Current trend of poor FUE results on HRN

[FUE2014]

Anyone else noticed this?

 

It makes you question whether there are inherent flaws with the practice (of FUE); or issues with the surgeons (such as Dr Doganay) that are contributing to complaints of poor growth.

 

Has anyone reevaluated their decision to opt for FUE in light of the poor results?

[JON86]

I think the alarming thing isn't the difference between the two procedures but that it is the fact that in some clinics techs are doing most of the work. How do we know how much experience a tech has? Both procedures have their place and can be done by a qualified physician but it is becoming more apparent that we as consumers are getting screwed by the dishonesty of this industry.

[Dr. Alan Feller]

It is incorrect to call it a "current trend" of poor FUE results, but rather a "continuing" trend that reflects the true reality of FUE results in the general population for the past 15 years.

[Stig]

It is incorrect to call it a "current trend" of poor FUE results, but rather a "continuing" trend that reflects the true reality of FUE results in the general population for the past 15 years.

 

Welcome back Doc, we missed you!

[esrec]

People love to focus the narrative on scar vs non-scar, as it detracts from the real concern they share: incision vs non-incision.

 

I mean this in most respectful way possible, but there's a "wimp" factor at play. Its more acceptable to say you dont want a scar than admitting you dont want to be cut open. I do wonder how many went with FUE in fear of the pain.

 

I'll readily admit, that was my biggest fear going into surgery. I thought I woud be immobilized and hurting for weeks. It was bs on my part--I was just afraid of getting cut open. As it turns out, the pain was minimal and I was feeling fine after a week. The post op aesthetics have proven much more taxing.

[LondonHTseeker]

Welcome back Doc, we missed you!

 

Spot the real backside smoocher.

[FUE2014]

Lol maybe he's right, maybe a lot of us have been sold the virtues of FUE, which do not actually reflect what surgeons who perform both procedures are seeing. One thing is for sure, the hair restoration industry is far from straight forward and even if you research for years, you still face so many unknowns.

 

Case in point is Dr Doganay. Rewind two years and put yourself in the position of someone who has researched for months beforehand. Reading HRN back in 2013/2014 you would easily be forgiven for thinking Dr Doganay was the best thing since sliced bread. Great results and cheap prices. How many patients signed up with him on the back of all the praise he was getting back then on HRN? Tons! Were they to know back then what we *seemingly* know now about his practices or that he was possibly using fake accounts? No, of course not.

 

Perception and reality are clearly very different things in hair restoration.

[HairLostYears]

People love to focus the narrative on scar vs non-scar, as it detracts from the real concern they share: incision vs non-incision.

 

I mean this in most respectful way possible, but there's a "wimp" factor at play. Its more acceptable to say you dont want a scar than admitting you dont want to be cut open. I do wonder how many went with FUE in fear of the pain.

 

I'll readily admit, that was my biggest fear going into surgery. I thought I woud be immobilized and hurting for weeks. It was bs on my part--I was just afraid of getting cut open. As it turns out, the pain was minimal and I was feeling fine after a week. The post op aesthetics have proven much more taxing.

 

Agree with this, definitely the case for me. I've seen Dr. Feller say the same thing but nobody seemed to admit to it.

 

I want my rockstar hair which would never be short enough to expose a scar. Never had any sort of surgery before and I just can't seem to get over the initial hurdle of allowing myself to be hacked open in the name of vanity.

 

Sometimes feels like I'm the only coward who's man enough to admit he's a coward. (ha!)

[esrec]

Agree with this, definitely the case for me. I've seen Dr. Feller say the same thing but nobody seemed to admit to it.

 

I want my rockstar hair which would never be short enough to expose a scar. Never had any sort of surgery before and I just can't seem to get over the initial hurdle of allowing myself to be hacked open in the name of vanity.

 

Sometimes feels like I'm the only coward who's man enough to admit he's a coward. (ha!)

 

 

I think I just admited it too

 

Listen, of course things like age, scalp laxity, closure method, and doctor, etc factor into extent of downtime, but I honestly felt no more than a 2 out of 10 on the pain scale on the worst day. It was more nuisance than anything. Don't worry.

[JON86]

I think Doctor Feller sees more everyday in his practice then I do on surfing the web. I for one believe what he says. I have done other consultations with doctors one who is pro fue

and he told me that fut was a better choice for more grafts. I am not saying fue doesn't work

but fut has it's place.

[romperstomper29]

People love to focus the narrative on scar vs non-scar, as it detracts from the real concern they share: incision vs non-incision.

 

I mean this in most respectful way possible, but there's a "wimp" factor at play. Its more acceptable to say you dont want a scar than admitting you dont want to be cut open. I do wonder how many went with FUE in fear of the pain.

 

I'll readily admit, that was my biggest fear going into surgery. I thought I woud be immobilized and hurting for weeks. It was bs on my part--I was just afraid of getting cut open. As it turns out, the pain was minimal and I was feeling fine after a week. The post op aesthetics have proven much more taxing.

 

Have to say this is total bullsh*t iv had surgery before and quite extensive at that and pain doesn't bother me in the slightest it was the scar that was off putting. I'd let a player cut me open anyday if the results would be superior but that big nasty looking scar is the off putting factor. With respect to u this assumption of urs is disrespectful and mis-guided largely by ur own fears I would guess.

[Tokoloshe]

I'd say the current 'trend' of poor results is down to the increased use of inferior protocol.

 

The small handful of FUE clinics with consistently excellent results do the following:

-Use of manual tools

-Most of the op performed by doc, technicians handling the forceps

-Extracting only small (<1000) amounts of grafts at a time

-Splitting larger cases over multiple days to minimize swelling, bleeding etc.

 

 

Many FUE docs aren't doing the above - they use morotized tools to perform mega-sessions, they over rely on technicians & massively over-estimate the number of grafts to compensate for poor yield.

 

In addition, certain docs with sterling reputations a couple of years ago have experienced massive increases in demand.

Clinics (mostly in Turkey) who were doing one patient per day in 2012 are now attending to 3+.

 

This sudden spike has led them to take on more technicians with less experience,

leading to the often seen situation where one side of a patient's head looks terrific and the other looks sparse.

Edited November 11, 2015 by Tokoloshe

[Melvin- Admin]

Lmao Dr. Feller after being relatively quiet on this forum, he sniffed this thread out like a police dog at a Colombian airport. FUE2014, when you see the current trend of poor results, you'll see another common trend, which is 100% tech extractions, previously doctors like doganay were performing the extractions and creating the recipient sites, it's becoming more alarming that popular FUE surgeons like Feriduni and doganay are only playing a minor role in the surgery, no doubt this will inevitably create inconsistent results. FUT physicians can get away with this, because skill and time is not required with the procedure, but I see it like this, imagine if technicians were the ones suturing the strip, you would see a string of bad stretched scars, is that the procedure or the negligence of the clinic?

 

I still maintain FUE is a good option on par with FUT, however and that's a big however, the surgeon has to be the one extracting and creating the recipient sites, my first FUE surgeon did the extractions himself with one lead tech, my yield was good but who knows how it would've been if it were left to just technicians. HRN needs to change their criteria for FUE physicians, that's why the cost should be more with FUE, there is more time and skill involved, when you try and cut costs you end up with techs doing 75% of the surgery and you end up with bad yield.

[romperstomper29]

Lmao Dr. Feller after being relatively quiet on this forum, he sniffed this thread out like a police dog at a Colombian airport

????couldn't have said it any better. Has he a spider sense for FUE vs FUT debates or threads which debate same and when one pops up he's nose starts tingling. To the FUT mobile Blake ???

[Dr Blake Bloxham]

I've always been very vocal about technician FUE. Extracting grafts via FUE is a process that takes a thorough understanding of what's going on, and will always matter more to the person who's name is on the door. Having said that, it's not a new phenomenon. Clinics have been doing technician FUE for DECADES. That's right, decades. People are only becoming wiser to it now because of the way it's shaping the market in certain areas of the world, but it's incorrect to correlate the rise in poor FUE results with technician FUE because it's absolutely not new.

 

There will always be those who truly want to believe in the FUE procedure and will subscribe to slightly skewed realities to justify subpar results. "There was a new tech on the right side that day, so that's why the right side grew poorer;" "I did X in the post-op period, so that's why I didn't grow in this area," "I was told the yield was only 80% because of Z;" et cetera.

 

We've heard them all. But there's a saying in science and medicine: the simplest answer is always the correct one. What is more plausible: that a huge number of FUE patients experience poorer yields on average because of a slew of technicians trotting the globe ruining procedures? Or that FUE patients are walking around smacking their heads carelessly after procedures en mass? Or is it more likely that there is singular unifying factor at play here?

 

The variable FUE results we're seeing posted are a direct reflection of the inherent problems with FUE. The technique places excessive trauma on grafts, creates a scenario where skeletonized grafts are sitting out of the body for excessive periods of time, and then calls for reimplantation of weaker grafts -- without the supportive material necessary for follicle health on the cellular level -- into unhealthy scalp.

 

This will always result in more variability and less impressive growth with respect to both quantity AND quality.

 

There will always be those who simply don't want to believe this and justify it in other ways, but the fact that this thread was created pretty telling. Thank you to FUE2014 for doing so.

[Dr Blake Bloxham]

Esrec,

 

I think you bring up a very valid point. I think many patients are more "put off" by the perceived invasive nature of a strip harvesting than they are of the idea of linear scar. Granted, there are still many who don't want a linear scar, but the issue you brought up isn't really discussed much online.

[esrec]

Have to say this is total bullsh*t iv had surgery before and quite extensive at that and pain doesn't bother me in the slightest it was the scar that was off putting. I'd let a player cut me open anyday if the results would be superior but that big nasty looking scar is the off putting factor. With respect to u this assumption of urs is disrespectful and mis-guided largely by ur own fears I would guess.

 

Congratulations. You're tougher than the rest of us.

 

I've spoken to enough people personally to know this is a factor for many. It just is. Someone chimed in already admitting it

 

No reason to be offended. Truth is its completely reasonable to be worried about being cut open. Obviously this assumption excludes you.

[Melvin- Admin]

I've always been very vocal about technician FUE. Extracting grafts via FUE is a process that takes a thorough understanding of what's going on, and will always matter more to the person who's name is on the door. Having said that, it's not a new phenomenon. Clinics have been doing technician FUE for DECADES. That's right, decades. People are only becoming wiser to it now because of the way it's shaping the market in certain areas of the world, but it's incorrect to correlate the rise in poor FUE results with technician FUE because it's absolutely not new.

 

There will always be those who truly want to believe in the FUE procedure and will subscribe to slightly skewed realities to justify subpar results. "There was a new tech on the right side that day, so that's why the right side grew poorer;" "I did X in the post-op period, so that's why I didn't grow in this area," "I was told the yield was only 80% because of Z;" et cetera.

 

We've heard them all. But there's a saying in science and medicine: the simplest answer is always the correct one. What is more plausible: that a huge number of FUE patients experience poorer yields on average because of a slew of technicians trotting the globe ruining procedures? Or that FUE patients are walking around smacking their heads carelessly after procedures en mass? Or is it more likely that there is singular unifying factor at play here?

 

The variable FUE results we're seeing posted are a direct reflection of the inherent problems with FUE. The technique places excessive trauma on grafts, creates a scenario where skeletonized grafts are sitting out of the body for excessive periods of time, and then calls for reimplantation of weaker grafts -- without the supportive material necessary for follicle health on the cellular level -- into unhealthy scalp.

 

This will always result in more variability and less impressive growth with respect to both quantity AND quality.

 

There will always be those who simply don't want to believe this and justify it in other ways, but the fact that this thread was created pretty telling. Thank you to FUE2014 for doing so.

 

Fascinating point of view, thanks for sharing Blake. Also, I would like to just add, there is no surgery without scars, while it would be wonderful to be able to buzz your head, it is simply not possible with FUE, please check out feller and bloxham FUT scars so small you'll forget they're there. Did I miss anything Blake? I love participating in these fascinating discussions with you and Dr. Feller.

[esrec]

Great explanation, sticky worthy. Thanks Doc.

[romperstomper29]

Congratulations. You're tougher than the rest of us.

 

I've spoken to enough people personally to know this is a factor for many. It just is. Someone chimed in already admitting it

 

No reason to be offended. Truth is its completely reasonable to be worried about being cut open. Obviously this assumption excludes you.

 

Yet I sense a very sneery tone to your message. I have a metal plate and screws and pins in my body so I genuinely mean it that I do not fear the pain of FUT it is indeed the scar which put me off the FUT as I like to cut my hair short. You obviously have a low opinion of the fellow forum members. Christ even boob jobs require incision.

[jsnw]

Dr. Blake - If this has been answered previously I apologize. I'm just curious, if FUE is so flawed, why name your new procedure "MFUE" after it? I've had FUE previously, but believe both strip and fue has it's place. Not looking to argue about the two, just curious about the "MFUE" name. Thanks

[Melvin- Admin]

Dr. Blake - If this has been answered previously I apologize. I'm just curious, if FUE is so flawed, why name your new procedure "MFUE" after it? I've had FUE previously, but believe both strip and fue has it's place. Not looking to argue about the two, just curious about the "MFUE" name. Thanks

 

Clever marketing, jut like their FUTvsFUE bait threads, truth is it should be called "modified old punch graft transplantation" essentially it's like the old punch graft procedures except with suture closure.

[Dr Blake Bloxham]

JS,

 

Good question. The name has definitely been a highly discussed point.

 

I'll give you the long answer:

 

If you read the ISHRS journal's (Hair Transplant Forum International) extensive piece about FUE nomenclature, you'll see that the naming and description of all these techniques and tools is actually quite convoluted and interesting.

 

According to the article, FUE was initially called something completely unrelated. In fact, I believe it was called the "top down" technique -- or something like this. When it was studied more extensively and began moving around the globe it was initially described as the "follicle isolation technique," or FIT, and this is what the experts generally agreed best defined FUE. This is because in the earlier days, FUE sometimes didn't involve the extraction of strict follicular units. Sometimes a smaller punch resulted in transection of a multi and only a single follicle from the group was removed and sometimes larger punches ended up taking multiple FUGs at once. Because of this, FIT was actually more accurate. However, by this time the name "FUE" caught on so it stayed.

 

Something similar happened with mFUE.

 

The first time we (Dr Feller specifically) ever did FUE was on a complicated repair patient who had extensive FUT and FUE procedures. He initially tried an FUE approach, but the sub-dermal scarring prevented reliable delivery and the grafts were ripping apart during delivery. In order to try and get something out, he modified his technique by using a much larger punch. So it really was a modification of his standard FUE or mFUE. That's the way he first described it, and it ended up catching on.

 

We discussed changing the name to something else a few times (the same way they did with FIT/FUE), but it's already in the lexicon so it'll stay for now. Frankly, I also think it's a pretty accurate description of what we do with mFUE.

 

And keep in mind that I do utilize FUE when it's appropriate. The technique itself still has it's place. But not in technician FUE and not in FUE megasessions.

 

Hopefully this explains. Thanks for asking.

[newbie33]

The variable FUE results we're seeing posted are a direct reflection of the inherent problems with FUE. The technique places excessive trauma on grafts, creates a scenario where skeletonized grafts are sitting out of the body for excessive periods of time, and then calls for reimplantation of weaker grafts -- without the supportive material necessary for follicle health on the cellular level -- into unhealthy scalp.

 

Blake, I understood until the 'unhealthy scalp' bit. What do you mean by that, and is and/or how is the scalp any different in FUE to strip?

 

On some of the other points, I had a consultation with Feriduni over three years ago. His techs were doing extractions back then. It was actually in that consultation that he suggested I opt for FUE (I'd assumed to get the number of grafts I'd need I would always require strip until that point).

 

Fast forward a few years and a tonne of research and consultations, and I've never really been able to convince myself that FUE would as near as damn it guarantee me a good result - or as good a result as strip. Clearly things like the number of grafts required, numbers transplanted in one session, the doctor extracting and implanting all grafts, and who the doctor is will make all the difference... but I've yet to find a clinic I'd trust that can guarantee how much the doctor will perform of the op (unless it's a doctor who will only perform small fue cases).

 

As an aside, I also consulted with Doganay nearly two years ago. Various things just didn't feel right to me. But the overriding impression I had was that he was going to give me a low hairline and a shitload of grafts no matter what I actually asked for - and that was mostly down to what he expected me to want and therefore go ahead with, and not what would be in my long-term interests.

 

And I'd agree with Romperstomper - it's not the pain that puts me off strip. I'd prefer fue (if it worked for sure), but I haven't ruled out strip. What's going against strip for me is the possibility of a stretched scar and the increased downtime after the surgery. But in both cases I'd dread the following months when it'd look crap and people would know I'd had an op - and that's probably as big a factor as any that's stopped me going ahead with an op.

[romperstomper29]

And I'd agree with Romperstomper - it's not the pain that puts me off strip. I'd prefer fue (if it worked for sure), but I haven't ruled out strip. What's going against strip for me is the possibility of a stretched scar and the increased downtime after the surgery. But in both cases I'd dread the following months when it'd look crap and people would know I'd had an op - and that's probably as big a factor as any that's stopped me going ahead with an op.

 

Newbie I had an FUE with 2,050 grafts by surgeon Marwan Saifi in poland who performs both FUT and FUE. he maintained a good surgeon should be able to perform both procedures as good as each other. He leaves the decision totally up to the patient. He does all the extractions and all the incisions himself. Techs only implant grafts. He even left a strip of untouched grafts in my donor area for the possibility of me changing my mind and considering an FUT down the line. He advocates for hair transplantation as a whole and not which procedure is better. When I had various consultations with top clinics I was told I need 4,000 grafts 5000+ grafts etc. Some docs will fire as much grafts into u as possible and look for wow results as opposed to developing a plan with the patient and factoring future loss etc. It's shouldn't be FUT vs FUE it should be FUT or FUE the choice is urs. Finding an ethical surgeon is one of the most important factors in deciding who to go to in my opinion.