Current trend of poor FUE results on HRN

[Dr Blake Bloxham]

Newbie,

 

Good to hear from you!

 

The scalp environment is the same in FUT and FUE, it's the grafts going into the scalp that make the difference. Let me try and explain.

 

A few years ago, one of the bigger European groups researching follicle stem cell cloning made an interesting announcement: They said that no matter how functional the pseudo-follicles they were creating from the cloned dermal papilla (follicle) stem cells were, they wouldn't survive if placed into the scalp of someone with advanced AGA.

 

Why??

 

Well, they found that there must be cellular cross talk between several different type of stem cells both inside and outside the follicle in order for follicles to survive in the scalp. Specifically, the dermal papilla stem cells had to send and receive information to and from fatty stem cells surrounding the follicles (adipocyte stem cells) and dermal sheath cells (DSCs) that are sort of outside the follicle niche too. Guess what they found is missing in AGA scalp?

 

When they made this announcement (it was actually on one of the other popular forums) people immediately asked: then why do transplants work? Well, they work because when you take a FUG and implant it into the balding scalp, you aren't just taking the follicles. You are also moving the surrounding dermal and subcutaneous supportive tissue with it. This tissue is loaded with the aforementioned cells needed for the follicles to survive the transplant process. When you strip a follicle of this supportive tissue, you're putting it into an unhealthy environment without the surrounding micro-environment it needs to survive. In this scenario, the long term survival rate is going to go down. This is why the skeletonized FUE grafts have lower survival in the scalp even if they are extracted and re-implanted in the most atraumatic manner possible.

 

Hope you do end up finding a procedure that works for you!

[esrec]

Easy gents. Nobody, including myself, was discounting the concerns around scar visibility.

 

I was merely calling attention to the other side. This is a reality that exists. It's a point of view often shared but rarely voiced.

 

Some people, understandably, are concerned with being cut open. Not just because of the incision itself, but potential mobility issues, nerve damage, and other pain sometimes reported. Is this even a controversial point of view?

 

The goal, as always. is to address all sides of the conversation. Back to the main topic.......

[Melvin- Admin]

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. an ethical surgeon is one of the most important factors in deciding who to go to in my opinion.

 

I agree, Dr. Rahal, Dr. Shapiro, Dr. Diep all perform both procedures consistently. I can understand how some doctors don't want to bother, because here they have a procedure in which they literally just cut a strip out of the head, pass it to techs for dissection, they close the strip and suture it, techs implant the grafts and they get good yield, why would they want to spend hours individually extracting each graft, it's time consuming, in the time they did one procedure of 2,000 grafts FUE, they could've done two strips at 3,000 grafts each with less work. It makes sense from a business standpoint especially in new physicians, learning curve in FUE takes years, but I think it's incorrect to say one is better than the other, in my opinion FUE yields a better overall cosmetic result, the fact that I'd may need to use scalp grafts via FUE to cover up a scar is an ultimate deal breaker for me, self conscious about balding, get surgery then end up self conscious about the scar makes no sense for me personally, I don't discourage anyone from having the procedure though, it should be up to the patient to decide what they want to have done, since this is elective surgery, just like rhinoplasty, you can choose to have open or closed rhinoplasty, if the surgeon can't perform closed rhinoplasty you go to one that can but the best plastic surgeons can do both.

[1978matt]

I found the recent FUE posters below without much difficulty (Poster ID withheld but you can PM if you want the list). I'm sure the list of posters complaining of poor FUT results with Feller pails in comparison.

 

Unfortunately people will continue to be duped by anonymous posters who claim FUE is as reliable as FUT. If you disagree then good luck and I hope you're not unlucky like the guys below.

 

____e - Recommended surgeon. Unhappy with density & direction of hair. Unnatural appearance.

____m - Poor growth from IAHRS surgeon fixed using FUT by coalition surgeon.

____l - Virtually no growth from coalition surgeon

____9 - Disappointed by growth from coalition surgeon.

____r - Regrets going FUE with unknown Turkish surgeon after successful FUTs.

____n - Disappointed by growth from coalition surgeon.

____t - Poor growth from recommended surgeon.

____h - Disappointed by growth from recommended surgeon.

____n - Uneven growth from recommended surgeon.

____o - Disappointed with growth from recommended surgeon.

____0 - Recommended surgeon. Unhappy with density & direction of hair. Unnatural appearance.

____s - Poor results from multiple well known surgeons.

____5 - Ok result but thin area corrected with free second surgery. Coalition surgeon.

____d - Disappointed with results from recommended surgeon. Second surgery with same doc.

____1 - Disappointed by growth from recommended surgeon.

____2 - Poor result from recommended surgeon.

____n - Poor result from recommended surgeon.

____m - Coalition surgeon. Questionable change in overall appearance. Not happy.

____6 - Disappointed by growth from recommended surgeon.

____8 - Disappointed by growth from recommended surgeon.

____2 - Disappointed by growth from recommended surgeon.

____D - Very poor result from recommended surgeon. Full refund.

____o - Bad results from unknown European surgeon.

____s - Needed 3 x FUE surgeries by 2 x coalition docs to get the desired result.

____4 - Poor result from unknown surgeon.

____e - Disappointing yield from well known reputed FUE surgeon.

____s - Needed a free second surgery by Coalition doc to compensate poor growth.

____y - Poor growth from unknown surgeon fixed using FUT by coalition surgeon.

____w - Disappointed by growth from recommended surgeon.

____n - Disappointed by growth from recommended surgeon.

____y - Areas of poor growth from recommended surgeon.

____l - Very poor growth from recommended surgeon.

____m - Disappointing experience with recommended surgeon (results not shown but angry).

____2 - Poor growth with unknown European surgeon.

____3 - States very poor growth from recommended surgeon (no pics).

____4 - Unhappy with weird look and lack of density. Known European surgeon.

____l - Poor results from unknown surgeon.

____r - Disappointing yield from recommended surgeon.

[Melvin- Admin]

I found the recent FUE posters below without much difficulty (Poster ID withheld but you can PM if you want the list). I'm sure the list of posters complaining of poor FUT results with Feller pails in comparison.

 

Unfortunately people will continue to be duped by anonymous posters who claim FUE is as reliable as FUT. If you disagree then good luck and I hope you're not unlucky like the guys

 

Are you not anonymous?

[mosd]

what are you guys saying? That FUT is better than FUE?

[Louisjams]

To make a somewhat larger point, I think that this bulletin board, and most internet bulletin boards in general, are skewed towards the extremes. For example, look at how many mega sessions get posted here, but the average HT in the USA is still between 2000-2500 grafts.

 

I have noticed here and on other hair loss boards that results posted tend to be one of two kinds:

1) Look at how amazing my results are!

or

2) Look at how awful my results are!

 

This is, essentially, sample error. Statistically, most average patients have average results and probably do not bother to post pics.

 

Could there be a bigger problem with FUE having less than stellar results more commonly than FUT? Possibly. Can we say so based on the postings on the board? I'm not so sure.

[romperstomper29]

To make a somewhat larger point, I think that this bulletin board, and most internet bulletin boards in general, are skewed towards the extremes. For example, look at how many mega sessions get posted here, but the average HT in the USA is still between 2000-2500 grafts.

 

I have noticed here and on other hair loss boards that results posted tend to be one of two kinds:

1) Look at how amazing my results are!

or

2) Look at how awful my results are!

 

This is, essentially, sample error. Statistically, most average patients have average results and probably do not bother to post pics.

 

Could there be a bigger problem with FUE having less than stellar results more commonly than FUT? Possibly. Can we say so based on the postings on the board? I'm not so sure.

 

I think this concept is flawed by the masses of people that post their immediate HT and then post pics monthly etc of their progress. how are they to know whether their transplant will be successful at the time of posting immediate post op photos? I have seen people progress with both excellent and average results but to insinuate there is some kind of premeditation associated with the results which are posted here is ridiculous

[Louisjams]

It's not premeditation, it's statistics and human nature. The extremes are more likely to be discussed. It's true in medicine, it's true in sports, it's true with the stock market, and I think it's true with HT.

[Louisjams]

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.

 

This. Exact. Point.

 

Right on target.

[Louisjams]

Duplicate post deleted.

[Dr Blake Bloxham]

Matt,

 

Wow. Quite the list!

[newbie33]

Thanks Blake. A very comprehensive explanation, as ever! I expect I'll pull the trigger one day, though heaven knows why - I'm not actually that bothered about my hair loss. Sure, I'd rather have hair and I'd look better for it, but it's basically an indulgence for me to get a HT. My life would be only marginally improved and I have a degree of guilt about not doing something much more useful with the money! Still, an interesting intellectual and anthropological pursuit to learn more about the process and those who undergo it!

 

Ironically, Louisjams, old chap, I think your statement that most average patients don't post their results is equally subject to the logic of sampling error! Without knowing the whole population, it's pretty difficult to tell if people only post the best and worst. I've seen plenty of results on here that I've thought were average - in the sense that they were neither brilliant nor terrible (but I've no real knowledge to say if they were representative of a statistical average, though I assume Bell curve distribution is likely for this as most other things in life).

 

Romper, I looked at Saifi a few years ago and for whatever reason he fell off my radar. Maybe I'll take a look again.

 

Matt, v interesting list! If you've got the time I'd appreciate it if you could pm me with it.

 

Have a good day, chaps!

[HairDew]

As if we can't come up with the list of failed FUT. This sample is not complete. It's mostly anecdotal but keep pressing on.

[MrGio-WHTCClinic]

The FUE surgeon's experience is the issue.

[Dr. Alan Feller]

The FUE surgeon's experience is the issue.

 

Disagree.

All things being equal, FUT produces the most consistent and reliable results due to the order of magnitude decrease in extraction trauma compared to FUE.

 

To claim it is the FUE surgeons experience rather than the increased trauma of the procedure is to ignore the elephant in the room. And we're talking BIG pachyderm here.

[wylie]

FUE has had proven results, we've all seen the success stories of FUE. So if FUE is proven to deliver a stellar result, what could be the problem? Execution.

 

Human error is to blame, and perhaps more so than human error is execution. Execution, as in human greed dictating less actual time with the patient and a higher number of patients, all to increase the bottom line. This approach will greatly diminish the chances of a successful result.

 

Doctors in this industry have gotten away with this approach by doing strip, which is far less labor intensive than FUE. To practice FUE and then try and implement the strip approach to HT's is not going to end well for the patient.

[Dr. Alan Feller]

FUE has had proven results, we've all seen the success stories of FUE. So if FUE is proven to deliver a stellar result, what could be the problem? Execution.

 

Human error is to blame, and perhaps more so than human error is execution. Execution, as in human greed dictating less actual time with the patient and a higher number of patients, all to increase the bottom line. This approach will greatly diminish the chances of a successful result.

 

Doctors in this industry have gotten away with this approach by doing strip, which is far less labor intensive than FUE. To practice FUE and then try and implement the strip approach to HT's is not going to end well for the patient.

 

 

FUE has proven results, just not on the same level of FUT. 80% growth of FUE is the generally agreed upon average. In many cases far far worse.

 

If a person had an FUE, the best result expected would be equal to FUT. However, the opposite is never said and never true. Think about that. Nobody ever says "hey, that FUT worked as well as that FUE".

 

Agreed too many FUE mills have sprung up. Not in the U.S. however due to regulations and lawsuits. And justifiably so.

 

To claim FUT is far less labor intensive than FUE is to have never performed either.

[wylie]

To claim FUT is far less labor intensive than FUE is to have never performed either.

 

Using a manual punch and extracting follicles one by one is not more labor intensive than cutting out a hair bearing strip and having a team of technicians prepare the grafts?

 

Come on now Dr. Feller.

[Dr. Alan Feller]

Using a manual punch and extracting follicles one by one is not more labor intensive than cutting out a hair bearing strip and having a team of technicians prepare the grafts?

 

Come on now Dr. Feller.

 

Ever do either my friend?

[wylie]

Ever do either my friend?

 

Is that an attempt to discredit my observations?

 

How about something a little more substantial then.

 

Most reputable FUE surgeons tend to do around 1000 grafts in a single session, with 1500 grafts usually being the maximum. That's not the case with a strip surgery. If one were to extrapolate this further, it would be reasonable to deduce the root cause of the discrepancy is the level of work involved in FUE is > than in strip surgery.

 

So, yes, I stand by my observation, and offer that to you as evidence why.

[Dr. Alan Feller]

Is that an attempt to discredit my observations?

 

How about something a little more substantial then.

 

Most reputable FUE surgeons tend to do around 1000 grafts in a single session, with 1500 grafts usually being the maximum. That's not the case with a strip surgery. If one were to extrapolate this further, it would be reasonable to deduce the root cause of the discrepancy is the level of work involved in FUE is > than in strip surgery.

 

So, yes, I stand by my observation, and offer that to you as evidence why.

 

So you have never actually performed either procedure.

[Melvin- Admin]

 

To claim FUT is far less labor intensive than FUE is to have never performed either.

 

Fascinating point of view Dr. Feller, your insight is invaluable, it makes sense cause FUE surgeries usually run until night time, while strip surgeries are finished within a few hours, must be that FUE surgeons are just slackers taking the easy route by extracting follicular units one by one, when they could take the hard route and cut a strip of meat behind the head and have technicians dissect the grafts. I guess these peanuts just don't get it huh doc:)

[Dr Tejinder Bhatti]

So you have never actually performed either procedure.

 

I have.

 

Greetings to everyone involved in this thread. I have read it in it's entirety with great interest but it appears the topic has veered from the original issue presented by Mr. FUE2014.

 

I believe there is indeed a body of poor results but it has to do more with the incredible influx of clinics that are now offering FUE with a very low, seemingly non-existent, surgical standard. If clinics have a high standard for surigical performance, enough years of experience and do not allow unlicenced technicians to perform the procedure then FUE is a wonderful modern alternative to FUSS with a strong expected outcome.

 

In my experience in India, the market is very similar to that of Turkey, where hundreds of clinics open with little to no experience and potentially without a doctor in sight. It is an epidemic really, and hits at the core problem with FUE. It is too easy for lay persons or inexperienced medical personnel to get involved and bring down the average success rate. A similar issue is occuring in the United States to a lesser degree. Automated machines are being marketed to clinics as an adjunct to their existing practices where they perform other medical cosmetic procedures. This too brings down the overall quality of results. There is no passion, there is no dediction, there is no specialization. In India, I am an anomaly in that I am one of the small handful (and that is being generous) of doctors that performs FUE myself and because I do the procedure myself I am able to control every aspect of the procedure.

 

Having performed many FUSS procedures over the years I am happy that I have switched to FUE only and I can say without hesitation that FUE is much more labor intenstive. I do not know of any of my colleagues that have also performed both to a respectable degree that will disagree with me, present company excluded of course. FUSS does have it's own set of skills and requirements, of course with great skill, but it is not as intensive as FUE. To compare, a proper strip is removed with a scalpel that incises the flesh to separate it from the donor scalp. Suturing is the standard for closure but staples are used by some to speed the process further. Some strips will take 20 minutes to remove but if safely and properly performed the strip removal process takes 45 minutes to an hour. Once completed the doctor can take a break or move on to the second, third or fourth patient while the technicians dissect the tissue to get to the follicular units.

 

FUE extraction however cannot be peformed in 45 minutes even in small cases. I get no such break after such a short amount of work. FUE extraction takes hours and the process is repetitive and requires extreme concentration, not to mention eye-hand coordination, over the course of several hours. This is not seen in strip excision. If performed properly and at an appropriate clinic there is much more direct involvement between doctor and patient with FUE than compared to strip thus there is more intensive work for the doctor overall.

 

FUE can never be supplanted by FUSS. The genie, as they say, is out of the bottle but it is imperative for patients to perform their diligence properly and to do their best not to be distracted by marketing and interaction that deflects from the points you wish to investigate. Does your clinic have consistent results or when you push for answers about results do you keep getting excuses?

 

Mr. FUE2014, I hope I have answered your question and shed some light on the issue with another point of view.

[tommygun]

My FUT was 7-8 hours (couple breaks) and seemed extremely labor intensive. No clue on FUE but it sure seems like that procedure would also be extremely labor intensive.

 

Here is my question to Dr Feller: if FUE is not more labor intensive and has poorer results, why does it carry such a higher cost to the client in your clinic? What is the primary driver for the cost difference? I am not trying to offend and I have no clue the correct answer, which is why I ask. In my line of work I have to justify higher cost to my clients should one exist between two different solutions. Will you please share your justification?