**PHOTOS** Question for the community: WHICH IS WHICH ???

[Dr. Alan Feller]

I disagree. While often polarizing in opinion, his results warrant an A Class rating in my book.

 

Thank you, Tommy. That was very nice of you. I appreciate the kudos.

[Matt27]

Nope, he prefers FUE for people who have great donor areas, for the "average" high NW patient, he prefers FUT. For example, stinger99 had a very strong donor area. Dr B, while he does a lot of FUE, pretty much agrees with the mainstream on the pros/cons of FUE vs FUT. I bet even Feriduni does the same. Just look at his portfolio, most of his high NW patients are FUT.

 

Most of the FUE results I have seen (and I have seen a lot) posted by Feriduni/Bisanga have donor densities of ~80 FU/cm^2. Basically Average.

 

But I think you have just repeated what i said in different words. That it's a lifetime donor issue. The patient's long term strategy is also important.

[Matt27]

KO,

 

Yup. Nailed it. Anyone who performs both obviously feels this way -- or, by definition, they wouldn't perform both. Most just aren't as active on the forums.

 

That isn't necessarily true. Many physicians will perform both because there is demand for both.

 

Budget and premium options are generally offered by any business. Not saying FUT is strictly a budget option as there is more to it than that, but there would be reasons to offer both regardless of such differences.

[Stig]

That isn't necessarily true. Many physicians will perform both because there is demand for both.

 

Budget and premium options are generally offered by any business. Not saying FUT is strictly a budget option as there is more to it than that, but there would be reasons to offer both regardless of such differences.

 

Isn't FUE in Europe cheaper than FUT in the States?

[Matt27]

3k grafts will cost around 10k euros I think. So no it's still pricey.

[Markhair100]

Hey doc feller. I like this. You make a game out of surgery. How can you really tell which is which unless you are doctor. I mean really? But I must say they both look really really great. Well balanced out and blends. One of my buddies got an HT that looked a bit not quite right. Ya know? But these guys look good. I'd be over the moon with those results.

[HairJo]

I'm pretty sure I got it right the one on the right is HT and the one on the left is fue I do agree they both look good and I enjoy the challenge

[KO]

That isn't necessarily true. Many physicians will perform both because there is demand for both.

 

Budget and premium options are generally offered by any business. Not saying FUT is strictly a budget option as there is more to it than that, but there would be reasons to offer both regardless of such differences.

No he's correct, these doctors do not believe that the two techniques are equal.

 

From Feriduni's own site:

 

Generally speaking, grafts extracted vie FUE are much more sensitive, as the extraction technique leaves much less protective tissue around the hair follicles. This ultimately leads to a slightly lower survival rate.

 

Now keep in mind, Feriduni is primarly known for his FUE, so there is some marketing speak here, but even then, he does not say that FUE yields are equal to or greater than FUT. At best he minimizes the difference. This line of reasoning (That FUT yield > FUE yield) is common and widely held among surgeons like Feriduni who are competent at both techniques. Feriduni is great at FUT too!

[Matt27]

No he's correct, these doctors do not believe that the two techniques are equal.

 

From Feriduni's own site:

 

 

 

Now keep in mind, Feriduni is primarly known for his FUE, so there is some marketing speak here, but even then, he does not say that FUE yields are equal to or greater than FUT. At best he minimizes the difference. This line of reasoning (That FUT yield > FUE yield) is common and widely held among surgeons like Feriduni who are competent at both techniques. Feriduni is great at FUT too!

 

I've already conceded that. What I initially said is that Bisanga and Feriduni will give the patient the option between FUE/FUT for most surgeries.

 

You said that they prefer FUE for patients with very good donor and I responded by saying that most FUE results they post (even large sessions) have average donor.

 

The reason I said what I did is because Dr. Feller suggested that there could be a business incentive for European physicians to push FUE. I said that, from what I can tell, they generally don't try to hard sell either method. They leave it up to the patient.

 

The exception is if you don't have enough donor for a decent result (as is the case with NW6+). Then they may deny you FUE. But I see them operate on tons of NW4-5s with average donor.

[KO]

Not really. Bisanga wants his FUE candidates, especially higher NWs to have above average donor density. He believes in depleting no more than 30% of the donor supply for FUE, and if you only have average donor density, that is not a lot of grafts!

 

As for Feriduni, I do not see him operating on "tons" of high NW cases with FUE regularly. The only "tons" of cases I see from him are low NW FUE. His portfolio of high NW FUE cases is significantly smaller than that of his high NW FUT cases.

[Matt27]

Maybe I exaggerated by saying tons, but I have seen them. And their FUE cases routinely do have average donor. Especially Feriduni's.

 

Bisanga is overly conservative anyway. He pushes finasteride more than anyone and seems more concerned about the possibility of an awkward looking transplant down the road than he is of a patient ruining his health. So I admit he was a bad example to use. He isn't an option for me anyway.

Edited September 9, 2015 by Matt27

[Markhair100]

I don't care which is which, I would take either of them ! Question for you doctor, what happens if they need more hair transplants in the future, like in the top area? Do you think they will have enough for it?

[ndubya]

Maybe I exaggerated by saying tons, but I have seen them. And their FUE cases routinely do have average donor. Especially Feriduni's.

 

Bisanga is overly conservative anyway. He pushes finasteride more than anyone and seems more concerned about the possibility of an awkward looking transplant down the road than he is of a patient ruining his health. So I admit he was a bad example to use. He isn't an option for me anyway.

 

I consulted with both Bisanga and Feriduni, both great guys. Bisanga estimated my donor at 2 1/2 times what Dr. Feriduni did. Dr Bisangas hairline was lower and he quoted more grafts per cm2. I liked both of them but Dr. Bisanga was more aggressive and assured me that I had enough donor to last me a lifetime

[Dr. Alan Feller]

 

The reason I said what I did is because Dr. Feller suggested that there could be a business incentive for European physicians to push FUE. I said that, from what I can tell, they generally don't try to hard sell either method. They leave it up to the patient.

 

Matt,

 

That's not what I said nor suggested.

 

I only asked you if you believed European physicians have business incentives to push FUE since you already wrote that American physicians had business incentives to hard sell FUT.

 

I wanted to see if you knew you were applying a double standard.

[destorius]

Maybe I exaggerated by saying tons, but I have seen them. And their FUE cases routinely do have average donor. Especially Feriduni's.

 

Bisanga is overly conservative anyway. He pushes finasteride more than anyone and seems more concerned about the possibility of an awkward looking transplant down the road than he is of a patient ruining his health. So I admit he was a bad example to use. He isn't an option for me anyway.

 

I think you are being a bit unfair here. The general consensus is that if it can be tolerated, Finasteride is a valuable ongoing tool after having an HT. In addition, wouldn't you want a doctor who is conservative in his approach? Lots of people years down the line regret packing 3k graphs in the hairline!

[Dr. Alan Feller]

I think you are being a bit unfair here. The general consensus is that if it can be tolerated, Finasteride is a valuable ongoing tool after having an HT. In addition, wouldn't you want a doctor who is conservative in his approach? Lots of people years down the line regret packing 3k graphs in the hairline!

 

The issue of front loading was the "hot debate" of it's time in the late 1900s and early early 2000s. When 3,000 grafts are packed into the front on someone with questionable hair loss potential in the top and back this can lead to an unbalanced look and not enough hair left in the donor to cover it years down the road. In some patients it can be done, but by and large should be avoided. I'm seeing a lot of FUE-only doctors "front loading" because they attract a very young patient population and that's what they want, but that doesn't mean it should be performed.

[destorius]

The issue of front loading was the "hot debate" of it's time in the late 1900s and early early 2000s. When 3,000 grafts are packed into the front on someone with questionable hair loss potential in the top and back this can lead to an unbalanced look and not enough hair left in the donor to cover it years down the road. In some patients it can be done, but by and large should be avoided. I'm seeing a lot of FUE-only doctors "front loading" because they attract a very young patient population and that's what they want, but that doesn't mean it should be performed.

 

100% on point. Whilst we would all love 5000 graphs in our front third, that is often not the sensible approach to follow. You could get a good cosmetic improvement and provides more doner to address further thinning in the future. I do worry about some of these young guys using 80% of their donor when they are in their late 20's and a Norwood 2-3.

[Sethticles]

I'm seeing a lot of FUE-only doctors "front loading" because they attract a very young patient population and that's what they want, but that doesn't mean it should be performed.

 

whats amounts to "front loading"

[Dr. Alan Feller]

whats amounts to "front loading"

 

Front loading is when a disproportionate amount of donor grafts are used to create or thicken a hairline that is too low to connect to the top should more hair loss occur in the future. The front loaded patient can look absolutely stunning for the first few years after transplant, but as the patient loses more hair behind the front loaded hairline the gap can't be filled because too much donor area was used in the first surgery so it looks unbalanced. That's why more conservative hairlines are the better choice. Unfortunately, so many young men demand lower hairlines that some doctors accommodate them even though it most certainly is not in the patient's best interest years down the line.

[wibbles180]

Hi dr feller , would it be possible to see an example of this front loading issue to see how bad it can turn out if hair is lost behind the hairline , I'm 33 and I am stuck between 2 surgeons to perform my first ht :-

 

Dr Lorenzo = 1800 to hairline 500 to crown (conservative)

Dr erdogan = 4000 total rebuild !

 

My thoughts are , seen as I am on finasteride I should be OK to go with the more aggressive approach and even if I did loose the mid scalp I could always buzz down and add some smp but still have a youthful hairline ?

 

Any advise would be greatly recieved , especially an example of the front loaded hairline issue . I will attatch a picture to a post below to see what you think would be my best approach ?

 

Thanks

[wibbles180]

Concervative or youthful hairline

[wibbles180]

This is my donor