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Dr. Alan Feller

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

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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.


Dr. Dow Stough - 1000 Grafts - 1996

Dr. Jerry Wong - 4352 Grafts - August 2012

Dr. Jerry Wong - 2708 Grafts - May 2016

 

Remember a hair transplant turns back the clock,

but it doesn't stop the clock.

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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.

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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.

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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


Dr. Dow Stough - 1000 Grafts - 1996

Dr. Jerry Wong - 4352 Grafts - August 2012

Dr. Jerry Wong - 2708 Grafts - May 2016

 

Remember a hair transplant turns back the clock,

but it doesn't stop the clock.

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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.

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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 by Mick50

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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 by Dr. Alan Feller
font and color

Feller Medical, PC

Great Neck, NY

 

Dr. Alan Feller is a member of the Coalition of Independent Hair Restoration Physicians

 

Providing FUT, FUE, and mFUE

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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 by MAGNUMpi

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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.


Feller Medical, PC

Great Neck, NY

 

Dr. Alan Feller is a member of the Coalition of Independent Hair Restoration Physicians

 

Providing FUT, FUE, and mFUE

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

 

 

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

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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.

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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.

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@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 by Swooping

Proud to be a representative of world elite hair transplant surgeon Dr. Bisanga - BHR Clinic.

Hairtransplantelite.com

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Online consultations: damian@bhrclinic.com

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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).

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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?

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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

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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.

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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

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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


12/11/17 2500 FUE Grafts with Dr. Steven Gable

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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?

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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.

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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."


Dr. Blake Bloxham is recommended by the Hair Transplant Network.

 

 

Hair restoration physician - Feller and Bloxham Hair Transplantation

 

Previously "Future_HT_Doc" or "Blake_Bloxham" - forum co-moderator and editorial assistant for the Hair Transplant Network, Hair Restoration Network, Hair Loss Q&A blog, and Hair Loss Learning Center.

 

Click here to read my previous answers to hair loss and hair restoration questions, editorials, commentaries, and educational articles.

 

Now practicing hair transplant surgery with Coalition hair restoration physician Dr Alan Feller at our New York practice: Feller and Bloxham Hair Transplantation.

 

Please note: my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

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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?

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