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

[MAGNUMpi]

Thanks Dr. Feller.

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

Ha. Yes. Results are what matter most. Edited June 18, 2017 by MAGNUMpi

[Dr. Alan Feller]

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 .

 

Indeed you were one of the lucky ones (luck of the Irish?).

 

 

Magnum stole my font.

[Mick50]

Indeed you were one of the lucky ones (luck of the Irish?).

 

 

Ha yea maybe Dr Feller maybe, I'll take it either way .

[Stig]

 

In this video, a graft is being delivered at 2:11 (and several right after). As you can see, while the initial grasp of the forcep is very superficial and near the epidermis, as tension is applied to the graft the second forcep grasps lower on the follicle. Even with a gentle grasp, this area is clearly outside of the region defined above. And although it is more superficial, it could still clearly be near the crucial bulge stem cell region (which is around 1.5-2mm deep).

 

 

 

 

 

 

.

 

I'm glad to see this website allowing the use of one of JT's videos again.

[MAGNUMpi]

Magnum stole my font.

Sorry about that.

When I copied your quote your font came along. I think I got it back to normal now.

[Swooping]

@Dr. Feller and Dr. Bloxham,

 

Thank you for your response. I can not speak for Dr. Bisanga, but here is a piece written recently by him that gives an insight behind the philosophy of our clinic.

 

 

For the sake of this topic we assume that both techniques are performed competently.

 

Deciding on a transplant is a hard decision; the technique used will play a major factor in your long-term happiness, goals and intentions. Both techniques have their pluses and negatives and so it is important to ensure you choose the correct technique for long term planning and getting the most out of your donor.

 

FUE, the donor surface area is opened to the maximum but that does not mean there are more follicular units (FU) to be taken in comparison to FUT. Every FU removed will reduce the density, the more removed can noticeably drop the density and impair the donor for future procedures, FUE or FUT. Assuming an average density around the safe zone of 80 FU cm2 if the extraction pattern is spread and no areas are over harvested around 4000 FU could be removed according to the protocol we use at BHR clinic, this will drop the overall density down by around 30%, leaving a density near 60 FUcm2 in the donor, and this would then be considered low density on a virgin scalp.

 

To sustain the density in the donor FUE is better suited to lower or mid-range graft numbers for the most, with an educated extraction pattern, no over harvesting or partial shaving then the density change to the scalp can be minimal, if the candidate has an average to good density to start with then around 1500 grafts can be removed and hardly affect the overall density.

 

Larger patterns of hair loss then FUE starts to be less of an option over one or multiple procedures; grown out results of 3500 FUE plus grafts are not the norm and require very good donor characteristics. If high FUE numbers are performed in one procedure, there is a greater risk the yield will not mirror that attained through FUT; a real medical concern of large FUE procedure is the effect on the body to heal multiple open wounds created in the recipient and donor area and how effective the body can sustain and heal whilst not impairing the scar healing in the donor and yield in the recipient.

 

A possible exception to the FUE rule on larger hair loss pattern candidates is when there are limited goals, not looking for total restoration, lower density placement due to specific hair styling, or the “5 o’clock shadow” look for those who want a high conservative hair line to frame the face and frontal area and intend to keep their hair short/shaved; but this is not the normal HT candidate and very important that goals and long term intentions are discussed and understood by the candidate and the doctor.

 

FUT will remove a hair bearing strip of tissue and therefore effectively the hair density has not changed significantly in the donor as the surface area is removed as opposed to hairs removed from the surface area. The scalp laxity allows for a strip to be removed without causing any long-term tension and over time the skin heals well. There are limits to how many times this can be repeated but in good conditions 2-3 times and with good skin healing attributes it will be able to englobe the existing linear scars to leave a single line rather than multiple wounds.

 

FUT removes a high concentrated number of FU from a relatively small area and they are removed still in their natural state of high density on the strip; 4000 grafts in one procedure is an achievable number in the majority of candidates unless the donor density or laxity is particularly weak. For long term planning and high NW stages FUT makes it easier to plan and cover with a good density the largest surface area possible.

 

FUT does have the disadvantage of leaving a linear scar so more visible signs a surgical procedure has been carried out but the advantage of being able to move a greater number of FU either in one procedure or multiple procedures compared to FUE and still sustain a similar density as before in the donor.

 

Conclusion, the advent of FUE means no need to be left with a linear scar for a relatively small to mid-range amount of grafts placed so from a cosmetic point of view it allows the patient to have an HT with little to no obvious signs a HT has been performed.

 

FUE due to the technical demands of the procedure being labour and time intensive as well as the medical healings better suited to smaller sessions for the majority of hair loss sufferers. If the pattern of hair loss is high and the goal is to cover a large surface area with a natural looking density then FUT would be the sensible and obvious choice to achieve the best result for the candidate. The combination of both techniques can be utilised to ensure the original scar quality healing is maintained and using FUE to maximise the donor extraction zone, whilst still allowing the potential for future surgery using both techniques if need be. Combining the two techniques allows the best attributes of both to be used, maximum movement of grafts and opens the donor zone, concentrated high number of grafts from FUT and harvesting outside the traditional safe zone with FUE. What has to be remembered though is with either technique they are both scalp/hair characteristic changing in their own way, hair is being removed and there will always be a consequence to this, be it loss of density or laxity or scarring.

 

 

Edited June 18, 2017 by Swooping

[Gasthoerer]

Swooping,

 

thank you for the insight. This sentence is a little confusing to me:

 

FUT will remove a hair bearing strip of tissue and therefore effectively the hair density has not changed significantly in the donor as the surface area is removed as opposed to hairs removed from the surface area.

It also contradicts this sentence a little bit:

 

Every FU removed will reduce the density, the more removed can noticeably drop the density and impair the donor for future procedures, FUE or FUT.

 

In my opinion, also strip reduces the remaining donor density. It just has to, as the same area has to be covered with less FU. The area might by wider and the FU more even distributed (due to the overall stretching of the skin) than in FUE, but the density has to drop by actually by the same amount (if the entire donor and not only the safe zone is considered and widening of the recipient area is not occuring).

[TrixGlendevon]

A possible exception to the FUE rule on larger hair loss pattern candidates is when there are limited goals......... the “5 o’clock shadow” look for those who want a high conservative hair line to frame the face and frontal area and intend to keep their hair short/shaved;

 

I actually wouldn't mind having the 5 o'clock shadow look and shaving my head for the rest of my life. Do you have any picture examples of patients the doctor has done this type of procedure to in the past?

[dan26]

Swooping,

 

thank you for the insight. This sentence is a little confusing to me:

 

 

It also contradicts this sentence a little bit:

 

 

 

In my opinion, also strip reduces the remaining donor density. It just has to, as the same area has to be covered with less FU. The area might by wider and the FU more even distributed (due to the overall stretching of the skin) than in FUE, but the density has to drop by actually by the same amount (if the entire donor and not only the safe zone is considered and widening of the recipient area is not occuring).

 

Density = FU's per unit of surface area --> FUT removes FU's AND surface area -->therefore overall density not as much affected as just removing FUs and no surface area as in FUE

 

This is why for most grafts possible over a lifetime it is recommended to do strip first up until your scalp allows then switch to FUE

[Gasthoerer]

Density = FU's per unit of surface area --> FUT removes FU's AND surface area -->therefore overall density not as much affected as just removing FUs and no surface area as in FUE

 

This is why for most grafts possible over a lifetime it is recommended to do strip first up until your scalp allows then switch to FUE

 

???

Yes, the definition of density is FU / area!

FUT removes the FU and the skin, I get that too.

 

But the remaining skin has to stretch (!) ,as your skull (surface) obviously does not shrink. That is why you are tested for you skin laxity to begin with.

 

Hence, FU removed and area remains constant after stretching --> Densitiy decreased. It is less obvious than with FUE (as more even distributed) but thinning also exist in FUT.

[Vainism]

I have a degree in quantum physics, so please let me elaborate my perspective with this debate. Throughout all the research I have conducted over the past few years in Harvard, I have come to the conclusion that strip scars are gay. End of story fue wins

[Dr. Alan Feller]

----------

Edited June 22, 2017 by Dr. Alan Feller

[MattyNJ1]

Nah, you don't even know what my business practices are. We've never met nor ever done business together. And after 24 years of full time successful national and international practice, multiple clinics, thousands of patients and not a single lawsuit or litigation of any kind I think my business ethics and practices are pretty solid.

 

You are just angry because you don't want to accept the truth about FUE. Hey, if you are so convinced of it's merits why bother to attack me? Just go ahead and get it done. You certainly don't need my approval.

 

Curious as to why you havnt done one the procedures yourself? You certainly are a candidate from the pictures ive seen of you. Always found it odd whether it be a cosmetic dentist with bad teeth etc...why haven't they become their own billboard so to speak..Thanks

[HairLostYears]

Matty, I'm pretty sure Dr. Feller has always been open about the fact that most, if not all, of his hair on top is transplanted. He'd likely be a total slaphead by now if not.

 

Since this thread was bumped, just something I've thought about from time to time which likely has been brought up before...

 

You don't see many (any?) reports of people who have gone to what are generally considered the top FUE clinics who seem to regret their decision in doing so.

 

Dr. Lorenzo's reputation seems as solid as ever even though he might delegate more of the workload these days. Dr. Erdogan and staff still seem to be thriving while pumping out multiple procedures on a daily basis.

 

By this time, surely the internet should be chock-full of their dissatisfied FUE patients if the results are really that much of a crap shoot. If the FUE procedure in general is really as unpredictable as you guys purport, even these top name FUE doctors should have plenty of negative press out there. Where are all these bad reviews?

[quidproquo82]

From what I can remember, he has done a procedure.

[TrixGlendevon]

Curious as to why you havnt done one the procedures yourself? You certainly are a candidate from the pictures ive seen of you. Always found it odd whether it be a cosmetic dentist with bad teeth etc...why haven't they become their own billboard so to speak..Thanks

 

1) That's pretty harsh and just a sly dig. It doesn't contribute to anything in the discussion, whether you agree with Doctor Feller or not

2) He has had procedures done. His whole hair is transplanted hair as he says in his Youtube videos.

[Dr Blake Bloxham]

Since this thread was bumped, just something I've thought about from time to time which likely has been brought up before...

 

You don't see many (any?) reports of people who have gone to what are generally considered the top FUE clinics who seem to regret their decision in doing so.

 

Dr. Lorenzo's reputation seems as solid as ever even though he might delegate more of the workload these days. Dr. Erdogan and staff still seem to be thriving while pumping out multiple procedures on a daily basis.

 

By this time, surely the internet should be chock-full of their dissatisfied FUE patients if the results are really that much of a crap shoot. If the FUE procedure in general is really as unpredictable as you guys purport, even these top name FUE doctors should have plenty of negative press out there. Where are all these bad reviews?

 

1978Matt has an interesting list he compiled. I'd PM him and inquire further. It illustrates the point that the dissatisfied -- or underwhelmed -- patients are absolutely out there in higher numbers.

 

And of course it isn't reflected online, but doctors -- and I can't speak for all of them, but I can speak for the ones I've discussed it with -- see it very frequently in practice.

 

For most, the results just simply aren't the same. There are a lot of colorful ways to have this discussion, but that's how it really breaks down in the end.

 

However, there is absolutely a right and wrong way to do FUE. And the good clinics doing it the right way are likely to have better results. But I will say that I believe the top FUE-only clinics have one big thing in common: screening. There are good and not good FUE patients right off the bat. The top clinics tend to do a solid job screening and hence they work on better suited patient population from the get-go. And this isn't a slight or anything like that; it's a very, very good thing that they screen and perform FUE on patients who are suitable for the procedure.

 

I also believe most unhappy patients -- and most happy patients too -- simply don't post online. They sign up, have their procedure, and then move on. Maybe it's because they are happy, maybe its because they aren't, but the majority of people simply don't post. It's a small percentage that feel very passionately one way or the other and do see it through.

 

I also think there will be a language/geographical bias here. Take Turkey, for example. If you read the following article, you'll see one Turkish clinic state that 90% of their business comes from the Middle East -- non-English speaking. If the majority of patients aren't coming from English-speaking countries, it's unlikely that they would post on an English-speaking/non-geographically focused forum.

 

Article: https://qz.com/954680/in-turkeys-cutthroat-hair-transplant-tourism-industry-the-biggest-losers-are-the-patients-and-syrian-refugees/

 

But one of the biggest issues I have personally isn't so much the results. This is obviously a huge part of it, but it's much more than that. One of the biggest issues is life-time grafts and keeping the donor in the best shape for future surgery. It's a complete farce that most people can have these very, very high FUE procedures. Some obviously have the donor for it, but the vast majority don't. What's more, there are issues with too much diffuse thinning, too much scarring under the surface, etc, that make future FUE procedures less certain. And even the most ardent FUE supporters tend to agree that FUT first allows for the most life-time grafts. So it's one thing to get a 3,000 graft procedure, be underwhelmed with the results, and then go back to augment and get it where you want. But it's a big, big problem when that one procedure can knock out the entire donor in one shot and put the patients in a bad situation up the road. And this is also where most people find out you can't simply "shave it and move on."

[JayLDD]

1978Matt has an interesting list he compiled. I'd PM him and inquire further. It illustrates the point that the dissatisfied -- or underwhelmed -- patients are absolutely out there in higher numbers.

 

And of course it isn't reflected online, but doctors -- and I can't speak for all of them, but I can speak for the ones I've discussed it with -- see it very frequently in practice.

 

For most, the results just simply aren't the same. There are a lot of colorful ways to have this discussion, but that's how it really breaks down in the end.

 

However, there is absolutely a right and wrong way to do FUE. And the good clinics doing it the right way are likely to have better results. But I will say that I believe the top FUE-only clinics have one big thing in common: screening. There are good and not good FUE patients right off the bat. The top clinics tend to do a solid job screening and hence they work on better suited patient population from the get-go. And this isn't a slight or anything like that; it's a very, very good thing that they screen and perform FUE on patients who are suitable for the procedure.

 

I also believe most unhappy patients -- and most happy patients too -- simply don't post online. They sign up, have their procedure, and then move on. Maybe it's because they are happy, maybe its because they aren't, but the majority of people simply don't post. It's a small percentage that feel very passionately one way or the other and do see it through.

 

I also think there will be a language/geographical bias here. Take Turkey, for example. If you read the following article, you'll see one Turkish clinic state that 90% of their business comes from the Middle East -- non-English speaking. If the majority of patients aren't coming from English-speaking countries, it's unlikely that they would post on an English-speaking/non-geographically focused forum.

 

Article: https://qz.com/954680/in-turkeys-cutthroat-hair-transplant-tourism-industry-the-biggest-losers-are-the-patients-and-syrian-refugees/

 

But one of the biggest issues I have personally isn't so much the results. This is obviously a huge part of it, but it's much more than that. One of the biggest issues is life-time grafts and keeping the donor in the best shape for future surgery. It's a complete farce that most people can have these very, very high FUE procedures. Some obviously have the donor for it, but the vast majority don't. What's more, there are issues with too much diffuse thinning, too much scarring under the surface, etc, that make future FUE procedures less certain. And even the most ardent FUE supporters tend to agree that FUT first allows for the most life-time grafts. So it's one thing to get a 3,000 graft procedure, be underwhelmed with the results, and then go back to augment and get it where you want. But it's a big, big problem when that one procedure can knock out the entire donor in one shot and put the patients in a bad situation up the road. And this is also where most people find out you can't simply "shave it and move on."

 

Does it necessarily make a fundamental difference whether FUT is used first or last to maximise donor capacity? Obviously a strip from someone with a donor already harvested by a substantial number of FUE grafts will yield less, but isn't this still a possibility?

[Dr Blake Bloxham]

Does it necessarily make a fundamental difference whether FUT is used first or last to maximise donor capacity? Obviously a strip from someone with a donor already harvested by a substantial number of FUE grafts will yield less, but isn't this still a possibility?

 

Donor will be maximized if FUT is used first. You can take several strips from the "sweet spot" of the safe donor region and then FUE all around the entire donor (even the "expanded" donor) -- which is virgin and untouched. FUT after FUE is very possible, but the yield from the strip will be less because it's been hit with FUE. If the entire donor is thinned out, you may also need to wear it longer to properly camouflage the scar as well.

[MattyNJ1]

1) That's pretty harsh and just a sly dig. It doesn't contribute to anything in the discussion, whether you agree with Doctor Feller or not

2) He has had procedures done. His whole hair is transplanted hair as he says in his Youtube videos.

 

Not at all. It was a sincere question and ABSOLUTELY relevant to this discussion/debate (that ive literally been reading for the past 6hrs straight). Dr Feller disclosing WHICH procedures he has had (if so) or whether or not hes had one at all and WHY are very relevant...no dig.

[TrixGlendevon]

He has had FUT and says so on his videos. He also doesn't take medication. Check them out.

[MattyNJ1]

He has had FUT and says so on his videos. He also doesn't take medication. Check them out.

 

thanks must have missed that video!...that's great, does he show his own procedure? pics etc?

[Hair4Chris]

As someone who is trying to research and make the best decision I can possible make going into a SURGERY, yes a SURGERY… Does anyone else find it discouraging and unnerving that arguable the best FUT surgeon in North America is arguing on these forums? I have spent two years trying to make a decision on doctor and procedure type and all I learned is it's a shady business with a bunch of non transparent pricing, results, and cut throat practices. At this point I am just ready to say F it and go bald. Going bald is a huge emotional stress, and is mentally taxing and the doctors certainly do not make it any easier.

 

From what I gathered is that doctors can get better results with FUT over FUE with the same amount of graphs, but add ~15% more graphs using FUE, it bridges the gap if the surgeon is good. FUE prevents a large linear scar with unpredictable height, as well as unnatural hair directional changes. I also really like that 99.9% of people have less hair on the top of their hair than the horse shoe around their head, and FUE helps even out the diffusion and creates some consistency all over the head. The biggest draw is the recovery, and how much less invasive it appears to be, 3 day donor recovery for FUE in some cases.

 

I also do not get how a FUT or FUE procedure is different in preserving the remaining donor hair. Say a strip has 3000 graphs, you transplant 3000, that’s 3000 less in the back of your head. Ok now say you FUE 3000 graphs, you transplant 3000, that’s 3000 less in the back of your head. It is the same amount. You can argue the perceived amount is different, because you are basically shortening the length of the back of your head with FUT and diffusing with FUE. If you get a huge scar though, that is worse than FUE thinning. You can also extract the exact amount you need with FUE, but not with FUT, so it can be wasteful.

 

As an unrelated afterthought, I feel like every doctor should be required to post every result good or bad by law, as well as the cost of their procedure publicly. This would help with expectations and propelling the industry forward. I mean hospitals need to post their cancer survival statistics. Why should this surgery be any different? Then we could see what is the best procedure, and the best value as well. I understand a lot of patients will not come forward with their 12 month post pictures but a partial refund incentive would fix that (like a security deposit for a lease).

[JayLDD]

Yes strip surgeons tend to lie and suggest that taking out a strip first and then utilising FUE will yield the most, however this makes no logical or mathematical sense. The way to best utilise the donor is through a combination. FUT removes surface area, while FUE diffuses it like you say. It doesn't matter whether you first remove a strip or first use FUE, the amount of hairs you can get out of the area remain the same. However obviously a strip will yield less down the track if FUE is done first.

 

In saying that, FUT has a number of advantages over FUE in the quality of the cosmetic results in the recipient, and most master surgeons can produce FUT with minimal scarring in most cases. The biggest reason most avoid FUT is fear of having a strip cut from their scalp, not because of the scarring.

[Dr. Alan Feller]

The best decision you can make is to have an FUT procedure.

 

An FUE will not grow as well and it will cause more damage to your donor area.

 

Forget about the internet hype and the trolling and look at the two procedures:

 

FUE is a blind procedure that rips the graft from the scalp.

 

FUT is a fully visualized procedure that allows for dissection of the grafts with the least amount of trauma known to man.

 

It's no contest.

 

FUT is the gold standard.

FUE is internet hype.

 

Here is a video of an FUT scar from a typical patient of ours who received 3000 grafts: