negativity has gone too far and I’m sure the posting history will show where the negativity is coming from.

 

I will remind everyone that the video was not removed. The video remains on Youtube, untouched, and in five postings by Dr. Feller.

 

Mr. Bill, you said the following,

 

“I've already acknowledged that I haven't followed the debate closely over the last week or so. If discussion of the video is dead, that's fine. But I wanted to make it clear that I never advocated for the removal or editing of the original video. I am a firm believer that apart from minor revisions for spelling or grammar, members should stand behind their posts and do minimal editing."

 

I did not suggest Mr. Bill that you advocate my actions. I stated earlier that you gave me permission. Do I misunderstand the word? I know the word “permission” to mean being allowed something. Does the word “permission” mean endorse or support? Indeed, you advised me and I chose to do what I thought would be acceptable. Dr. Feller has the original video posted five times so I did not believe it to be an issue and I do not understand why it is so controversial if the original is intact here and on my You Tube channel. I agree posts should remain with minor revisions for spelling or grammar and should not be removed but recent history suggests otherwise. My post was untouched but the video was edited over seventy pages ago and a private email exchange, that supports my original position still and shared without my permission, and I am being attacked for changing something that still exists in it’s original form with five copies and over 450 views. Dr. Feller even claimed that the embedding feature had been disabled when it clearly has not. Yet when another physician wishes to have his entire post removed it is done so without incident.

 

Mr. Mav23100gunther,

 

I believe this email trail, which was posted without my authorization, shows what I said from the beginning. I wished to concentrate on the extraction and I believe the circle of focus helps to do this. If you watch the edited version you will also see that from the 2:00 point to the 2:29 point there is no circle focus effect. You can also see that I have each sequence labeled for clarity and I have also included information about the forceps. They are the CIT forceps, which prevent crushing contrary to Dr. Feller’s claims. I’ve said this before.

 

I am of the belief that this obsession with the video is another effort to detract from the lack of evidence to support Dr. Feller’s claims. He says the detriment nature of the three forces he lists are fact but the only fact is that they are his theory. He has no proof that these forces are so detrimental that they cannot be overcome, which is required in science and medicine before a challenge to refute can be made. I also believe this is a ruse to reduce the credibility of FUE in support of his new procedure which supposedly solves problems that none of you knew existed.

 

I have some questions that I would like asked.

 

1. What is the size of the punch for mFUE?

2. How long has mFUE been in development?

3. Did Dr. Blake work on the development of mFUE while he was under your tutelage?

4. Did Dr. Blake know he would have a financial benefit from the development of mFUE or anything related to your practice?

 

Mr. Mavgunther21300, I believe you asked earlier why mFUE was of any concern regarding this thread. I had elected to not continue with this line of thinking as I felt the thread was finally retiring but since it is now revived I will tell you why I was discussing this. I believe it was compulsory for the professional relationship between Dr. Feller and Dr. Blake to be revealed to the community from the beginning, which according to Dr. Blake was two years ago. Dr. Feller is a competitor, not necessarily to me, but to many doctors in North America and particularly in New York and many of them are paying members of this website. For there to be a moderator of a forum that influences the surgical decision of many many people with his “opinion” while simultaneously being influenced by a a paying member that is a competitor, with financial gain either directly or assumed from the relationship, is a conflict of interest.

 

Harvard Medical School states…

 

"Research that involves human study participants or samples is subjected to higher scrutiny with respect to the potential for financial conflicts of interest. This is because the ramifications of bias in clinical research are more immediate and directly impact the safety and welfare of clinical research participants. This rule guards against bias, or the appearance of bias, that might occur if a faculty member conducted clinical research in which she or he had a financial stake in the outcome or allegiance to the funding company. Such a conflict might cause the faculty member to alter his or her study design, conduct, or reporting of the research in some way, whether consciously or unconsciously, or it may cause the public to lose trust in the reliability of the research outcomes. "

 

In a case such as Feller/Bloxham the “study participants” are you, the forum members. The “funding company” is Dr. Feller and the “faculty” is Dr. Blake.

 

In some cases some financial associations are acceptable but in every case the relationship must be disclosed, much like how representative on the forums must disclose their relationship with the clinic they work for, which was what Dr. Feller was accusing my patient Sethicles of being. In short, Dr. Blake was working/training with Dr. Feller and developing a new technique for two years with the intent of profit once training was completed and a partnership was formed. It is my opinion, based on statements and timelines shared that this is the entire reason for Dr. Blakes admitted transition from believing in FUE to being a naysayer. It is also the reason for the re-emergence of Dr. Feller after a year and a half and these threads designed to discredit FUE and deliver mFUE as the solution to the problem that cannot be proven to exist outside of Dr. Feller’s hands.

 

 

Good day.

 

Dr. Bhatti, You agree the negativity has gone too far, then in the same line throw fuel on the fire and attack me for having started the negativity.

 

So yes, let's go back to where all the negativity started: (Page 37, Post #366):

You titled your post: Dr Feller's baseless rantings !

 

That sure seems like negativity to me, especially since until that point I had never heard of you. I mean really, who says such a thing about a doctor he's never met? So who actually started the negativity, Dr. Bhatti ? And Mav23100gunther, respectfully, are these the words of a gentleman?

 

Dr. Bhatti, it's true you didn't remove the original video, but I believe it's because you knew if you had you would have been caught instantly. You may claim otherwise, but your posted reasons are not very believable.

And there is, of course, no valid reason to go back into an old post to remove the "incriminating" video and replace it for a more toned down version that clearly contradicted your views on this thread and supported mine. You could have simply ADDED the new video to the old post and nobody would have cared. Least of all I. But you didn't do that, you engaged in what could only be seen as a subterfuge that you were warned about by the moderator even before you did it.

 

You clearly will not stand by your technique as demonstrated in the video. You have spent pages and pages trying to get away from it and only scream and holler that I haven't provided "scientific evidence". Your original video IS the evidence. It's CLINICAL evidence and that's VERY scientific. In fact it's better because that's what's happening in real life and anyone can see what's going on. Nobody can look at that technique and not come to the conclusion that it is rushed, very indelicate, and more traumatic to the grafts than FUT. Even you haven't come out and said flat out " oh, there's nothing wrong with this technique. It's perfectly fine to rip the grafts out with a single forcep and rake them around on the head willy nilly." To outright say this would be contradict 25 years of hair transplant gospel -which states above all that GRAFT HANDLING is the most important aspect of ANY hair transplant surgery.

 

Your video is the single most important piece of evidence supporting my position that FUE is brutal on the grafts compared to FUT. You made a mistake posting it. Then you made a mistake in trying to blurr out the most egregious parts. Then you made a mistake trying to quietly slip the new version into your old post. Then you made a mistake trying to use your interaction with Bill as some sort of approval for your activities.

 

You made some poor judgments and choices. This isn't a court room. You're not going to get into "trouble" for it. Just accept your errors and move on. I get no enjoyment out of this exchange and don't feel I'm winning "points". My goal was never to have to get into a protracted personal battle with you, my goal was, and has ever been, to debate the aspects of the FUE technique. Doesn't matter who performs it. So I never focused in on you. As I wrote, I never heard of you prior to your first post.

 

Your technique as demonstrated in your original video is representative of FUE techniques in general and does not compare well to the delicacy of an equivalent FUT case. But even in the FUE world I think it is fair to say your technique appears rushed and more traumatic to the grafts and tissue compared to more paced and deliberate FUE techniques demonstrated by others. Certainly the two forceps approach would be superior. Don't you agree?

 

 

I think this thread has become one of the most transparent and educational threads on the topic of FUE from the objective "surgical" point of view, instead of the cherry picked subjective "results" point of view. Of course practitioners are only going to put up their best results. That's expected. And most patients who are unhappy are reticent to post their results so the bias is insurmountable.

That's why my focus on the three detrimental forces is so important. Because it subtracts out all the subjectivity, egos, and personalities. It demonstrates the success of the surgery from the graft's point of view. Everything else simply follows from that.

 

I will continue to espouse my position and opinion of FUE techniques like yours and continue to contrast it with the far more gentle and far more proven FUT technique. I'm truly sorry if this offends you or even if you find it threatening but the truth is the truth and someone has to deliver it for patients to be fully informed. For them to be LEGALLY informed they need to have this information available, and I have seen NONE of it online with the exception of this thread.

 

As long as you post your videos in good faith as a demonstration of an FUE technique, I will in good faith continue to use the information in those videos to support my points as they apply. I would invite you to counter my points if you can. If you refuse to, that's one thing. But if you can't then, respectfully, perhaps you should think about modifying your technique instead of the video you use to demonstrate it.

 

As for your other accusations they are absurd and demonstrably false. I'm used to being attacked by anonymous posters and know what I'm getting into when I post a thread online. But what you wrote as a physician in a public forum about Blake was extremely inappropriate and I for one think you owe him an apology.

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It is a such a shame that things have descended to virtually all-out hostility.

 

The bottom line is Dr. Feller's original post, whilst I believe well-intentioned and containing a lot good information, doesn't quite hold up in its entirety. That FUT is more popular than FUE I think is still fair - but that it is "by far" is more debatable. Plus, rightly or wrongly I think the popularity for FUE is rising exponentially, and I don't think that can be disputed.

 

The other assertion that "no doctor can overcome the three detrimental forces", whilst again I can somewhat appreciate, is not verifiable unless scientifically studied. It is very clear the top-FUE clinics are getting pretty great results on a consistent basis (yes they may cherry pick the best results for publication; what clinic, FUT or FUE, doesn't?). It is simply not possible to state without reserve that a patient who had a good FUE result would have had a better result via FUT. And then of course you get into all kinds of muddy waters - who is to say a patient wouldn't have had a better result if they went to, let's say, one FUT doctor over another? All surgical outcomes are somewhat variable - I don't think it's fair to act as if FUT will always trump FUE.

 

Then of course there are the other factors. Whatever the medical elements of FUE/FUT scarring, I think it's without doubt that the best FUE scarring blends more seamlessly than the best FUT scarring. This could be a major factor in the decision of an individual patient - the option to shave done, for whatever reason, may be something a patient values highly. Whatever Dr. Feller may feel about FUE vs. FUT scarring, the very fact he has developed mFUE is testament to the fact that the customer base for better aesthetic scarring, and the case for developing tools to achieve that, is clearly there.

 

I think what is indisputable is that FUE and FUT can both produce great, life changing results - and both are (in the hands of the right doctor) capable of grafting a large number of donor hairs to varying sizes of recipient sites. There's no doubt that the best work of doctors like Lorenzo, Bhatti et. al compare with top level FUT doctors - I just don't think that can be argued with. You can assert, perhaps even with a degree of confidence, an FUT procedure would have achieved the same or better results with less risk to grafts, but you cannot prove that save compiling a large amount of data from a range of clinics. After all, 3,000 grafts from one FUT doctor may look very different than 3,000 grafts from another FUT doctor - it's not just about comparing FUT/FUE, it's also about comparing one individual procedure to the next.

 

I think Dr. Feller made some good points, but I don't think anything was really proven. There are clearly doctors in both "camps" who feel they are capable of producing excellent results with either procedure, and proving that through their photo and video documentation. I don't know what else there would be to say - patients always have made their own decisions and always will. I don't think either camp has really come out "victorious" - and it's a shame in the meantime a lot of bad blood seems to have boiled over.

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Mr. Pupdaddy,

 

You are correct and I apologize. I should have followed up.

 

What is an FUE megasession? I consider an FUE megasession to be a session that requires more than 3000 scalp grafts. Speed is an essential component for megasessions.

 

FUE grafts have to have minimum out of body time for satisfactory survival.

I never do a megasession stretching beyond 2 days for the following reasons-

 

1. The efficacy of lidocaine (local anesthetic) becomes lesser on the second day and on subsequent days due to the inflammatory process that kicks off when the body starts to heal. The alkaline environment that results makes the anesthetic less effective.

 

2. More resulting pain and discomfort, more bleeding during the procedure and increased popping and fatigue of implanting grafts.

 

3. Longer the procedure is drawn over more than a day and a half, more the swelling and more the fibrosis affecting the final yield of grafts that eventually grow.

 

Speed is single most essential component of FUE technique esp. for megasessions. In my practice speed has served me well but I still rarely move past the 3000 graft per day threshold as we must be reasonable with the trauma we are creating to the scalp, the grafts, the patient and our physcial limitations. The out of body time is never more than 4-6 hours maximum for grafts in my clinic. This is the standard for my practice and FUE and was the standard for my FUT as well. I just do not like for grafts to be out of the body.

 

Your suggestion about rotating between set numbers is interesting but there is a patient comfort component we must consider. Patients are usually more comfortable with minimal requirements for movement. We do take breaks of course but I will admit that your suggestion has me thinking. Thus is the power of positive exchange:)

 

I hope this helps and accept my apology for not responding to you earlier. There is a book coming out this month that focuses solely on FUE. It is the first of it's kind that I am aware of and is exhaustive in it's value. I co-authored the chapter on "Avoiding Disatrous Outcomes in FUE Practice". If you send your address through PM I will send you a copy. See, Dr. Feller is not the only doctor that has been published regarding FUE:)

 

Mr. Bill,

 

I apologize if I misinterpreted the word permission as I was not indicating that you were condoning my actions, just that you were allowing the new link to the edit to be presented. It was not my intention.

 

Mr. Mavgunther23100,

 

" I thought it was well known that Dr Blake was performing his internship/residency with Dr Feller."

 

If this is true I was not aware of it. It is my understanding that this was first revealed in April, 2015, two months before Dr. Blake's departure from his official duties as moderator. The two months since the announcement are fine as the conflict was revealed. If the arrangment was revealed before April of this year please share the link. If it is true, and the relationship was revealed from the beginning, two years ago, then I will retract my opinion and apologize to Dr. Feller and Dr. Blake for my oversight. If it is not true then my opinion stands. It is common practice and requirement to reveal conflicts of interest and knowingly and conciously influencing patients in such a manner is not required for a conflict to exist. There is a potential subcouncious influence that an arrangement can have on one's opinion, in this case moderation, so it is incumbent upon those in the conflict to reveal the arrangement so that patients that may be influenced by those involved can make informed decisions based on such relationships. Revealing of conflicts of interest is designed to protect patients. As a paying members of this forum physicians in competition also have a right to know.

 

Dr. Feller, I will address you one final time. If you wish to have a debate about how this negativity started we can go all the way back to your accusation of my patient that he is a representative of my clinic. English is not my native language but even I know that when one refers to someone on the forums as a "representative" they are directly stating that the person is in the employ of a clinic.

 

"He is a representative for a a physician practicing FUE."

 

This is no other way to interpret your statements made on this subject. Do a search for the term representative on this forum and each reference will be made for actual representatives of clinics, not patients sharing their experiences. This is why I first posted on this thread, you were attacking my patient which I take personally. I was not involved prior. I called this thread baseless because it is your opinion only and you have no proof to support your position. Was my tone slightly harsh? For me, yes, but I find it difficult to believe you were genuinely offended. If you were then you have my apology but I feel it necessary that you should apologize to my patient. I require no such acknowledgement.

 

Our respective videos show two things. I am fast as that has served me well as evidenced with multiple dozens of results and satisfied patients through the years. I have MANY documented results of my FUE patients which speaks to my success. If my technique is so "detrimental" I would not be in business today and one of the moderators of this forum would not be happy with me. It is public for all to see. I will no longer address your video as to do so only continues the negativity. I'm sure you have happy FUE patients and that is all that matters, yes?

 

If you do not wish to answer the questions I posed, that is fine. I did not expect answers to begin with but I felt the need to ask. Time will reveal all. I will however ask some final questions of the readershi as they are more inclned to answer.

 

1. What determines the detriment of a surgical technique? The argument of it's technique without proof, pro or con, or the final result?

 

2. What determines the satsifaction of a patient? The result that he wished for or the manner in which he achieved the result?

 

3. What right is there by anyone to criticize a technique if the patient that wears the result of the technique is happy and satisfied enough to share with the world?

 

If there are more questions about my FUE, I'm happy to discuss. If not then I will no longer take part in the negative direction of this thread.

 

Good day.

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Mr. Pupdaddy,

 

You are correct and I apologize. I should have followed up.

 

What is an FUE megasession? I consider an FUE megasession to be a session that requires more than 3000 scalp grafts. Speed is an essential component for megasessions.

 

FUE grafts have to have minimum out of body time for satisfactory survival.

I never do a megasession stretching beyond 2 days for the following reasons-

 

1. The efficacy of lidocaine (local anesthetic) becomes lesser on the second day and on subsequent days due to the inflammatory process that kicks off when the body starts to heal. The alkaline environment that results makes the anesthetic less effective.

 

2. More resulting pain and discomfort, more bleeding during the procedure and increased popping and fatigue of implanting grafts.

 

3. Longer the procedure is drawn over more than a day and a half, more the swelling and more the fibrosis affecting the final yield of grafts that eventually grow.

 

Speed is single most essential component of FUE technique esp. for megasessions. In my practice speed has served me well but I still rarely move past the 3000 graft per day threshold as we must be reasonable with the trauma we are creating to the scalp, the grafts, the patient and our physcial limitations. The out of body time is never more than 4-6 hours maximum for grafts in my clinic. This is the standard for my practice and FUE and was the standard for my FUT as well. I just do not like for grafts to be out of the body.

 

Your suggestion about rotating between set numbers is interesting but there is a patient comfort component we must consider. Patients are usually more comfortable with minimal requirements for movement. We do take breaks of course but I will admit that your suggestion has me thinking. Thus is the power of positive exchange:)

 

I hope this helps and accept my apology for not responding to you earlier. There is a book coming out this month that focuses solely on FUE. It is the first of it's kind that I am aware of and is exhaustive in it's value. I co-authored the chapter on "Avoiding Disatrous Outcomes in FUE Practice". If you send your address through PM I will send you a copy. See, Dr. Feller is not the only doctor that has been published regarding FUE:)

 

Mr. Bill,

 

I apologize if I misinterpreted the word permission as I was not indicating that you were condoning my actions, just that you were allowing the new link to the edit to be presented. It was not my intention.

 

Mr. Mavgunther23100,

 

" I thought it was well known that Dr Blake was performing his internship/residency with Dr Feller."

 

If this is true I was not aware of it. It is my understanding that this was first revealed in April, 2015, two months before Dr. Blake's departure from his official duties as moderator. The two months since the announcement are fine as the conflict was revealed. If the arrangment was revealed before April of this year please share the link. If it is true, and the relationship was revealed from the beginning, two years ago, then I will retract my opinion and apologize to Dr. Feller and Dr. Blake for my oversight. If it is not true then my opinion stands. It is common practice and requirement to reveal conflicts of interest and knowingly and conciously influencing patients in such a manner is not required for a conflict to exist. There is a potential subcouncious influence that an arrangement can have on one's opinion, in this case moderation, so it is incumbent upon those in the conflict to reveal the arrangement so that patients that may be influenced by those involved can make informed decisions based on such relationships. Revealing of conflicts of interest is designed to protect patients. As a paying members of this forum physicians in competition also have a right to know.

 

Dr. Feller, I will address you one final time. If you wish to have a debate about how this negativity started we can go all the way back to your accusation of my patient that he is a representative of my clinic. English is not my native language but even I know that when one refers to someone on the forums as a "representative" they are directly stating that the person is in the employ of a clinic.

 

"He is a representative for a a physician practicing FUE."

 

This is no other way to interpret your statements made on this subject. Do a search for the term representative on this forum and each reference will be made for actual representatives of clinics, not patients sharing their experiences. This is why I first posted on this thread, you were attacking my patient which I take personally. I was not involved prior. I called this thread baseless because it is your opinion only and you have no proof to support your position. Was my tone slightly harsh? For me, yes, but I find it difficult to believe you were genuinely offended. If you were then you have my apology but I feel it necessary that you should apologize to my patient. I require no such acknowledgement.

 

Our respective videos show two things. I am fast as that has served me well as evidenced with multiple dozens of results and satisfied patients through the years. I have MANY documented results of my FUE patients which speaks to my success. If my technique is so "detrimental" I would not be in business today and one of the moderators of this forum would not be happy with me. It is public for all to see. I will no longer address your video as to do so only continues the negativity. I'm sure you have happy FUE patients and that is all that matters, yes?

 

If you do not wish to answer the questions I posed, that is fine. I did not expect answers to begin with but I felt the need to ask. Time will reveal all. I will however ask some final questions of the readershi as they are more inclned to answer.

 

1. What determines the detriment of a surgical technique? The argument of it's technique without proof, pro or con, or the final result?

 

2. What determines the satsifaction of a patient? The result that he wished for or the manner in which he achieved the result?

 

3. What right is there by anyone to criticize a technique if the patient that wears the result of the technique is happy and satisfied enough to share with the world?

 

If there are more questions about my FUE, I'm happy to discuss. If not then I will no longer take part in the negative direction of this thread.

 

Good day.

 

See the link below where Dr Feller extended an offer to Blake.

 

http://www.hairrestorationnetwork.com/eve/170915-new-videos-dr-feller-2.html'>http://www.hairrestorationnetwork.com/eve/170915-new-videos-dr-feller-2.html

http://www.hairrestorationnetwork.com/eve/170915-new-videos-dr-feller-2.html

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I called this thread baseless because it is your opinion only and you have no proof to support your position. Was my tone slightly harsh? For me, yes, but I find it difficult to believe you were genuinely offended. If you were then you have my apology but I feel it necessary that you should apologize to my patient. I require no such acknowledgement.

 

Dr. Bhatti,

 

Respectfully, EVERYTHING written on these chat sites are informal opinion. Each post is not a medical journal submission.

 

But I did find your opening statement offensive. You didn't just say my writings were baseless, you wrote they were "baseless RANTINGS". A clear pejorative and personal attack against me, not just a critical reference to the substance of the writing itself.

 

Why would you assume that I, or anyone else, wouldn't be genuinely offended ? You don't know me. What specifically made you think you could act so rudely on a public forum to a physician you've never met or talked to before. I honestly would like to know. Clearly it was something.

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In the event of a nuclear holocaust, I feel confident that cockroaches and this thread will be the only things to continue.

 

 

we wont be able to judge the video's 1 or 2 for at least 6 month even 12months. if a video is taken down, re-edited, shuffled about, blurred out, and the result is 97% success rate, which it could be, then Dr Bhatti has not only shut the door on the 3 detrimental forces but shown speed, high level of skill is needed in FUE. .

 

Seth - in a nutshell, this is the basic test, no? But when you say 97% success, do you mean 97% yield? And if so, Dr Bhatti, how do you measure yield? I asked the same question to Dr Feller who answered a while back.

 

Correct me if I'm wrong, but it mostly seems doctors bandy about yield figures based on an educated guess following observation.

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Feller while searching for your independent FUE patient results something surprised me of your opinion in the past;

 

fellerfue.jpg

 

Factually you seem to state in more postings back then that you believe FUE has the same yield as FUT. That is assuming a viable graft can get extracted. However every graft will endure the forces you speak about right?

 

Why did your opinion change 180 degrees?

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My thanks to Dr. Bhatti for addressing my questions about his "speed" approach to FUE extraction.

 

Interestingly, after 139 pages (!!) of discussion, Drs. Feller and Bhatti seem not to be all that far apart in their opinions about FUT vs. FUE. Both have stated that FUT remains the gold standard for consistently high yield in hair restoration. Both have stated that FUE yield is more variable than FUT yield. Both have stated that FUT yield generally is better than FUE yield. And both have noted the negative effect of fibrosis on FUE yield in subsequent sessions.

 

Where these two docs differ is in the quantification of FUT's yield advantage over FUE, whether this gap has been or can be diminished, and the degree to which it has been or can be diminished.

 

I have learned a good bit more about both methods of extraction than I knew before. Thanks to both docs for sharing their knowledge, experience, opinions, and points of view.

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Feller while searching for your independent FUE patient results something surprised me of your opinion in the past;

 

fellerfue.jpg

 

Factually you seem to state in more postings back then that you believe FUE has the same yield as FUT. That is assuming a viable graft can get extracted. However every graft will endure the forces you speak about right?

 

Why did your opinion change 180 degrees?

 

Dr. Feller, "Game, set, match". Discussion over.

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Feller while searching for your independent FUE patient results something surprised me of your opinion in the past;

 

fellerfue.jpg

 

Factually you seem to state in more postings back then that you believe FUE has the same yield as FUT. That is assuming a viable graft can get extracted. However every graft will endure the forces you speak about right?

 

Why did your opinion change 180 degrees?

 

Ha...great find Swooping! I suspect that his opinion changed when he realized that he wasn't that successful of a FUE doctor after all so then it became in his best interest to discredit it. Any shred of credibility that he had has now been completely wiped out.

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I agree, the negativity has gone too far and I’m sure the posting history will show where the negativity is coming from.

 

I will remind everyone that the video was not removed. The video remains on Youtube, untouched, and in five postings by Dr. Feller.

 

Mr. Bill, you said the following,

 

“I've already acknowledged that I haven't followed the debate closely over the last week or so. If discussion of the video is dead, that's fine. But I wanted to make it clear that I never advocated for the removal or editing of the original video. I am a firm believer that apart from minor revisions for spelling or grammar, members should stand behind their posts and do minimal editing."

 

I did not suggest Mr. Bill that you advocate my actions. I stated earlier that you gave me permission. Do I misunderstand the word? I know the word “permission” to mean being allowed something. Does the word “permission” mean endorse or support? Indeed, you advised me and I chose to do what I thought would be acceptable. Dr. Feller has the original video posted five times so I did not believe it to be an issue and I do not understand why it is so controversial if the original is intact here and on my You Tube channel. I agree posts should remain with minor revisions for spelling or grammar and should not be removed but recent history suggests otherwise. My post was untouched but the video was edited over seventy pages ago and a private email exchange, that supports my original position still and shared without my permission, and I am being attacked for changing something that still exists in it’s original form with five copies and over 450 views. Dr. Feller even claimed that the embedding feature had been disabled when it clearly has not. Yet when another physician wishes to have his entire post removed it is done so without incident.

 

Mr. Mav23100gunther,

 

I believe this email trail, which was posted without my authorization, shows what I said from the beginning. I wished to concentrate on the extraction and I believe the circle of focus helps to do this. If you watch the edited version you will also see that from the 2:00 point to the 2:29 point there is no circle focus effect. You can also see that I have each sequence labeled for clarity and I have also included information about the forceps. They are the CIT forceps, which prevent crushing contrary to Dr. Feller’s claims. I’ve said this before.

 

I am of the belief that this obsession with the video is another effort to detract from the lack of evidence to support Dr. Feller’s claims. He says the detriment nature of the three forces he lists are fact but the only fact is that they are his theory. He has no proof that these forces are so detrimental that they cannot be overcome, which is required in science and medicine before a challenge to refute can be made. I also believe this is a ruse to reduce the credibility of FUE in support of his new procedure which supposedly solves problems that none of you knew existed.

 

I have some questions that I would like asked.

 

1. What is the size of the punch for mFUE?

2. How long has mFUE been in development?

3. Did Dr. Blake work on the development of mFUE while he was under your tutelage?

4. Did Dr. Blake know he would have a financial benefit from the development of mFUE or anything related to your practice?

 

Mr. Mavgunther21300, I believe you asked earlier why mFUE was of any concern regarding this thread. I had elected to not continue with this line of thinking as I felt the thread was finally retiring but since it is now revived I will tell you why I was discussing this. I believe it was compulsory for the professional relationship between Dr. Feller and Dr. Blake to be revealed to the community from the beginning, which according to Dr. Blake was two years ago. Dr. Feller is a competitor, not necessarily to me, but to many doctors in North America and particularly in New York and many of them are paying members of this website. For there to be a moderator of a forum that influences the surgical decision of many many people with his “opinion” while simultaneously being influenced by a a paying member that is a competitor, with financial gain either directly or assumed from the relationship, is a conflict of interest.

 

Harvard Medical School states…

 

"Research that involves human study participants or samples is subjected to higher scrutiny with respect to the potential for financial conflicts of interest. This is because the ramifications of bias in clinical research are more immediate and directly impact the safety and welfare of clinical research participants. This rule guards against bias, or the appearance of bias, that might occur if a faculty member conducted clinical research in which she or he had a financial stake in the outcome or allegiance to the funding company. Such a conflict might cause the faculty member to alter his or her study design, conduct, or reporting of the research in some way, whether consciously or unconsciously, or it may cause the public to lose trust in the reliability of the research outcomes. "

 

In a case such as Feller/Bloxham the “study participants” are you, the forum members. The “funding company” is Dr. Feller and the “faculty” is Dr. Blake.

 

In some cases some financial associations are acceptable but in every case the relationship must be disclosed, much like how representative on the forums must disclose their relationship with the clinic they work for, which was what Dr. Feller was accusing my patient Sethicles of being. In short, Dr. Blake was working/training with Dr. Feller and developing a new technique for two years with the intent of profit once training was completed and a partnership was formed. It is my opinion, based on statements and timelines shared that this is the entire reason for Dr. Blakes admitted transition from believing in FUE to being a naysayer. It is also the reason for the re-emergence of Dr. Feller after a year and a half and these threads designed to discredit FUE and deliver mFUE as the solution to the problem that cannot be proven to exist outside of Dr. Feller’s hands.

 

 

Good day.

 

Dr. Bhatti,

 

Let's say a patient gets 4000 grafts implanted via fue. The second time they come back, let's say in a year, fir another 4000 would it be very difficult because of the fibrosis build up?

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Dr. Bhatti,

 

Let's say a patient gets 4000 grafts implanted via fue. The second time they come back, let's say in a year, fir another 4000

 

im only guessing here, but 8000 FUE generally is beyond the limits of a patients donor area, BHT would be Dr Bhatti next approach,

 

This is why Dr Feller always says strip strip until stripped out, allowing you to get in the ranges of 8000 - 10000 grafts,

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Feller while searching for your independent FUE patient results something surprised me of your opinion in the past;

 

fellerfue.jpg

 

Factually you seem to state in more postings back then that you believe FUE has the same yield as FUT. That is assuming a viable graft can get extracted. However every graft will endure the forces you speak about right?

 

Why did your opinion change 180 degrees?

 

 

Great catch. It was posts from 2004/2006, but still very interesting.

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Dr. Bhatti,

 

Respectfully, EVERYTHING written on these chat sites are informal opinion. Each post is not a medical journal submission.

 

But I did find your opening statement offensive. You didn't just say my writings were baseless, you wrote they were "baseless RANTINGS". A clear pejorative and personal attack against me, not just a critical reference to the substance of the writing itself.

 

Why would you assume that I, or anyone else, wouldn't be genuinely offended ? You don't know me. What specifically made you think you could act so rudely on a public forum to a physician you've never met or talked to before. I honestly would like to know. Clearly it was something.

 

Unusual that you would pick out this issue among the rest. Dr. Feller, you have my most sincere and whole hearted apology for saying that you have been making baseless rantings. I had no idea how this would be misinterpreted and cause you so much distress.

 

"Respectfully, EVERYTHING written on these chat sites are informal opinion."

 

Then we are done here. Nothing you have presented is a fact, just your "informal opinion" according to your own words spoken here. Everything I have expressed about your opinion is also an opinion based on my own experience.

 

The facts are that you do not believe FUE is as successful for me and other FUE practioners claim despite the hundreds and hundreds of photos and HD videos that say the opposite. Another fact is that I believe you have motive to be the only reputable hair restoration physician in the world to make the claims that the three forces experienced by FUE grafts during harvest are detrimental to consistently successful outcomes and have not been overcome. Who is right and who is wrong? I believe we are both right.

 

You have your FUE results, I have my own as do the dozens of recognized FUE physicians in the world. Until real studies can be performed everything else is pure conjecture and "informal opinion" based on our own respective experiences.

 

Good day.

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I think that's the proverbial nail getting hit on the head. It's all conjecture and opinion. Not baseless or uninformed opinion, but opinion nonetheless.

 

Clearly there are a good many reputable doctors out there who feel FUE is a safe, reliable and effective treatment in their hands that can deliver good yield and large sessions, and who would appear to have the results to prove it.

 

Clearly there are some doctors out there who believe the risk/reward ratio of FUE isn't up to their personal standards, making strip the preferred method in their opinion and perhaps relegating FUE to a procedure more suited to smaller sessions and more modest ambitions in their eyes.

 

The only way any debate could be resolved or factually continued is scientifically - with data. As in a proper study of multiple FUE/FUT cases and a corroborated investigation into yields, graft damage etc. etc. with photos and factual reporting.

 

I don't think this debate can progress from this point without more being brought to the table scientifically. All I know is that there are good results and high regard for Dr. Feller and the same for Dr. Bhatti, and that both are achieving them with a difference of opinion over which procedure they prefer.

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im only guessing here, but 8000 FUE generally is beyond the limits of a patients donor area, BHT would be Dr Bhatti next approach,

 

This is why Dr Feller always says strip strip until stripped out, allowing you to get in the ranges of 8000 - 10000 grafts,

 

O really? How much typically can one pull out via FUE?

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Yeah that's check mate for Feller. He knows he can't put up a argument against that. That's why he is so quiet. It became in his own interest to discredit FUE.

 

Mahhong makes some good points and I concur. Until proper studies are conducted this debate is useless.

 

However the individual that posted here mentioned that the ISHRS is performing a multi center study regarding the survival of FUT vs FUE. He said that all preliminary data suggest that the survival rates are equal. We don't have the details yet obviously. I guess we will have to wait.

 

Let me tell you one thing though if that proves to be true FUT will get another crushing blow. It won't take long before FUT will be dying, it already is actually. I am quite certain that this will happen in the near future already. Time will tell us.

Edited by Swooping
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Feller while searching for your independent FUE patient results something surprised me of your opinion in the past;

 

fellerfue.jpg

 

Factually you seem to state in more postings back then that you believe FUE has the same yield as FUT. That is assuming a viable graft can get extracted. However every graft will endure the forces you speak about right?

 

Why did your opinion change 180 degrees?

 

What am I missing here? I was 100 % correct. Can you please point out specifically where you "got me" ?

 

Thank you

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Mr. Lileli sir, you ask a very good question that I am happy to answer for you.

 

"Dr. Bhatti,

 

Let's say a patient gets 4000 grafts implanted via fue. The second time they come back, let's say in a year, for another 4000 would it be very difficult because of the fibrosis build up?"

 

Scar tissue can indeed create problems if we do not approach the situation with care, experience and understanding. The scars have matured mostly in 9 months time after which the skin is soft enough for a sharp punch to enter easily. In addition, when we use smaller punches common today the space between the extractions is equally just as small so there is greater room for variance between previous exractions thus reducing the peripheral impact of the resulting subdermal scarring.

 

As you may know I use the Harris blunt punch. However for the second and subsequent sessions I use the sharp punch used in CIT.

 

I have a simple way to calculate the number of grafts I will get from the patient in a lifetime through my technique of leaving one follicle (what I call the sentinel follicle') in between 2 punch holes (1:5 or 20% harvest). AssumeI get 4000 scalp grafts in the first session. The second shall give me half the amount- 2000 and similarly sessions that follow decrease the amount that is harvestable by 50% each session.

 

If we say the back has 20,000 follicular units, we should not harvest ever beyond 40% or the skin starts to show. Much like the baldness in the scalp starts to appear when 50% hair are lost.

 

There is no great limit of grafts from the scalp available through FUE compared to FUT.

I do not think there is any marked difference in lifetime yield from the scalp as compared to FUSS. And remember we do not expand the crown :) And then we have the luxury of a whole lot of body hair that the FUT only surgeon cannot get to.

 

Btw, I believe we should reference FUT as FUSS as FUT is technically both FUE and strip. FUSS specifically references strip alone.

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Mr. Lileli sir, you ask a very good question that I am happy to answer for you.

 

"Dr. Bhatti,

 

Let's say a patient gets 4000 grafts implanted via fue. The second time they come back, let's say in a year, for another 4000 would it be very difficult because of the fibrosis build up?"

 

Scar tissue can indeed create problems if we do not approach the situation with care, experience and understanding. The scars have matured mostly in 9 months time after which the skin is soft enough for a sharp punch to enter easily. In addition, when we use smaller punches common today the space between the extractions is equally just as small so there is greater room for variance between previous exractions thus reducing the peripheral impact of the resulting subdermal scarring.

 

As you may know I use the Harris blunt punch. However for the second and subsequent sessions I use the sharp punch used in CIT.

 

I have a simple way to calculate the number of grafts I will get from the patient in a lifetime through my technique of leaving one follicle (what I call the sentinel follicle') in between 2 punch holes (1:5 or 20% harvest). AssumeI get 4000 scalp grafts in the first session. The second shall give me half the amount- 2000 and similarly sessions that follow decrease the amount that is harvestable by 50% each session.

 

If we say the back has 20,000 follicular units, we should not harvest ever beyond 40% or the skin starts to show. Much like the baldness in the scalp starts to appear when 50% hair are lost.

 

There is no great limit of grafts from the scalp available through FUE compared to FUT.

I do not think there is any marked difference in lifetime yield from the scalp as compared to FUSS. And remember we do not expand the crown :) And then we have the luxury of a whole lot of body hair that the FUT only surgeon cannot get to.

 

Btw, I believe we should reference FUT as FUSS as FUT is technically both FUE and strip. FUSS specifically references strip alone.

 

Thank you for your comprehensive answer Dr. Bhatti. I very much appreciate it!

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