Feller and Bloxham

[Dr. Alan Feller]

To the posters here: I have consulted with a ton of the "top" physicians here. First, a bunch who tried the ARTAS machine refuse to use it anymore and they do so because the results are not close to expected. These top docs have conscious but if ARTAS worked well I am sure many would continue to use it. It does not work well. Stay away.

 

EVERY one of those docs admitted privately that strip is still the best to ensure results. All offer FUE and use a variety of methods depending on the doc (e.g. manual punch, drill, even innovative beneath the scalp extractions from the "bottom up"). There is ongoing research as to how many grafts can be safely extractedl before compromising density, how to regenerate grafts, etc etc, All agreed for those needing major grafts (oh maybe between 3500-,8000) then strip in a good docs hand is still the best bet.

 

I've had the strip removed multiple times. It is intimidating. But it was the right thing to do for my case. If I need a small case to top off areas yeah sure maybe I'd risk losing some grafts via FUE--but I know it won't be as good as strip. And I've got pristine areas above and below the scar to explore if needed via FUE or MFUE. Now would I like to be able to cut my hair shorter and not expose the scar? Sure! But I would never have gotten the grafts I needed with FUE---as told to me by multiple docs.

 

Amen.

[mav23100gunther]

It's not a "big statement" it is what it is. I take exception to anyone who delegates surgery to unlicensed unqualified personnel. It doesn't matter who they are. You as the public should as well.

 

Thanks for your honesty. BTW - I actually agree 100% with your statement, even though Dr Rahal is my surgeon and he hit a home run for me using FUT. I would have no issues letting him perform FUE on me either though, probably because he earned my trust, even though he would be delegating the extractions.

 

It is not lost on me though that you chose your words very carefully in that last reply. I'm wondering why you are now limiting to unlicensed and unqualified. What about delegating the extractions (cutting) to a licensed and qualified technician/nurse? Just for the record of course.

[JayLDD]

I can't speak for what other people say or why they say it. Nor does it matter. The facts are the facts. FUE causes more trauma to the grafts and therefore do not grow as well as their FUT counterparts.

 

Dr. Hasson firmly understands this and has always agreed with this reality. If he has changed his position on this he certainly never shared his reasons with me or anyone else that I know of. It would be nice if he shared his revelations with the public. That would make for a great forum topic.

 

What I do reject is the reasoning that because Dr. Hasson (or anyone else) is an excellent and world class leader in FUT that this somehow makes him an expert on FUE. It doesn't.

 

Nor did Dr. Hasson or Doug make this claim for themselves. The inference was entirely made up by anonymous online lay posters.

 

For the record, Dr. Hasson didn't claim that he was an expert on FUE, however he did claim that Erdogan and Lorenzo were, noticeably not Dr. Feller and Dr. Rassman or any other American doctor.

 

Also not sure why you expect to get a memo from Dr. Hasson on this Dr. Feller, the industry doesn't revolve around you, whether or not you think it does.

[andy_+_+]

I can't speak for what other people say or why they say it. Nor does it matter. The facts are the facts. FUE causes more trauma to the grafts and therefore do not grow as well as their FUT counterparts.

 

Dr. Hasson firmly understands this and has always agreed with this reality. If he has changed his position on this he certainly never shared his reasons with me or anyone else that I know of. It would be nice if he shared his revelations with the public. That would make for a great forum topic.

 

What I do reject is the reasoning that because Dr. Hasson (or anyone else) is an excellent and world class leader in FUT that this somehow makes him an expert on FUE. It doesn't.

 

Nor did Dr. Hasson or Doug make this claim for themselves. The inference was entirely made up by anonymous online lay posters.

 

 

I never said Dr.Hasson was an expert in FUE. And the inference that was made by Doug was the survival rate was similar but in that same example he said the patient would have more grafts in a lifetime if he went FUT.

 

Dr. Feller, questions don't mean I disagree with you. I would strip and then FUE at the end.

 

I'm not attacking you so not sure why you are so hostile.

[JayLDD]

I never said Dr.Hasson was an expert in FUE. And the inference that was made by Doug was the survival rate was similar but in that same example he said the patient would have more grafts in a lifetime if he went FUT.

 

Dr. Feller, questions don't mean I disagree with you. I would strip and then FUE at the end.

 

I'm not attacking you so not sure why you are so hostile.

 

Because he knows he is wrong. If the results spoke for themselves he wouldn't have to cry like a baby every time the debate comes up.

[Dr. Alan Feller]

I don't think this discussion can be resolved without Feller explaining how Doctors such as Erdogan, Ferudini and Lupanzula put out FUE results consistently better than his own. It's all well and good to cite made up numbers and arrogantly spout "Well I'm a doctor!" but so are the Europeans putting out better work than yours with FUE and for a cheaper price than your FUE.

 

I'm not looking to be insulting or offensive, I think Feller has done great service to HT in the US as a practitioner of the art but also to educate patients and I very much enjoy his Youtube videos. The problem is that the appeal to authority fallacy is a bad argument to begin with, but when other doctors make conflicting claims AND have RESULTS to back up that FUE yields can be consistently just as good then you have a serious issue.

 

And that is the serious elephant in the room. Why are there MORE Erdogan results on the internet (all FUE) and on average I would consider them to be more aesthetically pleasing, and even more consistent. I've seen bad Feller results, I haven't seen bad Erdogan results, and there are more of them.

 

And it comes down to that, HT skill comes down to results and a natural, aesthetically pleasing result with minimal turmoil to the donor area. Without a doubt and I'm sure others here agree there are European FUE doctors doing a job just as good as Feller.

 

And still, Feller is scared to mention these doctors by name. Much appreciated that H+W are prepared to come out to praise and learn from EUROPEAN masters, not mediocre long time US FUE surgeons like Feller and Rassman.

 

Jean, you are offensive. And you mean to be.

I do not appeal to authority, I am the authority.

You are just a loud layman who simply doesn't know what he doesn't know. You embarrass yourself and confuse well meaning people.

You really should stop assuming to speak for the doctors who perform the actual surgeries. They didn't ask you to. You have no idea of how many procedures they are performing nor what their success and failure ratio is.

You also should stop trying to suppress the views and posts of those you don't agree with. I've already had at least one your phony posts deleted by the moderator. But by all means keep commenting on my Youtube videos, you boost their rankings.

[Dr. Alan Feller]

I never said Dr.Hasson was an expert in FUE. And the inference that was made by Doug was the survival rate was similar but in that same example he said the patient would have more grafts in a lifetime if he went FUT.

 

Dr. Feller, questions don't mean I disagree with you. I would strip and then FUE at the end.

 

I'm not attacking you so not sure why you are so hostile.

 

Andy,

No hostility at all.

And I fully agree with you to go for strip then FUE. That's exactly how it should be. We are on the same page.

I'm glad doug said patients would have more grafts in a lifetime if they go for FUT. You didn't include that in the original quote.

[JayLDD]

Jean, you are offensive. And you mean to be.

I do not appeal to authority, I am the authority.

You are just a loud layman who simply doesn't know what he doesn't know. You embarrass yourself and confuse well meaning people.

You really should stop assuming to speak for the doctors who perform the actual surgeries. They didn't ask you to. You have no idea of how many procedures they are performing nor what their success and failure ratio is.

You also should stop trying to suppress the views and posts of those you don't agree with. I've already had at least one your phony posts deleted by the moderator. But by all means keep commenting on my Youtube videos, you boost their rankings.

 

I enjoy your Youtube videos and will continue to comment on them if I feel like it, nothing I say is offensive or backed up by malice or bad intention.

 

I will concede that I cannot know the fail rate of these doctors however online a number of them have more results than you do both patient posted from day one and also the clinic and I would consider their level of aesthetically pleasing results to be as good as yours on results of equivalent graft numbers and surface area coverage. They are also consistently getting over 6000 FUE grafts on Norwood 6 pattern patients without an over harvested look.

 

Dr. Keser has done small experiments achieving 100% graft yield on a small square of FUE grafts placed at a density of 70 units/square cm.

 

I'm not trying to suppress the views of anyone, if anything I strongly emphasise that most of all patients should look at the results for themselves and find a doctor with a large archive of patient and doctor posted results over a large period of time. I take this far more seriously than uncited "fact based" comments by a Doctor wedded to FUT.

[Davis91]

JeanLuc

 

Good grief man what quantitative evidence is out there on FUE hair yields by this European doctors ? Qualitative photos are really SO subjective regarding yield and result. Do you know how few docs even list the vital stats on graft counts broken down at time of extraction on this site ? Minimal. Some of those Europeans doxsndo it well but man photos are just not a good way to evaluate, sorry. There are few clinics willing to post an "average" result. Pictures rarely show punctate scars, transacted grafts, potential donor area deforestation with FUE. How do photos shows subdermal scarring that may compromise a further round of FUE? They don't. It would take a hands on approach by an experienced hair transplant surgeon. Or what about the well documented phenomenon of Spanish /Italian stronger density? How does that affect the results ? Are the Spanish FUE docs playing with a stacked field by virtue of their practice location? See how complicated it is ? It's is nor as easy as you make it out to be to assess results. You are not qualified to do so.

[Dr. Alan Feller]

JeanLuc

 

Good grief man what quantitative evidence is out there on FUE hair yields by this European doctors ? Qualitative photos are really SO subjective regarding yield and result. Do you know how few docs even list the vital stats on graft counts broken down at time of extraction on this site ? Minimal. Some of those Europeans doxsndo it well but man photos are just not a good way to evaluate, sorry. There are few clinics willing to post an "average" result. Pictures rarely show punctate scars, transacted grafts, potential donor area deforestation with FUE. How do photos shows subdermal scarring that may compromise a further round of FUE? They don't. It would take a hands on approach by an experienced hair transplant surgeon. Or what about the well documented phenomenon of Spanish /Italian stronger density? How does that affect the results ? Are the Spanish FUE docs playing with a stacked field by virtue of their practice location? See how complicated it is ? It's is nor as easy as you make it out to be to assess results. You are not qualified to do so.

 

Davis, your post is dead on. Really well written. Good to see someone is using their brain and thinking things through.

[JayLDD]

JeanLuc

 

Good grief man what quantitative evidence is out there on FUE hair yields by this European doctors ? Qualitative photos are really SO subjective regarding yield and result. Do you know how few docs even list the vital stats on graft counts broken down at time of extraction on this site ? Minimal. Some of those Europeans doxsndo it well but man photos are just not a good way to evaluate, sorry. There are few clinics willing to post an "average" result. Pictures rarely show punctate scars, transacted grafts, potential donor area deforestation with FUE. How do photos shows subdermal scarring that may compromise a further round of FUE? They don't. It would take a hands on approach by an experienced hair transplant surgeon. Or what about the well documented phenomenon of Spanish /Italian stronger density? How does that affect the results ? Are the Spanish FUE docs playing with a stacked field by virtue of their practice location? See how complicated it is ? It's is nor as easy as you make it out to be to assess results. You are not qualified to do so.

 

DSLR imagery in harsh lighting from over 20 angles with wet and dry hair is hardly "subjective". Many put out comb through videos as well. This is an cosmetic surgery after all, it's all very good to lie (lets be honest) about yields, however when the patient is pleased and the HD imagery and comb throughs look fantastic, the tiny % yield difference doesn't mean a whole lot. When FUE is achieving full coverage on norwood 6s with below average donors (there was a result from Lupanzula with around 5600 grafts in the past few days as such) then questions have to be raised about the necessity of FUT, whether or not it is easier and the yield is higher.

 

Also to say that most of the prominent FUE clinics don't put out graft counts is just a blatant lie as well. You know as well as I do we aren't talking about Turkish chop shops. You also ignore my emphasis on PATIENT POSTED RESULTS. Certain clinics like ASMED have hundreds of these posted from day 1. How do you explain that not a single one of these is a poor result?

 

The "subdermal scarring" argument is interesting however I've only heard it spoken about by American physicians, not European doctors and never heard of a patient complaining because they were inhibited from further surgery or a poor looking donor area due to this phenomenon. It's the same fear mongering that some FUE flag wavers claim against FUT when it comes to pain or scarring. Dr. Vories for example has studied this and claims no difference in transection rate in secondary FUE procedures. He did find however that the the transection rate for FUE is higher around the scar areas after and FUT surgery.

 

 

I also certainly agree that the Italian and Spanish hair texture and thickness is a factor as to why some of these European surgeons "appear" to be hitting so many home runs.

 

The primary issue I take with Feller is that you act as if successful megasessions and success with multiple FUE surgeries after another are not the norm. Unfortunately in 2017, they actually are the norm, whether or not it is still more common to see this with FUT. When some I ask to see some bad or low yield results of certain FUE surgeons and I can't get a single one from anyone despite the fact that these surgeons have more results online posted by both the patient and doctor than Dr. Feller, it certainly raises questions.

 

That's all it comes down to, a tiny bit of research and you'd see that these great, and consistent large scale European FUE results are not all that rare. The key I'd emphasise in this matter is that the best results are performed with a manual punch and lateral slit incisions. To say that these are anomalies in the larger FUE landscape is certainly true, however there are certain doctors that are clearly breaking the trend.

[JayLDD]

JeanLuc

 

Good grief man what quantitative evidence is out there on FUE hair yields by this European doctors ? Qualitative photos are really SO subjective regarding yield and result. Do you know how few docs even list the vital stats on graft counts broken down at time of extraction on this site ? Minimal. Some of those Europeans doxsndo it well but man photos are just not a good way to evaluate, sorry. There are few clinics willing to post an "average" result. Pictures rarely show punctate scars, transacted grafts, potential donor area deforestation with FUE. How do photos shows subdermal scarring that may compromise a further round of FUE? They don't. It would take a hands on approach by an experienced hair transplant surgeon. Or what about the well documented phenomenon of Spanish /Italian stronger density? How does that affect the results ? Are the Spanish FUE docs playing with a stacked field by virtue of their practice location? See how complicated it is ? It's is nor as easy as you make it out to be to assess results. You are not qualified to do so.

 

http://www.hairrestorationnetwork.com/eve/181277-warning-if-considering-dr-james-boland-colorado-surgical-center-read.html

 

Is Dr. James Boland who performed this trainwreck better qualified than us to talk about hair transplantation simply because of his title? You send yourself down a dark, and ugly rabbit hole when you deny logic and reason and instead embrace titles and give certain individuals an infallible status.

 

Facts and evidence matters, not the word of one who calls themselves a God on a subject. And what about the other doctors who clearly are qualified by your definition and have the opposite stance on the FUE FUT debate? Are they both right somehow?

 

Don't be a sheep, look at the results and data for yourself. Reason and evidence over those who claim they don't need it because they have a "qualification" any day of the week.

[Davis91]

What sound do sheep make ? Baaaaah? I'll make that sound for now but not because I am following Dr. Feller. I will make that sound because I have heard first hand from multiple top docs on here that yields are getting better but are not the gold standard nor close to replacing on average the results of strip. ON AVERAGE. There are no doubt excellent FUE docs who are pushing the envelop. New research is coming out all the time. Boundaries are being pushed and FUE is the popular kid on the block. But it is one tool that may be beneficial to use for patient outcome and efficacy SOMETIMES.

 

I do not believe FUE megasessions are the norm in 2017. How do we define megasessions and is there any data to back that up?

 

I am amazed at those rare cases of NW6 being transformed by FUE. A lot of factors need to be looked at in these cases including donor density, scalp hair quality and characteristics and scalp size (not all NW6s are created equal in terms of diameter needed to be covered).

 

Yes the case of the doctor you posted is horrible and I would run far far away from him.

 

Have you looked at Dr. Umar's cases ? I give him credit for posting his results. Because he shows the LIMITS of trying to restore an NW6 with FUE only. He taps into body hair quite a bit mixed with scalp hair and the results in many cases are far from complete or even partial restorations.

 

Again I do not get my reason and evidence from Dr feller. I've never met him. I get my reason and evidence from a combination of sources and it all started with MAJOR top docs in the USA and Canada telling me they are following the research on FUE and basically saying the exact same thing Dr feller has.

 

BTW some of those European FUE docs are pushing the envelope and taking grafts from potential non safe zones and making calculations of xxx years before a patient recedes in those areas, using topical propecia as mitigator, using rogaine etc.

 

Here is my gold standard: what do you need to complete YOUR goals; what is your likely donor count; assume propecia or rogaine may not work so you aren't screwed if they don't down the road; find a surgeon who is experienced or well trained by an experienced doc; one who is willing to show you an average result from his clinic; one who will give you an opinion about what is best for you (I wanted FUE but was talked out of it by multiple surgeons --all of whom had the staff to do FUE--ethics ! And hopefully as a bonus a doc who is following the research and willing to adapt and offer new options if proven.

 

It's what Dr feller said : will ONE doc or two or even their reps please stand up to counter what he is saying?? Will one confirm ?? Dr. Lindsey actually comes close as he publically states

Multiple times inhis videos and posts that FUE just isn't there yet.

 

Spex where are you? Probably sleeping but you will see this when you get up. Respond . Any others?? Come on it's for patient education. So step up and debate!

[Dr. Alan Feller]

Like mentioned in my previous post here:

I really appreciate your motivation to educate hair loss sufferers in this forum. But like mentioned before as well, you do not help you case by being so one sided and, sorry, arrogant.

To make it simpler, I highlighted some of you statements:

1. Your theory of the three forces is simple physics and the trauma of the donor (Under the skin) is easy to understand as well. The problem: You do show few (nicely said) data to back it up and which makes it still a theory not a fact. Personally I believe you are right, though. Question is: How big is this effect?

2. This could be a reason, but there can be a lot of other reasons why no other clinic joins the discussions. Also in other discussion few clinics are as active as you. And if fear of being attacked is the reason…you are one of the most aggressive attackers.

3. Again, you reason is very valuable, but it is no fact. The data is very poor. Do not misunderstand me. Again, personally I believe you are right.

4. All data shown in the other thread lead to the conclusion that FUE is getting more and more popular. Your 99 to 100 or even 999 to 1000 has not been backuped by anything. Also, there are many reason to perform FUT even if the results would be very close. Available grafts, hair type etc.

5. There are a lot of (great) FUE results here and on their own websites from FUT and FUE clinics.

6. Hasn’t Dr. X chosen the FUE only route? I think I have seen a Video in the net about strip scar and why FUE is superior. Again, I am not saying he is right. Also, if both methods go hand in hand, why giving up on strip? You logic is flawed.

7. In my country the most well known clinics perform FUT, even for very small cases. Actually with terrible results and poor skill level. Hairloss websites in my country recommend to go elsewhere (even for FUT), and my country is world class in other medical departments (and many other fields). Doesn’t make sense, but it is what it is.

8. Like I said. You are a major reason for this dogfight.

 

Once again, I appreciate what you are doing. But as a hairloss sufferer I wish you argumentation would not be so one sided. Then I could not only trust more in what you say, but also a real discussion could arise like:

- How big is the difference in yield etc.

- Especially compared to the dissection of grafts by the strip itself

- Is there a mathematical break even for either method at a certain amount of grafts

- Does fast extraction really cause more trauma then slow extraction?

- Which hair type and pattern benefits more from FUT or vice versa

- Why are there still poor FUT results even from world class clinics? What is this X-Factor?

Sorry again for my poor English as I am not a native speaker. This makes it difficult to be as precise in my words as I want to.

 

I am only being one sided because that's what the facts and experience dictate. If you do not perform the surgery then you can't understand the realities that these facts are based on. People, such as yourself, see this as "arrogant". I am not an egalitarian. Doctors know more than laymen. That's just how it is. This reality rubs some people the wrong way so they lash out and call me arrogant. But this doesn't change the truth.

 

The numbers you are looking for do exist. The popularly accepted growth yield for FUE is 75%. I believe it is lower because these figures do not include the number of grafts killed during the extraction attempt. The number only relate sto the grafts that were actually removed SEEMINGLY intact.

 

There are tons of data out there that support the failure or retardation of growth of FUE grafts vs. FUT grafts. Just look at the results posted on this site alone. Also look at the results those doctors who are capable of performing both choose to present on their websites and this site. They are overwhelmingly FUT results for a reason.

 

Sure, there are poor FUT doctors and poor FUE doctors. But that doesn't make the procedures equivalent. A poor FUT will likely grow better than a poor FUE. And if X factor negatively affects FUT then you can bet your last dollar it affects FUE to the same extent or worse.

 

We do not need to set up studies to know with scientific certainty that a graft that has been compressed, twisted, and literally RIPPED from the skin will grow poorly compared to one that has not. We do not need to perform physiological tests on a graft that has been skeletonized to know it is not going to grow as well as one with all the necessary tissue still wrapped around it.

 

Despite the obviousness of it all, the scientific method was applied to quantify and qualify the damage inflicted on FUE grafts during extraction. It was called the FOX test and it showed that fully 80% of grafts are damaged during extraction. I believe the number is actually higher because even grafts that LOOK intact are not. Amazingly, however, as the internet hype of FUE ratcheted up the FOX test became conveniently forgotten.

 

The acceptance of FUE has been anything but scientific.

 

 

The proof is in the pudding. When photos of "successful" FUE procedures are presented as "evidence" that FUE works as well as FUT I say on it's face this claim is misleading. If you show only people who won at Casinos and ignore those who lost their shirts one would come to the conclusion that most people win in Vegas. But of course it isn't true.

 

Every patient, and I mean every human being, has a right to the procedure that offers them the best chance of growth in the recipient area. Offering FUE to the exclusion of FUT denies them this right.

 

I believe it is highly unethical to offer FUE to the exclusion of FUT in almost all cases. It is just wrong. But people are making money doing it so you don't hear much fuss about it. I, for one, will not accept making money this way. I want to do it right or not at all. Many of my colleagues, unfortunately, do not feel the same way.

 

One cannot produce a skeletonized graft via FUE and ethically reinsert it into that persons scalp while all along knowing had the procedure been performed as an FUT instead that graft would not have been skeletonized at all.

[Dr. Alan Feller]

What sound do sheep make ? Baaaaah? I'll make that sound for now but not because I am following Dr. Feller. I will make that sound because I have heard first hand from multiple top docs on here that yields are getting better but are not the gold standard nor close to replacing on average the results of strip. ON AVERAGE. There are no doubt excellent FUE docs who are pushing the envelop. New research is coming out all the time. Boundaries are being pushed and FUE is the popular kid on the block. But it is one tool that may be beneficial to use for patient outcome and efficacy SOMETIMES.

 

I do not believe FUE megasessions are the norm in 2017. How do we define megasessions and is there any data to back that up?

 

I am amazed at those rare cases of NW6 being transformed by FUE. A lot of factors need to be looked at in these cases including donor density, scalp hair quality and characteristics and scalp size (not all NW6s are created equal in terms of diameter needed to be covered).

 

Yes the case of the doctor you posted is horrible and I would run far far away from him.

 

Have you looked at Dr. Umar's cases ? I give him credit for posting his results. Because he shows the LIMITS of trying to restore an NW6 with FUE only. He taps into body hair quite a bit mixed with scalp hair and the results in many cases are far from complete or even partial restorations.

 

Again I do not get my reason and evidence from Dr feller. I've never met him. I get my reason and evidence from a combination of sources and it all started with MAJOR top docs in the USA and Canada telling me they are following the research on FUE and basically saying the exact same thing Dr feller has.

 

BTW some of those European FUE docs are pushing the envelope and taking grafts from potential non safe zones and making calculations of xxx years before a patient recedes in those areas, using topical propecia as mitigator, using rogaine etc.

 

Here is my gold standard: what do you need to complete YOUR goals; what is your likely donor count; assume propecia or rogaine may not work so you aren't screwed if they don't down the road; find a surgeon who is experienced or well trained by an experienced doc; one who is willing to show you an average result from his clinic; one who will give you an opinion about what is best for you (I wanted FUE but was talked out of it by multiple surgeons --all of whom had the staff to do FUE--ethics ! And hopefully as a bonus a doc who is following the research and willing to adapt and offer new options if proven.

 

It's what Dr feller said : will ONE doc or two or even their reps please stand up to counter what he is saying?? Will one confirm ?? Dr. Lindsey actually comes close as he publically states

Multiple times inhis videos and posts that FUE just isn't there yet.

 

Spex where are you? Probably sleeping but you will see this when you get up. Respond . Any others?? Come on it's for patient education. So step up and debate!

 

Davis, you are good. Damn good. If we had just five more posters like you online the internet FUE hype would be stopped dead in it's tracks. Thank you for posting. You are extremely lucid and articulate.

[JayLDD]

I am only being one sided because that's what the facts and experience dictate. If you do not perform the surgery then you can't understand the realities that these facts are based on. People, such as yourself, see this as "arrogant". I am not an egalitarian. Doctors know more than laymen. That's just how it is. This reality rubs some people the wrong way so they lash out and call me arrogant. But this doesn't change the truth.

 

The numbers you are looking for do exist. The popularly accepted growth yield for FUE is 75%. I believe it is lower because these figures do not include the number of grafts killed during the extraction attempt. The number only relate sto the grafts that were actually removed SEEMINGLY intact.

 

There are tons of data out there that support the failure or retardation of growth of FUE grafts vs. FUT grafts. Just look at the results posted on this site alone. Also look at the results those doctors who are capable of performing both choose to present on their websites and this site. They are overwhelmingly FUT results for a reason.

 

Sure, there are poor FUT doctors and poor FUE doctors. But that doesn't make the procedures equivalent. A poor FUT will likely grow better than a poor FUE. And if X factor negatively affects FUT then you can bet your last dollar it affects FUE to the same extent or worse.

 

We do not need to set up studies to know with scientific certainty that a graft that has been compressed, twisted, and literally RIPPED from the skin will grow poorly compared to one that has not. We do not need to perform physiological tests on a graft that has been skeletonized to know it is not going to grow as well as one with all the necessary tissue still wrapped around it.

 

Despite the obviousness of it all, the scientific method was applied to quantify and qualify the damage inflicted on FUE grafts during extraction. It was called the FOX test and it showed that fully 80% of grafts are damaged during extraction. I believe the number is actually higher because even grafts that LOOK intact are not. Amazingly, however, as the internet hype of FUE ratcheted up the FOX test became conveniently forgotten.

 

The acceptance of FUE has been anything but scientific.

 

 

The proof is in the pudding. When photos of "successful" FUE procedures are presented as "evidence" that FUE works as well as FUT I say on it's face this claim is misleading. If you show only people who won at Casinos and ignore those who lost their shirts one would come to the conclusion that most people win in Vegas. But of course it isn't true.

 

Every patient, and I mean every human being, has a right to the procedure that offers them the best chance of growth in the recipient area. Offering FUE to the exclusion of FUT denies them this right.

 

I believe it is highly unethical to offer FUE to the exclusion of FUT in almost all cases. It is just wrong. But people are making money doing it so you don't hear much fuss about it. I, for one, will not accept making money this way. I want to do it right or not at all. Many of my colleagues, unfortunately, do not feel the same way.

 

One cannot produce a skeletonized graft via FUE and ethically reinsert it into that persons scalp while all along knowing had the procedure been performed as an FUT instead that graft would not have been skeletonized at all.

 

"graft that has been compressed, twisted, and literally RIPPED from the skin"

 

This reminds me of a quote from Trump in a debate regarding abortion. It's effective fear mongering, but hardly a good scientific explanation as to whether these grafts will have an equivalent yield to an FUT graft.

 

"The acceptance of FUE has been anything but scientific. "

 

Can hardly believe you make this claim about "science" a paragraph lower than capitalising the term "ripped" to make FUE sound more barbaric.

 

"The proof is in the pudding. When photos of "successful" FUE procedures are presented as "evidence" that FUE works as well as FUT I say on it's face this claim is misleading. If you show only people who won at Casinos and ignore those who lost their shirts one would come to the conclusion that most people win in Vegas. But of course it isn't true."

 

There is no doubt this is true and that FUE produces lower quality grafts, however there are clearly doctors such as Erdogan, Feriduni, Lupanzula and Keser that are not doing this on a random basis. They are doing it time, after time after time. Erdogan in particular has more results than the vast majority of FUT surgeons. I'm not saying this to advertise for them I agree they don't need it, I'm just using this to make a point.

 

And again, Keser has performed an experiment with a small square of grafts on a patient and achieved 100% yield on a patient at 70 FU/cm squared

[JayLDD]

What sound do sheep make ? Baaaaah? I'll make that sound for now but not because I am following Dr. Feller. I will make that sound because I have heard first hand from multiple top docs on here that yields are getting better but are not the gold standard nor close to replacing on average the results of strip. ON AVERAGE. There are no doubt excellent FUE docs who are pushing the envelop. New research is coming out all the time. Boundaries are being pushed and FUE is the popular kid on the block. But it is one tool that may be beneficial to use for patient outcome and efficacy SOMETIMES.

 

I do not believe FUE megasessions are the norm in 2017. How do we define megasessions and is there any data to back that up?

 

I am amazed at those rare cases of NW6 being transformed by FUE. A lot of factors need to be looked at in these cases including donor density, scalp hair quality and characteristics and scalp size (not all NW6s are created equal in terms of diameter needed to be covered).

 

Yes the case of the doctor you posted is horrible and I would run far far away from him.

 

Have you looked at Dr. Umar's cases ? I give him credit for posting his results. Because he shows the LIMITS of trying to restore an NW6 with FUE only. He taps into body hair quite a bit mixed with scalp hair and the results in many cases are far from complete or even partial restorations.

 

Again I do not get my reason and evidence from Dr feller. I've never met him. I get my reason and evidence from a combination of sources and it all started with MAJOR top docs in the USA and Canada telling me they are following the research on FUE and basically saying the exact same thing Dr feller has.

 

BTW some of those European FUE docs are pushing the envelope and taking grafts from potential non safe zones and making calculations of xxx years before a patient recedes in those areas, using topical propecia as mitigator, using rogaine etc.

 

Here is my gold standard: what do you need to complete YOUR goals; what is your likely donor count; assume propecia or rogaine may not work so you aren't screwed if they don't down the road; find a surgeon who is experienced or well trained by an experienced doc; one who is willing to show you an average result from his clinic; one who will give you an opinion about what is best for you (I wanted FUE but was talked out of it by multiple surgeons --all of whom had the staff to do FUE--ethics ! And hopefully as a bonus a doc who is following the research and willing to adapt and offer new options if proven.

 

It's what Dr feller said : will ONE doc or two or even their reps please stand up to counter what he is saying?? Will one confirm ?? Dr. Lindsey actually comes close as he publically states

Multiple times inhis videos and posts that FUE just isn't there yet.

 

Spex where are you? Probably sleeping but you will see this when you get up. Respond . Any others?? Come on it's for patient education. So step up and debate!

 

 

I agree with this in particular and the majority of the rest of your comment. There is a case by case decision that should be made based on what a doctor doing consistent work decides through analysis, and also what the patient hopes to achieve.

 

"MAJOR top docs in the USA and Canada telling me they are following the research on FUE "

 

I find this quote is particularly interesting and it does point back to the continental differences in literature and results. Why such a major shift in opinion across the sea? It all comes down to the fact that American doctors cannot utilise techs during the extractions and that labour is so much more expensive in America, effectively making it incredibly hard to compete. Of course on the one hand this means that you have infinitely more FUE chop shops in Europe, however you also have a select group with far more experience with the procedure than American doctors will ever hope to achieve. The low prices push up demand and the increased supply means more competition and refinement for certain clinics to stand out. This doesn't occur nearly as much in the states as it is simply impossible to perform FUE at such low prices. This is basic economics to a point. Competition improves products and services.

[Dr. Alan Feller]

Jean,

 

As I've written many times before: I don't debate laymen. You are not qualified to debate me.

[JayLDD]

Jean,

 

As I've written many times before: I don't debate laymen. You are not qualified to debate me.

 

I think that answer speaks for itself. I just encourage others to do as much research into the matter as they possibly can, both from a European and a North American standpoint in regards to both scientific literature as well as results posted by doctors and patients.

[aWidowsPeek]

I've had 4000+ FUE grafts and they all grew in nicely. It's completely changed my life. I have no visible scars and it didn't cost me a fortune.

[Dr. Alan Feller]

Thanks for your honesty. BTW - I actually agree 100% with your statement, even though Dr Rahal is my surgeon and he hit a home run for me using FUT. I would have no issues letting him perform FUE on me either though, probably because he earned my trust, even though he would be delegating the extractions.

 

It is not lost on me though that you chose your words very carefully in that last reply. I'm wondering why you are now limiting to unlicensed and unqualified. What about delegating the extractions (cutting) to a licensed and qualified technician/nurse? Just for the record of course.

 

I did not make any special effort to choose my words. I don't know what you are getting at there.

 

There are no technicians or nurses worldwide who are qualified to do the scoring (cutting). It doesn't matter if they are licensed in their fields or not. What is the point of having doctors (referred to as surgeons) if just anybody can perform surgery?

 

In the United States, the center of the modern world and modern surgery, the "First Surgeon" must be a physician. Not a tech, not an assistant, not a nurse, not a PA.

 

No non-doctor is qualified to perform the cutting. These ancillary staff may ASSIST the first surgeon, but not take his place. Thus, when the first surgeon leaves the surgical field, much less the room, the staff member becomes the first surgeon and that is against the law.

 

Look at it from a moral perspective. If living human tissue is going to be cut it should be cut by the most qualified person in existence. By the person at the top of the pyramid of: skill, responsibility, and accountability. That person is the doctor. The others are just hired hands with no overarching responsibility for the patient. That lays purely with the licensed physician.

 

If the doctor leaves the room he may be blamed for a poor job being performed by a subordinate, but that doesn't help the patient on whom the poor job was inflicted. Had the doctor done this job himself, as proscribed by law in the Unites States, the poor job might not have happened in the first place.

[mav23100gunther]

Like I said, what you say makes complete and utter sense, and I completely agree with you. The reality though is that some of the top FUE surgeons don't practice in the US (besides Konior and Shapiro of course), and these same surgeons such as Lorenzo and Erdogan delegate the cutting. I'm still struggling to conceptialize the fact that this is the norm. All the top guys such as Rahal, Erdogan, Hasson, Wong and Lorenzo do it this way, yet we know they are all highly esteemed surgeons, so looks like there is a disconnect to what they believe and therefore practice versus what you believe to be highly inappropriate. I would personally like to see it somehow become a big no no for a surgeon to delegate the cutting, maybe a requirement that the surgeon has to do all the cutting to gain admission to the coalition and be recommended by this very site. I also think a lot of folks would agree with me on that. At present, if one determines that Dr X is the best FUE surgeon for him, then chances are that he probably delegates the extractions. Like I said previously, if I needed FUE, I'm going to most likely stick with my surgeon Dr Rahal, but I'd have to and probably would have to risk accept the fact that he delegates . It would be nice if this wasn't a factor at all.

 

Thanks for taking a stand on this particular matter Dr Feller, I think it's about time this practice of delegation during FUE gets called out. Please keep it up.

[Mick50]

We've gone as far as we can go with this thread unless other top FUE docs get Involved nothing more can be learned for the layman .

Edited April 29, 2017 by Mick50

[Gasthoerer]

 

1. I am only being one sided because that's what the facts and experience dictate.

2. Doctors know more than laymen. That's just how it is. This reality rubs some people the wrong way so they lash out and call me arrogant. But this doesn't change the truth.

3. The numbers you are looking for do exist. The popularly accepted growth yield for FUE is 75%. I believe it is lower because these figures do not include the number of grafts killed during the extraction attempt. The number only relates to the grafts that were actually removed SEEMINGLY intact.

4. Despite the obviousness of it all, the scientific method was applied to quantify and qualify the damage inflicted on FUE grafts during extraction. It was called the FOX test and it showed that fully 80% of grafts are damaged during extraction.

5. The acceptance of FUE has been anything but scientific.

 

Thank you for you detailed answer, which I again have broken down a little bit.

 

1. Then please show us the data from scientific research which are so clear. Most data you have provided so far (in your own thread), were just made about by you. And they all hints we have, leads to the conclusion, that they are completely out of proportion.

 

2. I think you talk about medical doctors, right? But anyway, (medical) doctors (might) know more than laymen in a very specific topic. However, being a HAT surgeon doesn’t make you more knowledgeable about physics or statistics as an engineer or physician. Being a surgeon doesn’t make you more knowledgeable about biology than someone with a graduation in Biology. There is your arrogance, as anyone is a laymen very close to what is his specific field of research is.

 

3. These are numbers which I have seen as well, but with very (!) poor data backed up. Because none of this work was performed by FUE specialists if I recall (and we looking at the similar studies). Also number of patients were poor (and therefore statistics). But if you have better studies, please sent us a link.

 

4. Ok, but what does this mean: Will this grafts grow worse any by how much (e. g. % of diameter reduction, % of non-growth? Will this effect reduce over time and give the same results but just later? Questions about questions…

 

5. You are right, but this is hardly an excuse to be non-scientific as well.

 

If all would be as clear as you claim, then please answer my questions:

 

- How does the extraction process affects the grafts growth in the long term (in % of diameter of the hair etc.)?

 

- Does "stick&place" reduce these differences?

 

- How big is the difference in yield by experienced surgeons from either procedure taking into account the dissection of grafts by the strip itself (which you never speak about)

 

- What is then the mathematical break even for either method at a certain amount of grafts? At 500, 1000 or 2000 grafts?

 

- Does fast extraction really cause more trauma then slow extraction and why? Background: Is fast extraction more critical cause you think the control of the device is the problem or do you think the stress on the grafts increases by the speed even if control of the device is not the problem. This is so important as it connects skill (control of the surgeon) with bio-physics (stress on the graft as a function of extraction speed).

 

- Which hair type and pattern benefits more from FUT or vice versa FUE

 

- Why are there still poor FUT results even from world class clinics? What is this X-Factor?

 

 

 

[Dr. Alan Feller]

1. I have provided scientific data. You just choose to ignore it:

a. The FOX test.

b. Dr. Beehner's studies.

c. Dr. Wesley's studies.

d. The consensus of all HT doctors I've ever met save one.

e. The position statement of the ishrs declaring the primacy of FUT over FUE.

f. My 17 years of having performed FUE, offered the first live demonstration, and patented tools.

 

Finally, do you really need "scientific data" to know that if someone smashes down on your foot it will be damaged ? Because that is the "proof" and the "data" you are asking for.

 

You are layman, so you have no idea what is and is not out of proportion.

 

2. Your second question is a statement, more of an attack, than a question. It doesn't matter how smart or educated someone is any field. If a physicist doesn't also perform hair transplants, why should I care what they think? And if their rational and logic is wrong, it's wrong, no matter what their background.

 

All I've ever heard from the FUE doctors who have tried to defend the graft mauling they engage in include the rejection of common sense thinking with regards to the involved physical forces on the graft; and the most convenient and self serving inability to see a plainly injured graft sitting right in front of their faces in the form of skeletonization.

 

Of course you can't appreciate this because you are a laymen. So this is not necessarily your fault. The FUE doctors know better, or should know better. At least most of the HT doctors who perform both will, for the most part, admit the truth that FUE grafts are traumatized more than FUT grafts. Even if they try to downplay this reality.

 

3. You are a laymen and can't understand any studies that are presented. They are not written for you, they are written for practicing surgeons. It doesn't matter if the doctor performing the FUE perform FUE only or FUE/ FUT. The reality and physics of the situation are the same. No doctor, no matter his focus of specialty, utilizes a method that address and decreases the three detrimental forces that injure FUE grafts: Traction, Torsion, and Compression.

 

4. Yes, grafts will grow worse if they are injured. Just as your eyes will work worse if I squeeze, pull, and twist them them with a forcepts. Just as your foot will work worse if you drop a couch on it. No further analysis is needed. FUE is worse on the grafts than the analogies I just gave you, but you couldn't understand that because you've never held a graft or performed surgery.

 

5. Simple: Dead grafts don't grow. Injured grafts produce poorer hairs.

- No, stick and place will not bring dead grafts back to life or "uninjure" traumatized grafts.

-Damage to FUT grafts are negligible. When compared to FUE it is non-existent.

-Fast extraction causes more damage because all the detrimental forces are increased. When I see fast extraction I see medical malpractice. It's just a matter of time before a failed FUE patient takes his doctor to court and shows the carelessness with which the "fast harvest" FUE doctors engaged in to perform the surgery. That doctor will be toast, which is why you don't see this kind of doctor in the United States. In the third world, anything goes.

-As for the speed of the punch during surgery, you wouldn't understand because you don't perform them.

 

 

Gas, you sound like an FUE clinic representative to me. Why don't you just admit it and have your doctor come on here and debate me ? Let the world see the kind of work he is doing. In fact, I would love a video of your doctor quickly harvesting grafts. Another FUE-only doctor did that and it didn't work out too well for him. When the public posted how aghast they were at seeing this doctor literally and carelessly ripping grafts out indiscriminately he quickly tried to edited the video to cover up what he was doing. You will rarely ever see such a blatant demonstration of the consciousness of guilt as that one.

 

But perhaps your FUE doctor will stand more firmly behind his own work. Perhaps he can educate me. I'd love to be wrong.