1,250 FUE pre-op, Immediate post op, 3 day post op recipient and donor

[Dr. Alan Feller]

My personal goal for FUE is to make the results the same as strip surgery. To achieve this I believe the work has to be "clean looking" from start to finish. In fact "ultra-refined" may be articulated as "clean and tight" work, I'm just adapting it to FUE.

 

When I perform FUE I make sure to put each and every extraction under the microscope to make sure they are in good conidition and to trim away any excess tissue. Excess tissue, usually eptidermis, requires the slit sizes to be larger and makes the skin prone to irritation so I feel it is best to trim the grafts down to minimum epidermis and dermis.

 

This patient had an excellent donor area with many multi-haired (3,4,5) follicular units. The problem was that his grafts were so large that had I attempted to implant them into the recipient area I would not have been able to achieve as high a density as I would like. So we divided his multihair grafs down to single hair grafts and packed them tightly into the recipient area.

 

The goal was to match the density of the surrounding hair to fill in the obvious gap. My feeling is that he will hold onto his forelock for a few years, but despite this, I planted his transplants in such a way as to cover the forelock area should he lose it sooner.

 

As with many FUE patients his goal is to keep his hair short and shave his head.

 

We packed 1,250 FUE into the frontal area.

 

Here are his photos before, during, and three days after his procedure hours before he boarded a plane for home.

 

Note how the donor area holes, which were made with a 1mm Feller Punch, contracted and closed on their own.

 

[mattj]

Dr. Feller, when examining the grafts extracted via FUE. do you often have reason to reject them and discard them?

By being extra careful like this, would you say that graft yield with FUE matches, or comes close to matching, that which you can achieve with strip?

[Dr. Alan Feller]

Hello Matt,

Thankfully I don't "often" have reason to reject FUE grafts, but every one of them must be inspected under the microscope and nearly everyone needs to be trimmed as excess tissue is usually present.

 

I think being extra careful does improve yields, dramatically in some cases, but there is still very much an "x-factor" associated with FUE. I still tell my patients that I don't expect FUE yields to match Strip yields, but that doesn't mean they never do or that they often do. As in all surgery it's best to give the patient the education needed to make up their own mind.

For myself I probably wouldn't bother with a strip if the surgery were only 1000 grafts or less. If however I needed more than 1000 grafts I would still opt for strip surgery.

 

Thank you for your comments. Best to Dr. R.

 

Dr. F

[Raphael84]

Dr Feller, great documentation as always. One question I have. You explain that due to dense packing issues with the grafts containing more hairs, you divide these down to single hairs. In this 1250 graft procedure, do each of these single hairs count as a graft, or is the graft count pre seperation?

[Dr. Alan Feller]

In this particular case we could not leave his follicular units together because he would have looked very stalky or pluggy that way. To get the homogeneous coverage we needed he had to be cut to pure singles. We would have done this whether it was a strip or FUE and it is usually very very effective.

 

1,250 grafts, in this particular case, is AFTER separation and preparation, just like strip surgery. In most cases, however, there is parity or near parity as the average number of single hair grafts is about 20-25% and the rest are two and three hair grafts just as in a strip procedure.

 

Dr. F

[youngsuccess]

Impeccable post-op presentation, as expected. Looks like the density throughout the recipient area will be relatively consistent with his surrounding native hair, too.

 

I'm a big proponent of using only singles anywhere even remotely near the hairline after experiencing firsthand the damage that even some double-hair grafts can do. And I have pretty fine hair, so I can imagine how artificial the more offending larger units might look in someone with thicker caliber locks. Definitely the right thing to do rather than taking the lazy way out.

 

Great job.

[Mick from Farjo]

Dr Feller,

 

The more i see of your FUE work, the more i begin to appreciate the work that you have put in to this area of transplantation during the past few years.

 

Mick

[Dr. Alan Feller]

Right on target youngsuccess.Thank you.

 

And thank you Mick, I appreciate the kudo's.

[hair_me_out]

Looks like clean work, as always, Dr. Feller. I look forward to seeing the results in the coming months.

[bally]

Hello all, the above pictures are of my FUE treatment done by Dr Feller on the 13th November 2009.

 

I would like to share my experience with anybody who is thinking of getting HT done and which surgeon to go with.

As I am based in London, I naturally wanted to try and get a HT done in the UK. I am 26 years old and the front of my hair was thinning, this affected my confidence when going out and talking to people. I thoroughly researched the web and found several clinic in London. To be honest a lot of them had differing opinions and types of HT to be carried out. However, after coming to find this forum I got a better insight as to the results attained by these clinics, I lost faith as I had no real customer interaction with the clinics or there so called 'sale reps'.

Searching this forum I kept coming across Dr Feller and how reputable he was, so I thought I'd research him a bit more.... I came to know that I did not come across any negative feedback with Dr Feller but the ever growing success of his HT treatments. One major factor in me obviously choosing Dr Feller was the support I had from Spex based here in the UK. He was not a sales man or anything but just someone who offered unbiased views on HT and places to get treatment done from. Spex was very informative and helpful, as he always gave me the pros and cons of getting a HT done and the types of HT available. I sent him some photos and within a day or two I got DR Fellers opinion. I researched a bit more on this forum and I decided to go with DR FEller. His reputation, success and Spex's help was the factor which made me decide to go with them.

 

The whole experience was very smooth and convenient. I booked into the 'Andrew Hotel' which was a 10 min drive to the surgery of DR FEllers.

On the day of the surgery I met up with Dr Feller, he re confirmed what type of treatment would be right and the amount of grafts going to be placed and where. Dr Feller as described by Spex is very very down to earth and a cool guy. He not only takes interest in his work in great detail but also you as the patient...he offers a bespoke service to the patients needs.

 

the surgery to my surprise was not painful at all, as they numb the back and the front of your head accordingly with multiple little injection pricks which didn't feel that bad. After that its over to the docs to carry out there treatment.

 

all in all, the FUE surgery was a success as you can tell from my pictures above and going forward I will submit new photos to show you my progress. Spex is a great guy, he offers a lot of help when and how you need it. Dr Feller is amazing and so is his staff, they regularly gave me updates as to the procedure and always checked if I was ok.

 

I think Dr Feller is one of the best HT surgeons around, I am proof he is a legend and you wont regret it if you go to see him along with Spex's help.

 

thanks

 

Bally

[omy]

The donor and recipient areas look great . Is it possible to conceal the donor area with longer hair for very small cases to go un noticed until grown out ?

[trigger50]

Great write up bally, the results look excellent. The fine art of fue at it's very best. I'm booked for 1200 fue myself in Jan with dr feller. I sent you a PM also

[trigger50]

Got in touch cheers spex. Any update pics spex?

[TC17]

Dr. Feller,

 

I'm curious as to why you placed grafts in the particular pattern that you did. Isn't it likely that this patient will continue to lose at least more hair from the front, necessitating a second surgery? Why wasn't the full frontal third filled in?

[JimJohnson]

Originally posted by TC17:

Dr. Feller,

 

I'm curious as to why you placed grafts in the particular pattern that you did. Isn't it likely that this patient will continue to lose at least more hair from the front, necessitating a second surgery? Why wasn't the full frontal third filled in?

 

My guess is that he couldn't afford more grafts at a price of 10$ per graft.

[notjustyet]

this was a $12500 job as it was..

[JimJohnson]

Originally posted by spex:

Hey TC17,

 

The patients plan was always to have further work via FUE as understands the limitations FUE presents. The plan initially is to address the areas most in demand with the safe amount of FUE that was able to be harvested in one session. The patient only wanted FUE as plans to keep hair short. He will in time return to Dr Feller to continue his journey through if/when required as planned out by the doc and himself.

 

With regards to the comments about Dr Fellers pricing.. (anyone running a search against certain posters would think they had an agenda against Feller...) - This patient received 1250+ but only paid for 1000 ( very common for Feller patients to get free grafts) making the patient session $8 a graft.

 

Nobody has an agenda against feller, spex. I think he's a very good surgeon, but come on man, 8$ per graft, that's even more than Armani charges!!!

[orangehair]

JJ.....$8/graft is not a prohibitive cost, especially given the nature of the FUE method

[TC17]

Spex,

 

First, thanks for the reply, I appreciate it buddy. Do you have any idea how long it took Dr. Feller to do 1,250 grafts from FUE? Also, why didn't the patient just perform a two day procedure so that he could maybe have 2,000 or 2,500 over two days, instead of one session of 1,250 and then be compelled to return in a few years?

[Bill - Seemiller]

JimJohnson and NotJustYet,

 

I think you're just going to have to accept that $8 to $10 is the going rate for FUE. You might not like it, but it is what it is.

 

To date, cost is still one of the deterring factors preventing some patients who are qualified from getting FUE. Whether or not it will come down in price with time is hard to tell. Perhaps as speed increases (assuming efficiency doesn't decrease) it just might. In the meantime, those who choose to undergo FUE are accepting the price as is. Remember that hair transplant surgery is an elective procedure.

 

Best wishes,

 

Bill

[JimJohnson]

Hey Bill!

 

Just wondering, how the hell do I write PM's over here??!

 

Btw, there are better FUE suergons who charger 3?‚¬ per graft, which is far less than 8-10$ per graft!

 

greets

[Bill - Seemiller]

Jim,

 

To send a private message, just click on the users name on the left and choose "Invite 'user' to a private topic".

 

You are entitled to your opinion on which doctor you like best. But if you've already found a surgeon you like better who charges less, why not go to them? While I too would like the fees of FUE to come down, it's not going to do any good to harp on a physician about his/her fees every time they post results.

 

Bill

[Dr. Alan Feller]

"More expensive" doesn't always mean better. Likewise "Cheaper" doesn't always mean worse.

 

With that said, bargain basement hunting for any kind of surgery is probably not a good idea.

 

The price for FUE tends to fall in the $8-$10 range in the United States because that's what it takes for a quality and well established clinic to introduce FUE into the practice and keep it.

 

The costs associated for a medical physical- plant, staff, regulation compliance, and insurance alone would suprise most regular participants on this website.

 

Corner cutting methods taken by clinics that attempt to charge less (beyond an introductory offer) have included the use of technicians to cut and remove FUE grafts. Essentially, the technician performs the surgery while the doctor is in another room. To my knowledge this is an illegal practice in most if not all states. It most certainly is an immoral practice nevertheless.

 

Technician performed surgery, however, occurs with impunity because it rarely comes to light and is NEVER advertised or discussed transparently on the internet. The patient is completely unaware that a technician is performing the actual cutting. If and when such a clinic is sued for malpractice, the truth will come out in the wash and that will spell big trouble for that particular clinic.

 

Another reason prices might be set lower is simply because the doctor is relatively new to HT in general. There were many new hair transplant doctors who popped up with the introduction of FUE. To them, it seemed like a cake-walk because the overhead was less than that for a strip clinic. Or so it seemed. Most of these clinics have either gone out of business or simply abandoned FUE.

 

In my own particular case I do not have to perform FUE at all. There is plenty of strip work to keep me busy. However, I find the challenge of FUE to be compelling as it is an open area where I can make signfiicant contributions in terms of instrumentation, technique, and discovery. Simply put, it is difficult and so I am drawn to the challenge. As most of you know, I have attempted to do so openly and unabashedly since the end of 2002. I have posted my successes and my failures and make sure to tell each and every patient the TRUE ups and downs of the FUE procedure. I believe failure to give informed consent with respect to FUE is rampant.

 

There's a reason the overwhelming majority of established hair transplant clinics charge in the $8-$10 range for FUE. But if you find a significantly cheaper one, the first question you need to ask is does the doctor do the actual cutting with his own hands? Also, ask how many years they have been performing FUE and do they have GROWN OUT patients to see? NOT strip results, but pure FUE results!

 

In my own particular case I performed FUE for years at my own expense before I ever charged anyone a penny- just to make sure I had successfully grown results to show. And to demonstrate that I could say, with force, that I knew what I was doing. Most don't do that. They simply buy an off-the-shelf punch and jump in by charging for the surgery without having a single grown out result to show.

 

Are there doctors out there who have a natural flair for FUE surgery? I believe there are and these are the ones who may start out with lower prices. But as their successes pile up and their practices grow they will inevitably raise their prices-as we all did on the strip side.

 

Dr. Feller

[notjustyet]

But as their successes pile up and their practices grow they will inevitably raise their prices-as we all did on the strip side.

 

Exactly. Say whatever but this is the ONLY reason FUE is in this price range. Let me and a handful of others stand among the cheering throngs and be the only ones who quietly (and only occasionally) post "The Emperor has no clothes on"..

[thanatopsis_awry]

Who's "The Emperor", and what exactly does his "nakedness" represent in this usage of the phrase/metaphor?

 

Also, what do you propose is done to get FUE's across the board pricing to your liking?

 

TC raises an interesting question about the possibility of performing back2back days of procedures to aim for more grafts. This is a facet of FUE that seems to be different from clinic to clinic.

 

The work looks strong as usual, and 1250 is a real healthy number of grafts for a one day procedure.