Why NOT to get an FUE- Interview with Dr. Willaim Reed- by Dr. Feller and Bloxham

[Gasthoerer]

1. Summary:

1.I asked for your name and phone number and you would not give them.

2. You made conditions I could not accept.

3. I never agreed to conditions in the first place.

 

2. Your conditions were unreasonable. I immediately PM'd you back that I don't accept conditions. Either the call would be totally open and transparent or it would be pointless. Instead you posted online that you WOULD give them, but that I would have to agree to conditions that no reasonable person could accept especially if the goal was to do a recorded and transparent interview.

 

 

3. I ignored your conditions and immediately posted what my questions would be limited to. Which were nothing sinister by the way. Just basic FUE questions. That should have been enough. …

4. First, how can I be expected to control which way the conversation goes ? In an interview the discussion goes where it goes. I certainly had no expectations of an emotional phone call, but apparently you did.

And second why should I not report online that the doctors refused to participate if that's what they choose to do ?

 

Dr. Feller,

This is my last post on this, as I made everything transparent and clear.

1) Timeline is clearly given by screenshots

 

a) You first sent a PM that you cannot accept my conditions. This is fine and your choice.

 

b) I answered, that I am sorry to hear and went away to a business trip.

 

c) Then you stated in the forum that you accept not making my name public and I should get in touch. You even called me out for it.

 

d) After being back I immediately answered you with my name and a link which should help you to verify my background (especially as you have accused me wrongly before). I even apologized for being away.

- You could have answered to that PM

- You could have answered in the forum

- You could make a proposal for a timing

- You could answer if you like skype or phone

- Why is this all my task? Why did you all of sudden ignored everything I wrote?

 

? My name is much more precious than my phone number (which I can easily change when you publish it). So why should I give you my name if I am not serious? If you think I was not serious? Why don’t you ask? You had the time to send a PM to a third person but you could not contact me.

 

2) If the conditions are unreasonable, why asking for my name again after first declining and claiming we would go through? I just do not get that?

 

3) So you can make conditions and define questions and I cannot? Why? We all have questions which we would like being answered.

 

4) Please, Dr. Feller, you have been in numerous fights in here: With other users, with other clinics (which you mock, month after the discussion is over), threads got closed etc. You are (to say it positive) very emotional about this. Is my request not to mock the other clinic or start calling people out, really that unreasonable? I do not think so.

 

Well, finally, you have now everything you wanted (with the only exception, that you shall not publish my name). You have my name, you have my phone number, you can verify my background, I can show you pictures of my case if you want (as the response of other clinics to my case started all this), I dropped any conditions but my name being public, you have my first questions,…

 

If you want also dates, I am available at the following times (all at the evening so it is more convenient for you because of the time delay):

- Sa 17th of June any time from 6-10 pm (Berlin time)

- Su 18th of June any time from 6-10 pm

- Tu 20th of June any time from 8.30 to 10 pm

- Fr 23rd of June any time from 8.30 to 10 pm

 

If all these times are to short notice or not possible for anyone, please send other suggestions. So after making the claim twice to different Users in this forum that you would do this call: Do it or drop this entire thing for the sake of this discussion.

[Dr Blake Bloxham]

Bill,

 

I have visited Dr. Bisanga in Brussels on Monday. I was very impressed, to say the least.

 

Anyway, we also talked about FUE. I did bring up the question of growth yield to Dr. Bisanga.

 

He doesn't think there is any difference in growth yield between FUT and FUE in his practice.

 

Hope that helps,

 

Damian.

 

Damian,

 

Obviously I wasn't there to hear your conversation, so I won't make assumptions. However, if we look at what Dr. Bisanga has actually put into print for the entire world to see on his own website, I don't think it's as simple as: there is no difference.

 

If you read through his website, you'll note two very important things:

 

1) He states that FUE is best suited for cases below a NW IV. FUE is only appropriate in candidates NW IV and higher when they have a higher than average donor area.

 

So, how do I interpret this? FUE is best suited for smaller cases unless the patient has an excellent donor.

 

Here's the quote:

 

Larger areas of thinning say NW4 and higher can be treated with FUE but the person has to have better than average donor hair density and good hair characteristics to ensure sufficient FU numbers can be safely extracted and leave options for the future.

 

2) He further states that "hair characteristics" and "FU constitution" play a large role in how suitable a patient is for FUE. It is "misunderstood" that FUE is suitable for all hair types.

 

So how do I interpret this? Not all patients are candidates for FUE.

 

Here's the quote:

 

Hair characteristics and FU constitution can play a large part in how suitable FUE can be; it is misunderstood that FUE is suitable for all hair loss stages and hair types and some may not have the right attributes to ensure a solid result.

 

So, what does it really mean when you break it down? Not all patients are candidates for FUE, and the doctor needs to SCREEN patients and intervene with FUE only when they are good candidates.

 

So I do believe that Dr. Bisanga believes that a good candidate for FUE will have a pretty similar result to one of his FUT patients -- and he is excellent at both -- but this is not the same as saying "they are about the same" if we are to use his written website as his philosophy.

 

As I've said before: what is actually the "best" FUE tool? A good screening tool.

 

Source: https://en.bhrclinic.com/technique/follicular_unit_extraction/

[Swooping]

Damian,

 

Obviously I wasn't there to hear your conversation, so I won't make assumptions. However, if we look at what Dr. Bisanga has actually put into print for the entire world to see on his own website, I don't think it's as simple as: there is no difference.

 

If you read through his website, you'll note two very important things:

 

1) He states that FUE is best suited for cases below a NW IV. FUE is only appropriate in candidates NW IV and higher when they have a higher than average donor area.

 

So, how do I interpret this? FUE is best suited for smaller cases unless the patient has an excellent donor.

 

Here's the quote:

 

Larger areas of thinning say NW4 and higher can be treated with FUE but the person has to have better than average donor hair density and good hair characteristics to ensure sufficient FU numbers can be safely extracted and leave options for the future.

 

2) He further states that "hair characteristics" and "FU constitution" play a large role in how suitable a patient is for FUE. It is "misunderstood" that FUE is suitable for all hair types.

 

So how do I interpret this? Not all patients are candidates for FUE.

 

Here's the quote:

 

Hair characteristics and FU constitution can play a large part in how suitable FUE can be; it is misunderstood that FUE is suitable for all hair loss stages and hair types and some may not have the right attributes to ensure a solid result.

 

So, what does it really mean when you break it down? Not all patients are candidates for FUE, and the doctor needs to SCREEN patients and intervene with FUE only when they are good candidates.

 

So I do believe that Dr. Bisanga believes that a good candidate for FUE will have a pretty similar result to one of his FUT patients -- and he is excellent at both -- but this is not the same as saying "they are about the same" if we are to use his written website as his philosophy.

 

As I've said before: what is actually the "best" FUE tool? A good screening tool.

 

Source: https://en.bhrclinic.com/technique/follicular_unit_extraction/

 

Well, yes, Dr. Bisanga does screen every patient meticulously. So if you are not a suitable FUE candidate he will tell you. Hence, I was only talking about the survival yield he has observed in all patients that were indeed suitable FUE patients and underwent surgery with him.

[dan26]

Damian,

 

 

So I do believe that Dr. Bisanga believes that a good candidate for FUE will have a pretty similar result to one of his FUT patients

 

 

Source: https://en.bhrclinic.com/technique/follicular_unit_extraction/

 

Do you agree with this assessment Dr Bloxham? I know Dr Feller thinks FUT is a superior procedure in all cases except where the patient is not a candidate for it, but would you say that with a great donor, skilled surgeon, and proper protocol the yields are comparable and it is a reasonable risk to take (ignoring future loss and less total donor supply from FUE)?

[Gasthoerer]

Damian,

 

1. Obviously I wasn't there to hear your conversation, so I won't make assumptions. However, if we look at what Dr. Bisanga has actually put into print for the entire world to see on his own website, I don't think it's as simple as: there is no difference.

 

If you read through his website, you'll note two very important things:

 

2. He states that FUE is best suited for cases below a NW IV. FUE is only appropriate in candidates NW IV and higher when they have a higher than average donor area.

 

So, how do I interpret this? FUE is best suited for smaller cases unless the patient has an excellent donor.

Dr. Bloxham,

 

1. Be careful, a similar topic started the entire “recorded phone call” discussion ;-)

 

2. Honestly, I think you missing the point in this particular case. There are two topics: Liftetime available grafts and yield. The quote of Bisanga by Swooping was clearly about yield and your quote refers (as well or even mainly) to available grafts.

One could easily say, that Bisanga thinks FUT(+FUE) gives more lifetime available grafts than FUE even when yield is different and hence is better suited for higher NW.

 

However, I have a hard time someone saying that yield is exactly the same. I have heard a “minor difference” in yield, or “no visible difference” in yield. No difference sounds like a stretch.

[Dr Blake Bloxham]

Well, yes, Dr. Bisanga does screen every patient meticulously. So if you are not a suitable FUE candidate he will tell you. Hence, I was only talking about the survival yield he has observed in all patients that were indeed suitable FUE patients and underwent surgery with him.

 

Excellent to hear that he screens meticulously. He's clearly an ethical doctor. My interaction with him has been limited, but he's always come across as a gentleman.

[Dr Blake Bloxham]

Do you agree with this assessment Dr Bloxham? I know Dr Feller thinks FUT is a superior procedure in all cases except where the patient is not a candidate for it, but would you say that with a great donor, skilled surgeon, and proper protocol the yields are comparable and it is a reasonable risk to take (ignoring future loss and less total donor supply from FUE)?

 

I agree with Dr. Feller's assessment. Based upon both what I have seen in clinical practice and the initial findings of the FOX testing -- this study really deserves a second look from the HT field because it correctly predicted a lot of things and gave sound reasoning as to why.

 

A great donor, a skilled surgeon, and proper protocol are paramount to maximizing your prospects at a good FUE. However, even a "good donor" doesn't take into account how well your skin will want to let go of the grafts and how accepting your follicles will be to the FUE process. Everything can look great on paper and still not proceed as hoped.

[Dr Blake Bloxham]

Dr. Bloxham,

 

1. Be careful, a similar topic started the entire “recorded phone call” discussion ;-)

 

2. Honestly, I think you missing the point in this particular case. There are two topics: Liftetime available grafts and yield. The quote of Bisanga by Swooping was clearly about yield and your quote refers (as well or even mainly) to available grafts.

One could easily say, that Bisanga thinks FUT(+FUE) gives more lifetime available grafts than FUE even when yield is different and hence is better suited for higher NW.

 

However, I have a hard time someone saying that yield is exactly the same. I have heard a “minor difference” in yield, or “no visible difference” in yield. No difference sounds like a stretch.

 

I understand what you are referring to, but I'm not sure Dr. Bisanga was stating the same. However, it's not worth getting into too deeply because for me, it doesn't change the crux of the argument:

 

Dr. Bisanga -- who has the ability to offer both high quality FUT WITH an appropriate staff and FUE -- states that not all patients are candidates for FUE and meticulous screening is necessary.

 

Despite the belief of some, Dr. Feller and I are not "against" the FUE procedure. I do them all the time. But it must be done under the right circumstances. And this is what Dr. Bisanga touches upon. Now, I will take it one step further and state that even under the best conditions, the outcome is still MUCH more variable compared to an FUT of similar size. But what we have spoken out against heavily is the practice of "FUE for all," and even worse is "FUE megasessions" for all. This we take issue with.

[JayLDD]

No. Dr. Beehner has completed many landmark studies in our field -- and this is one of them -- and I have referenced this study many times before, but it's not the one I'm referring to. The one I'm referring to is a study specifically looking at the amount of supportive tissue around grafts and survival rate. As predicted, there is a statistically significant positive correlation.

 

 

 

I don't think he was being specific about "splitting;" and if he was, I hope there is a follow-up clarification because it is not how it read.

 

Regardless, the splitting of multis to smaller multis or multis into singles is not industry standard for FUT. In fact, it's very much frowned upon save for very rare situations. Not only because it was a practice used in the day to claim you were doing more grafts or charge for more grafts, but survival rate decreases when you try to split a natural follicular unit (FU) down into smaller pieces. The same way it decreases if you only get part of a FU during FUE or if you skeletonize a graft beyond it's natural comfort zone during FUE.

 

 

 

I purposely tried to include fair examples. There are obviously very bad pictures of FUE grafts out there, and these have been used for various purposes in the past -- draw your own conclusions here. While the quality and appearance of grafts removed via FUE is highly variable, I didn't think it was fair to include obvious bad examples. So I picked pretty fair ones. What's more, if you look at the video I included in my initial reply, you'll see live graft examples that have the same appearance: a healthy amount of supportive tissue to the level of scoring and a stripped appearance below. There is simply no way around it when performing minimal depth scoring with sharp punches.

 

 

 

Agreed.

 

Dr. Beehners studies on FUE are a joke and for any serious doctor to reference these is laughable.

 

A study of his on survival rates from July 2016 to the ISHRS of which the opening lines criticise FUE and labels FUT the "gold standard" does not even mention the holding solution used for grafts, and mentions that although he considers himself an above average FUE physician, he has only conducted EIGHTY FUE PROCEDURES IN OVER 8 YEARS. How can you possibly conduct a study like this without mentioning holding solution? He also says he is only experienced in FUE procedures averaging around 500 grafts.

 

There are also multiple photo sets in the study of a set skeletonized FUE grafts in contrast to chubby FUT grafts. I have had an FUE procedure and seen the grafts, and they look absolutely nothing like the destroyed grafts in this study.

 

Studies and patient graft counts by Dr. Erdogan and a small experiment with Dr. Keser achieving over 95% yield with FUE exist for any to see. As suggested by Swooping and Dr. Lupanzula prominent FUE doctors that also are heavily experienced in FUT don't feel they achieve a significant difference in yield.

 

Anyone can throw around studies to prove their point, and it is extremely telling that anti-FUE doctors cite studies by doctors like Beehner who are totally inexperienced at FUE when expressing their views. Why cite a study on FUE by a doctor who has performed less than 10 FUE procedures per year and doesn't do more than 600 grafts at a time on average and biggest FUE procedure was 1300 grafts? None of that to discredit Dr. Beehner as a highly competent FUT surgeon, however you can't take a study by someone inexperienced with FUE to compare FUT results seriously.

 

A legitimate study requires an exclusively FUE doctor who believes their work equals FUT such as Lupanzula with a doctor like Feller and comparing yields on the same patients in the same facility with controlled variables. Data comparing results by a single doctor with a single set of controlled variables (and in this case not a legitimate FUE doctor) is just that, results of a single doctor, under their own conditions with non-standardised tools.

Edited June 15, 2017 by JeanLDD

[Gasthoerer]

 

FUE (changed by me) must be done under the right circumstances. And this is what Dr. Bisanga touches upon. Now, I will take it one step further and state that even under the best conditions, the outcome is still MUCH more variable compared to an FUT of similar size. But what we have spoken out against heavily is the practice of "FUE for all," and even worse is "FUE megasessions" for all. This we take issue with.

 

I think almost anyone in this forum and elsewhere could agree with this assessment. From my standpoint it is thought through and sums up almost the entire story.

 

However, I have a hard time to align this content with the posts of Dr. Feller and with the numbers you (Feller and Bloxham) quote (Average growth rates).

[Dr. Alan Feller]

Well, yes, Dr. Bisanga does screen every patient meticulously. So if you are not a suitable FUE candidate he will tell you. Hence, I was only talking about the survival yield he has observed in all patients that were indeed suitable FUE patients and underwent surgery with him.

 

Then we are in fact mostly on the same page here and right back where we started.

 

The popular hype is that FUT is being replaced by FUE. However, if any doctor who can do both has to screen their patients for one or the other then obviously both procedures are not going anywhere. And, indeed, history has shown this to be the case as FUE has now been around for over 17 years and nobody has come up with a novel way to perform FUE of any significance.

 

The misinformation fired at me during these online discussions has always been that I am anti-FUE. This is false. I am pro-FUE but for SMALL cases that have been well screened. For everything else I prefer Strip and perhaps even a strip/FUE combo, or mFUE of course.

 

But physician competency, experience, and goodwill are not at the core of the issue here. The issue is the mechanics of the FUE procedure itself when compared to FUT. Not the doctor who performs it.

 

When you compare the two procedures independent of the doctor or even the patient, FUE is downright brutal to the grafts. Graft trauma is the number one predictable reason for graft growth failure. And if our textbooks and meetings and lectures emphasized one thing over and over it is that safe and delicate graft handling is essential to graft survival and overall result. Mishandling grafts is a sin. And the trauma inflicted on FUE grafts, no matter who performs it, is orders of magnitude greater than for FUT.

 

FUT does not inflict nearly the level of damage on grafts and donor area that FUE clearly does and has no analogue to FUE in terms of detrimental forces.

 

I know Dr. Bisanga. Lovely and genuine man and surgeon with great experience and skill, but even in his hands the disadvantage of FUE over FUT are simply not addressed. Is he better than the newbie FUE surgeon ? Of course. Does he have a better body of work because he meticulously screens patients for FUE instead of willy nilly taking anyone for FUE surgery who requests it ? No doubt. He has maximized the potential of FUE. And if you are going to have FUE done you better get it done with him or a surgeon like him. Of which there are not many. But the limitations of FUE still exist in frightening proportions are not something he can overcome as they are inherent to the very procedure itself.

 

Until and unless a doctor creates a brand new way of performing the FUE procedure that does not inflict the three detrimental forces of FUE ,and does not thin out the donor area, then they cannot claim parity with FUT. This isn't debatable.

 

A doctor can maximize their chances of getting a good yield with FUE, but in each and every circumstance, without exception, performing that same procedure with FUT will always end with a consistently better result. Not sometimes, EVERY time.

 

I don't have to look at any particular FUE doctor's photo gallery to know that no matter how good their results may look it was attained at a higher physiological price compared to FUT. Look at all of the poor FUE results posted on this site to date. All of them would have had a much greater chance of growing well if they had opted for and were given FUT first because their grafts would not have been injured nearly so much.

[Dr. Lupanzula Emorane]

Dr. Feller,

 

I have very limited time to discuss these issues as I have 12 hour work days as well as a young family to tend to so I will address what I can with the short window of time at my disposal. Before I do, I would remind you that my name is not “Dr. L”. My name is Dr. Lupanzula. Thank you.

 

I have heard these same things stated by different FUE doctors for 17 years now.

 

I’m surprised to read this because I was not aware of any surgeons performing FUE 17 years ago with regularity except for one and he was not in North America. It wasn’t even introduced into North America until 2002 which was 15 years ago. Who else was performing FUE seventeen years ago? I do not see the connection between hearing these points before and their accuracy with regards to truth today. Logically, the points would be more valid today than they would have been 15 years ago (or 17) as there would be fifteen years of experience to back it up. In my opinion, this is the case with FUE as the early years could not have logically provided the view that we have today as such experience to give valid conclusions simply did not exist. This is not a slight in any way, but is a common sense. Is it not logical to understand something in life better with fifteen years of experience under one’s belt rather than having only six months of experience?

 

Regarding the studies you cite, I would like to address them both along with the contradictions. In the Beehner study it was noted that everyone involved in the procedure had eight years of experience however the total number of procedures having been performed in those eight years was ninety procedures. This is the equivalent of having performed less than nine FUE surgeries each year. Nine. I appreciate the information in this study but the experience level is not the same as one that does the same number of procedures in eight days as opposed to eight years. In addition, as you stated, a manual punch is

the very best way to perform an FUE

and later

I absolutely agree however that the use of rotary machines has markedly increased the degree of damage due to torsion.

yet this study you reference was using a motorized continuous rotation punch. Furthermore, the author stated

I certainly would concede that some of the very experienced FUE practitioners who have mastered this technique over many years may very well have obtained higher follicle survival percentages than we did.

 

With regards to the FOX test, I think it is safe to say that this falls under the “experience” category that I referenced earlier and I disagree that a paper written with experience garnered from various small scale tests applies to an entire industry after fifteen years of discussion and sharing among peers. With all due respect, to believe that nothing has changed in fifteen years is paramount to walking with blinders. And this begs the question; if we have a study that shows something is problematic, do we simply give up, thereby creating a truth that validates the study through inaction and lack of effort to improve? I do not know you, but from your comments, you do not appear to be one that allows studies by third parties dictate how you run your practice.

 

My comment about torsion is not incorrect as you are assuming the follicle to be completely rigid, which it is not. I specifically said that torsion is not an issue if the distance traveled in the oscillation is short. This is why manual oscillation that is controlled from an experienced practitioner is the superior method compared to continuous rotation. There is a difference.

 

The “hand over hand” method you reference does not by definition require significant compression to be applied at all points of contact. In fact, your incorrect assumption is the point of contact itself. I can go into detail but I did not intend for this to turn into a tutorial and these are points that I teach to my students that must spend a minimum of six months in my clinic, many times up to a full year, learning the correct FUE method.

 

Skeletonization is unique to FUE, and the way it is produced is exclusive to FUE. There is no process in FUT that leads to skeletonization and no analogue.

 

Interesting.

 

Comparison of survival of FU grafts trimmed chubby, medium, and skeletonized

Beehner-2010

 

This study was designed to help explore whether there was a difference in FU graft survival when grafts were trimmed “chubby,” “medium”, or “skinny” (skeletonized).

(Their terminology, not my own)

 

In the spirit of sharing research I found this information to be particularly interesting.

 

I don't think that these scars should be the cause of such concern. After all, they are the normal result of elective (or any) surgery. Most of my patients have normal scars, although you absolutely will get someone who will stretch or have some unique complicaiton. By and large, however, the strip method is excellent and doesn't deserve the "villification" it has been receiving.*

 

With respect to FUE, I am not studying, researching, and performing this procedure simply to avoid the strip method. I am doing this because it may ultimately offer HIGHER follicular yields than a disected strip. In fact I have already proven this in my office and have documented this in photos and video. I suspect other less vocal practitioners of this technique have also noticed this and may attribute their excellent results to this phenomenon.

- Dr. Feller, November 16, 2002

 

http://www.hairrestorationnetwork.com/eve/145487-another-question-dr-feller.html

 

 

What has changed since your own research showed a yield that is "higher" than "a dissected strip"? This is largely a rhetorical question.

 

 

Dr. Feller, I appreciate your passion in this subject and it is this type of vigor that translates well to believing in your craft as you present it to your patients. If you do not believe, you are not genuine and this is against our oath. However, I wish to be clear. I am not here to convince you of anything as it is clear that you are steadfast in your beliefs and I do not believe I am the one to change your mind, nor do I wish to be. I recently heard of you and of your position and comments and felt that some balance should be presented to the issue. Do we have enough raw data for conclusiveness across the field? No, because the field itself is rife with misrepresentation of the highest degree along with a multitude of inconsistencies for an equal multitude of reasons. In this absence we must rely on our own experiences and those of our colleagues that are willing and eager to share, and in turn learn themselves, and this is what I do with my own teachings to my students. I do not conduct weekend seminars and I do not hold video workshops. I take the art of FUE and my oath very seriously, and make no mistake, proper FUE is an art indeed. Physicians that wish to learn from me must reside in Brussels for a minimum of six months if they are already experienced hair restoration physicians, and one year if they are physicians that are not experienced in hair restoration surgery. This procedure is infinitely more difficult to perform compared to strip surgery thus it requires an understanding, dexterity and touch that cannot be achieved with anything short of extreme repetition, practice and passion and these are the forces that are , in my opinion and that of my colleagues, far more powerful than torsion, compression and traction. Good day.

[Dr Blake Bloxham]

I think almost anyone in this forum and elsewhere could agree with this assessment. From my standpoint it is thought through and sums up almost the entire story.

 

However, I have a hard time to align this content with the posts of Dr. Feller and with the numbers you (Feller and Bloxham) quote (Average growth rates).

 

How so? I stated that it's "MUCH" less predictable and more variable in nature.

 

Which is the truth.

[dan26]

This is getting good!

[Gasthoerer]

How so? I stated that it's "MUCH" less predictable and more variable in nature.

 

Which is the truth.

 

Yes it is the truth indeed, but what you mention say now is totally different than the sound of what Dr. Feller (and maybe partly you, I am not sure though) say otherwise.

 

Remember: That Thread is not listed as "Before FUE you should find a great FUE clinic which screens meticulously" it is called "Why not have an FUE".

 

And typical quotes are not "If you are a good candidate and chose a clinic you can have results close to strip". The typical quotes are:

 

"Growth rates from FUE usually start at 75% that of FUT and go well down from there. That hardly counts as marginal"

"What I can't understand is how the poorer growth guaranteed with the FUE procedure is NOT a deal breaker"

"just as fair to describe your scarring from your FUE procedures as a massive amount of shotgun holes"

I assume you see the difference between your statement and the typical statemens in this thread.

By the way:

- Dr Lupanzula and JeanLuc gave some arguments why the FUE results in the "Beehner studies" might (!) have been so low. I am not saying this is the only reason.

- Do you have an idea why his strip results were so poor. Or do you think 86 % growth for FUT/FUSS is normal?

[Dr. Alan Feller]

Dr. Feller,

 

I have very limited time to discuss these issues as I have 12 hour work days as well as a young family to tend to so I will address what I can with the short window of time at my disposal. Before I do, I would remind you that my name is not “Dr. L”. My name is Dr. Lupanzula. Thank you.

 

 

 

I’m surprised to read this because I was not aware of any surgeons performing FUE 17 years ago with regularity except for one and he was not in North America. It wasn’t even introduced into North America until 2002 which was 15 years ago. Who else was performing FUE seventeen years ago? I do not see the connection between hearing these points before and their accuracy with regards to truth today. Logically, the points would be more valid today than they would have been 15 years ago (or 17) as there would be fifteen years of experience to back it up. In my opinion, this is the case with FUE as the early years could not have logically provided the view that we have today as such experience to give valid conclusions simply did not exist. This is not a slight in any way, but is a common sense. Is it not logical to understand something in life better with fifteen years of experience under one’s belt rather than having only six months of experience?

 

Regarding the studies you cite, I would like to address them both along with the contradictions. In the Beehner study it was noted that everyone involved in the procedure had eight years of experience however the total number of procedures having been performed in those eight years was ninety procedures. This is the equivalent of having performed less than nine FUE surgeries each year. Nine. I appreciate the information in this study but the experience level is not the same as one that does the same number of procedures in eight days as opposed to eight years. In addition, as you stated, a manual punch is and later yet this study you reference was using a motorized continuous rotation punch. Furthermore, the author stated

 

With regards to the FOX test, I think it is safe to say that this falls under the “experience” category that I referenced earlier and I disagree that a paper written with experience garnered from various small scale tests applies to an entire industry after fifteen years of discussion and sharing among peers. With all due respect, to believe that nothing has changed in fifteen years is paramount to walking with blinders. And this begs the question; if we have a study that shows something is problematic, do we simply give up, thereby creating a truth that validates the study through inaction and lack of effort to improve? I do not know you, but from your comments, you do not appear to be one that allows studies by third parties dictate how you run your practice.

 

My comment about torsion is not incorrect as you are assuming the follicle to be completely rigid, which it is not. I specifically said that torsion is not an issue if the distance traveled in the oscillation is short. This is why manual oscillation that is controlled from an experienced practitioner is the superior method compared to continuous rotation. There is a difference.

 

The “hand over hand” method you reference does not by definition require significant compression to be applied at all points of contact. In fact, your incorrect assumption is the point of contact itself. I can go into detail but I did not intend for this to turn into a tutorial and these are points that I teach to my students that must spend a minimum of six months in my clinic, many times up to a full year, learning the correct FUE method.

 

 

 

Interesting.

 

Comparison of survival of FU grafts trimmed chubby, medium, and skeletonized

Beehner-2010

 

(Their terminology, not my own)

 

In the spirit of sharing research I found this information to be particularly interesting.

 

- Dr. Feller, November 16, 2002

 

http://www.hairrestorationnetwork.com/eve/145487-another-question-dr-feller.html

 

 

What has changed since your own research showed a yield that is "higher" than "a dissected strip"? This is largely a rhetorical question.

 

 

Dr. Feller, I appreciate your passion in this subject and it is this type of vigor that translates well to believing in your craft as you present it to your patients. If you do not believe, you are not genuine and this is against our oath. However, I wish to be clear. I am not here to convince you of anything as it is clear that you are steadfast in your beliefs and I do not believe I am the one to change your mind, nor do I wish to be. I recently heard of you and of your position and comments and felt that some balance should be presented to the issue. Do we have enough raw data for conclusiveness across the field? No, because the field itself is rife with misrepresentation of the highest degree along with a multitude of inconsistencies for an equal multitude of reasons. In this absence we must rely on our own experiences and those of our colleagues that are willing and eager to share, and in turn learn themselves, and this is what I do with my own teachings to my students. I do not conduct weekend seminars and I do not hold video workshops. I take the art of FUE and my oath very seriously, and make no mistake, proper FUE is an art indeed. Physicians that wish to learn from me must reside in Brussels for a minimum of six months if they are already experienced hair restoration physicians, and one year if they are physicians that are not experienced in hair restoration surgery. This procedure is infinitely more difficult to perform compared to strip surgery thus it requires an understanding, dexterity and touch that cannot be achieved with anything short of extreme repetition, practice and passion and these are the forces that are , in my opinion and that of my colleagues, far more powerful than torsion, compression and traction. Good day.

 

Dr. Lupanzula,

Your response is disappointing.

 

You didn't address any of the substantive FUE issues. You simply attacked me.

 

But I will not take the bait and allow the thread to get off track.

 

Let me ask you this...

 

Which graft suffers less injury ?

 

A graft that was removed via strip that was divided under a microscope.

 

Or a graft that has been grabbed hand over hand along its length with a forceps while under compression and traction powerful enough to literally rip it free from the dermis ?

 

Thank you.

[Dr Blake Bloxham]

Yes it is the truth indeed, but what you mention say now is totally different than the sound of what Dr. Feller (and maybe partly you, I am not sure though) say otherwise.

 

Remember: That Thread is not listed as "Before FUE you should find a great FUE clinic which screens meticulously" it is called "Why not have an FUE".

 

And typical quotes are not "If you are a good candidate and chose a clinic you can have results close to strip". The typical quotes are:

 

"Growth rates from FUE usually start at 75% that of FUT and go well down from there. That hardly counts as marginal"

"What I can't understand is how the poorer growth guaranteed with the FUE procedure is NOT a deal breaker"

"just as fair to describe your scarring from your FUE procedures as a massive amount of shotgun holes"

I assume you see the difference between your statement and the typical statemens in this thread.

By the way:

- Dr Lupanzula and JeanLuc gave some arguments why the FUE results in the "Beehner studies" might (!) have been so low. I am not saying this is the only reason.

- Do you have an idea why his strip results were so poor. Or do you think 86 % growth for FUT/FUSS is normal?

 

Again, I must disagree. We're arguing semantics or different writing/speech styles. The crux is the same.

 

Of course FUE doctors should -- and the good ones already do -- screen heavily, and patients should be fully aware of the pitfalls before committing. To do so without this understanding constitutes a lack of informed consent.

 

But even with meticulous screening and a trained hand, it's still more variable and less likely to give you the rich, thick, dense results that made the HT industry what it is today -- IE FUT megasessions. How much more variable? 75% growth rate on average.

 

They should also know that it does cause diffuse skin changes in the back and limits the number of lifetime grafts. It's a much, much worse use of the donor compared to FUT.

 

So this should confirm that I stand by the claimed differences. My stance hasn't changed at all.

[JayLDD]

Again, I must disagree. We're arguing semantics or different writing/speech styles. The crux is the same.

 

Of course FUE doctors should -- and the good ones already do -- screen heavily, and patients should be fully aware of the pitfalls before committing. To do so without this understanding constitutes a lack of informed consent.

 

But even with meticulous screening and a trained hand, it's still more variable and less likely to give you the rich, thick, dense results that made the HT industry what it is today -- IE FUT megasessions. How much more variable? 75% growth rate on average.

 

They should also know that it does cause diffuse skin changes in the back and limits the number of lifetime grafts. It's a much, much worse use of the donor compared to FUT.

 

So this should confirm that I stand by the claimed differences. My stance hasn't changed at all.

 

You didn't address the fact that you made up the 75% number or simply took it from Dr. Feller's quotes. You didn't address the fact that you quoted a study on FUE by a doctor who has only done 80 FUE procedures over 9 years.

 

Your stance hasn't changed IN SPITE of the evidence. You'll continue your tune no matter what unfortunately, even if that means making things up or quoting bad data by an FUT surgeon who opens his study stating that FUE is a poor procedure and doesn't state a number of important controlled variables such as holding solution.

 

The crux of your argument is backed up by evidence; FUT grafts are of a higher quality and have less force ultimately inflicted upon them, and these will on average yield higher. FUT for the average patient will also yield more lifetime grafts than FUE.

 

Beyond this, why do you have to make things up and quote bad data on FUE that's either fifteen years old or by a surgeon who has barely done FUE? Why make up the 75% figure when European surgeons such as Lupanzula, Feriduni, Erdogan and Keser have studies and results counting yield to confirm this is not the case? Hasson + Wong even state on their website that they believe they can "cherry pick" grafts with FUE and that the yields are equivalent. They also noticeably studied and learned FUE techniques from Dr. Erdogan, not Dr. Feller for example.

 

Everyone here who has researched and looked at hundreds of results from doctors across the world is aware that you are exaggerating on your criticisms of this debate, whether or not the principle is correct. It sounds ridiculous because people only have to look at the FUE section of this website from the past year to see that your claims are unfounded. It isn't a good look.

 

The fact is that there are FUE doctors yielding over 90% on a consistent basis and more and more doing cases moving up into the 6-7-8000 graft numbers through FUE across multiple procedures. 5000 FUE in a single pass is visible on various forums on a daily basis and from surgeons like Erdogan not only does the average donor look pristine a few months post surgery, 95% look pristine, totally at odds with claims that more than 1500 is unsafe or that FUE isn't suited to megassessions.

[Shampoo]

Which graft suffers less injury? A graft that was removed via strip that was divided under a microscope. Or a graft that has been grabbed hand over hand along its length with a forceps while under compression and traction powerful enough to literally rip it free from the dermis ?Thank you.

 

I mean "duh". Why is it that fanatical FUE patients get so defensive about obvious truth?

 

Of course there are pros/cons to both....but there is little doubt that FUE grafts suffer MORE INJURY vs. FUT grafts. Amazing after years of FUE cheerleading we finally get some balance and some get offended by "balance" which only can help uninformed patients make a better more fully informed decision.

[JayLDD]

I mean "duh". Why is it that fanatical FUE patients get so defensive about obvious truth?

 

Of course there are pros/cons to both....but there is little doubt that FUE grafts suffer MORE INJURY vs. FUT grafts. Amazing after years of FUE cheerleading we finally get some balance and some get offended by "balance" which only can help uninformed patients make a better more fully informed decision.

 

NO ONE is arguing against this, and no one is defensive on this point. What thread have you been reading? Is it that hard to actually READ the arguments made by the side you're not cheerleading for? I know its easier to create a straw-man than address legitimate points, but come on.

 

Not a single post here has argued that FUE yields are as consistent or high as FUT on average, and no one has argued that FUE alone will be the best way to utilise precious donor area. The argument with you and Dr. Feller are so fantastic at avoiding and providing strawmans for is simply that FUE is a viable method for extensive loss, the yield for the best FUE surgeons (Dr. Beehner is not one of them) is consistently in the 90% range and the average donor can handle over 5000 manual FUE extractions. Cry about FUE forces all you like and grafts being "ripped" from the scalp (similar manipulative language to Trump in the debates referring to abortion as involving the baby "ripped" from the womb), it doesn't make the fantastic and consistent results of certain doctors like Lupanzula and Erdogan that rival any FUT doctor any less real, whether or not you would like them to go away.

 

Is FUT the more appropriate method for the majority of patients? Most likely. Will FUE achieve the goals of the patients who opt for it, including not having a strip cut from their scalp? For the majority going to a top end FUE surgeon, it most certainly will.

[Gasthoerer]

 

1. Again, I must disagree. We're arguing semantics or different writing/speech styles. The crux is the same.

 

2. How much more variable? 75% growth rate on average.

 

3. So this should confirm that I stand by the claimed differences. My stance hasn't changed at all.

 

Sorry, Dr. Bloxham,

 

All answers I have read from you so far come across thought through, balanced and highly informative. We have a great discussion in the mFUE thread of yours. Well, actually you are giving great answers to my questions.

 

1. But to call the differences which I highlighted "semantics" is embarrasing to you and me.

 

2. "More variable" and "75 % growth rate" (not even overall yield) of FUE relative to strip is hardly the same.

 

And do play the math game: Dr. Feller was actually claiming 75 % as a starting point! The average has to be much (!) lower based on his statement.

 

As an example: If strip is at 90 % (4 %-point higher that the Beehner study) and the average of FUE would be 65 % (my assumption of Dr. Fellers <75 %) of FUT the overal average growth rate of FUE is: 58.5 %. If strip is 95 % and FUE at 70 % of that (very close to Dr. Feller max value) it is still only 66.5 % overall.

 

3. Do you agree with this numbers? Yes or no?

 

Again, I have a hard time to believe this numbers (58.5-66.5 % FUE growth in average in a good clinic). I believe (!) FUE has to be (!) lower than FUT, but I do want correct numbers, so that we (patients) can make wise decisions.

[Shampoo]

I know its easier to create a straw-man than address legitimate points, but come on.

 

I've seen post after post after post in recent years in this forum basically claiming FUE was the near perfect solution. It was was also at times stated in demeaning ways ("greedy doctors"...which is laughable) about patients and doctors still pro-FUT. It is not strawman to FINALLY get some balance to this topic. In an odd twist of fate, if I ever have another procedure it will have to be FUE...lol

[MAGNUMpi]

We have to also consider the other factors here. A great doctor performing FUE with a patient with good donor and thick hair is probably going to end up looking better than FUT performed by a mediocre doctor with a patient with thin hair and poor donor. There are great/mediocre/bad doctors out there performing both techniques. So unless both the patient and the doctors are robots, tuned perfectly, we will never really be able to quantify these claims.

Also even a great doctor can be amazing at FUE (for a host of reasons) and not as interested in FUT, or the other way around.

Personally the scar does play a factor in my mind. Too many repair cases online to count.

For my money, donor, and NW level, I would choose an amazing manual FUE doctor. That's only because (after countless hours of research) I understand what both entail.

[Mick50]

As Dr Feller has pointed out as layman we don't know what we don't know ,by the same token I know what I know and that is I had 4200 FUE grafts and have had an amazing result I was a NW 5-6 and 4200

grafts have made a huge difference ,I mostly don't wear a hat ,I'm going home to Ireland next week and will be meeting people I haven't seen for many years ,it's going to be a totally different experience than if I was still bald .

I had my transplant 2.5 years ago and touch wood it is still going strong, of course I will need a second one for the crown that would have been the case with FUT being the real estate that needed covering and 4200 grafts will only go so far .

I totally accept that FUT is the way to go for most big cases but my thinking is if I got a great result form basically a tech clinic in turkey ,Doc just drew the hair-line ,surely Doctors like Erdogan etc can equal and surpass the result I've had , I've put pics up on here on different thresds,just to add it looks as good in reality people have commented on it.

This is just a different slant than all the technical points being made on here ,ha which I wouldn't attempt to get into as there are many more articulate posters able to do that with Dr feller ,as I have said before

it's great that Dr /Feller Bloxham post these threads /videos as I'm sure they have put a few guys on the right track ,but as I said I can only speak form my own experience .

 

I know Dr Feller will say no matter how good a FUE transplant may be an FUT would have been better which is fair enough, but

if in his opinion the best to hope for is say 60 percent as an average ,the question is was I just one of the lucky ones as no way

would 2520 grafts have given me the result that was achieved .

Edited June 16, 2017 by Mick50

[Dr. Alan Feller]

We have to also consider the other factors here. A great doctor performing FUE with a patient with good donor and thick hair is probably going to end up looking better than FUT performed by a mediocre doctor with a patient with thin hair and poor donor. There are great/mediocre/bad doctors out there performing both techniques. So unless both the patient and the doctors are robots, tuned perfectly, we will never really be able to quantify these claims.

 

100% agree with this. That's why I focus on the differences between the two procedures themselves and not the doctors who perform them nor the patients they are performed on.

 

When you view it that way a mediocre FUT doctor will out perform a very experienced FUE doctor each and every time.

 

The doctor who moves the most grafts without damage wins. Everything else is secondary in an HT surgery.

Edited June 16, 2017 by Dr. Alan Feller
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