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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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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.

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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.

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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?

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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).

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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.

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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:

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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.

 

Agreed but if you think about it, the missing hairs in the strip are already implanted in the front of your head, resulting in the same amount of transplanted hair. Why i feel it makes no difference what is done first.

 

As far as why FUT looks better than FUE, do you know why that happens? Is the hair thinned out if you do FUE versus FUT? What is the science behind that? Say you do 20% more graphs FUE than FUT, shouldn't it look the same to account for the transection loss?

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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.

 

Why is it that FUE does not grow as well at FUT? For the sake of this question say you transplant 1000 graphs FUT, and 1000 graphs FUE, and you confirm all 1000 grow with each procedure type, 100% yield for the sake of this question, regardless if you think that could happen. Will the FUE grow thinner and more straggly? Or is this just a question of yield, and if so can't you just use more FUE graphs to get the same visual result if its say a difference of 9-20% growth yield. So you transplant 1200 graphs FUE and 1000 graphs FUT. What makes it look so much better?

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Why is it that FUE does not grow as well at FUT? For the sake of this question say you transplant 1000 graphs FUT, and 1000 graphs FUE, and you confirm all 1000 grow with each procedure type, 100% yield for the sake of this question, regardless if you think that could happen. Will the FUE grow thinner and more straggly? Or is this just a question of yield, and if so can't you just use more FUE graphs to get the same visual result if its say a difference of 9-20% growth yield. So you transplant 1200 graphs FUE and 1000 graphs FUT. What makes it look so much better?

 

Excellent question. Here's the answer.

1000 FUE will not look as good as a 1000 FUT in the recipient area even assuming 100% growth yield on both. The reason is the damage inflicted on the follicles by the FUE procedure. A follicle is composed of cells each of which contribute to the final thickness of the hair. If only part of the follicle is damaged it may still grow and thus be counted as a "successful" transplant, but the shaft diameter of the hair will be thinner and often kinky.

 

Depleting the donor area to make up for a poor yield of FUE, or the thinner hair shaft of FUE, is not an acceptable surgical protocol. If you were cutting fabric then that would be fine, but when you're dealing with human flesh ETHICAL doctors don't act this way.

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My experience as a Former FUT and FUE patient:

 

 

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

 

An FUT will cause more damage to your donor area, period. Oh, just look beneath the scarline, you will very often see the remaining grafts are of FAR less quality because of FUT harvesting. So FUT often WEAKENS the donor area for future usage.

 

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 equally blind as it destroys the FU along the cutting line.

 

FUT is a fully visualized procedure that allows for dissection of the grafts with the least amount of trauma known to man. Yes, but you would have to trust on a lot of techs getting it done right. No surgeon in the world can watch over all these techs at the same time. So in the end the Surgeon has NO idea how many grafts where damaged.

 

It's no contest. Indeed, FUE is least invasive method and should be prefered for this reason alone, along with many other reasons.

 

Oh, and all the records of most grafts transplanted are ... indeed all FUE cases!

 

 

FUT is the gold standard. Used to be, sorry. Diesel and petrol cars still the gold standard, only because it is cheaper .. but dirty at the same time. Take away cost and people will be driving electric cars forever.

 

 

 

FUE is internet hype. Yes, and there are so many good reasons it is hyped. ONe of the reasons is that many surgeons have done a lot of dammage using FUT (even the good docs out there).

 

FUE is not 'perfect', but it is really the best option available out there for the moment.

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FUE has set records for most grafts transplanted? Can you cite evidence? How is this possible when the total lifetime grafts available from FUE are less than FUT?

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My experience as a Former FUT and FUE patient:

 

 

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

 

An FUT will cause more damage to your donor area, period. Oh, just look beneath the scarline, you will very often see the remaining grafts are of FAR less quality because of FUT harvesting. So FUT often WEAKENS the donor area for future usage.

 

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 equally blind as it destroys the FU along the cutting line.

 

FUT is a fully visualized procedure that allows for dissection of the grafts with the least amount of trauma known to man. Yes, but you would have to trust on a lot of techs getting it done right. No surgeon in the world can watch over all these techs at the same time. So in the end the Surgeon has NO idea how many grafts where damaged.

 

It's no contest. Indeed, FUE is least invasive method and should be prefered for this reason alone, along with many other reasons.

 

Oh, and all the records of most grafts transplanted are ... indeed all FUE cases!

 

 

FUT is the gold standard. Used to be, sorry. Diesel and petrol cars still the gold standard, only because it is cheaper .. but dirty at the same time. Take away cost and people will be driving electric cars forever.

 

 

 

FUE is internet hype. Yes, and there are so many good reasons it is hyped. ONe of the reasons is that many surgeons have done a lot of dammage using FUT (even the good docs out there).

 

FUE is not 'perfect', but it is really the best option available out there for the moment.

 

I'm afraid the entirety of your post is misinformed.

 

FUE does not hold the record for most grafts implanted, FUT does by a wide wide margin:

You are being fooled by the fact that FUE clinics misleadingly use the term "in one procedure" to refer to multiple days of surgery, whereas FUT clinics always mean a single day.

 

In order to approach the density and growth success of FUT, FUE doctors NEED to take more grafts to make up for the lower yields and thinner hair shafts. FUT doctors have no such disadvantage and thus fewer grafts are needed by comparison.

 

Furthermore, when FUE megasessions are performed almost all of them take hair from OUTSIDE the safe donor areas. FUT practitioners do not need to.

 

You are correct that there are bad FUT procedures out there. But almost all of them were performed by amateur practitioners seeking to perform HT on a part time basis. That's why patients NEED to look for clinics that perform FUT fulltime and have a full staff. Unfortunately, many patients find out AFTER their procedure that their clinic was amateur.

 

FUE has it's place, but only for smaller procedures or AFTER the strip procedure can no longer be performed.

 

And your statement about FUT techs is also incorrect. Of course there is some wastage during dissection, but orders of magnitude less than FUE. Furthermore, none of the FUT grafts get traumatized whereas ALL FUE grafts are traumatized all the time. Then you have to pray that the grafts tolerated the FUE procedure and hope they grow. This is why FUE yields and results are poorer compared to FUT and why so many more grafts are needed to achieve the same results.

 

The public is getting wise to the realities of FUE megasessions.

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It makes me laugh seeing these arguments on both sides play out over and over again.

 

Ultimately though most people can have their needs met by FUE and don't want a strip cut out of the back of their head.

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I just read the whole thread. I'm getting a HT this fall with Dr Wolf. I did a in office consult with him and he advised that FUT was a better option then FUE in my case. I have seen 3 different Dr's before deciding and all 3 of them said that I was a excellent patient for FUT. I was told that the only way my donor hair could be any better was if it was curly. I'm 52 and have had back surgery that left a scar and had colon surgery that left a nice scar. One on the back of my head covered by hair is no big deal.

hair3.jpg.698280583d0c7460c9125ad379f5f31a.jpg

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My experience as a Former FUT and FUE patient:

 

 

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

 

An FUT will cause more damage to your donor area, period. Oh, just look beneath the scarline, you will very often see the remaining grafts are of FAR less quality because of FUT harvesting. So FUT often WEAKENS the donor area for future usage.

 

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 equally blind as it destroys the FU along the cutting line.

 

FUT is a fully visualized procedure that allows for dissection of the grafts with the least amount of trauma known to man. Yes, but you would have to trust on a lot of techs getting it done right. No surgeon in the world can watch over all these techs at the same time. So in the end the Surgeon has NO idea how many grafts where damaged.

 

It's no contest. Indeed, FUE is least invasive method and should be prefered for this reason alone, along with many other reasons.

 

Oh, and all the records of most grafts transplanted are ... indeed all FUE cases!

 

 

FUT is the gold standard. Used to be, sorry. Diesel and petrol cars still the gold standard, only because it is cheaper .. but dirty at the same time. Take away cost and people will be driving electric cars forever.

 

 

 

FUE is internet hype. Yes, and there are so many good reasons it is hyped. ONe of the reasons is that many surgeons have done a lot of dammage using FUT (even the good docs out there).

 

FUE is not 'perfect', but it is really the best option available out there for the moment.

 

Not even remotely surprised to see you're a shill for a FUE only clinic in Belgium. If FUE was so great why do you have to blatantly lie and exaggerate to make it seem that way?

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I've had both as well. But I've seen photos that show the area beneath the scar is markedly thinner as result of the strip excision. DR. FELLER, what do you think of that statement ?

Edited by jbl2093

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I've had both as well. But I've seen photos that show the area beneath the scar is markedly thinner as result of the strip excision. DR. FELLER, what do you think of that statement ?

 

The statement is a non-starter. Sure, there can be donor thinning under the scar but it is usually just within the first weeks to months just after surgery and normally completely resolves on it's own. I may see this phenomenon once in every 30 surgeries and none have been permanent.

 

It is the donor thinning from FUE that is aggressive, permanent, and often the subject of online posts from unhappy FUE patients.

 

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Sure, there can be donor thinning under the scar but it is usually just within the first weeks to months just after surgery and normally completely resolves on it's own. I may see this phenomenon once in every 30 surgeries and none have been permanent.

 

It is the donor thinning from FUE that is aggressive, permanent, and often the subject of online posts from unhappy FUE patients.

 

 

Sorry, I didn't want to involve before I had my 2nd assessment with the clinic which recommended FUE to me and ask the questions we have discussed forth and back.

 

But I have to step in here.

For the record:

 

Dr. Feller, do you say that there is typically (!) no (long term) donor thinning with strip? If yes, pleas explain how this is mathematically possible.

 

And yes, I am well aware that thinning with FUE is much worse. That is not my point. But there has to be donor thinning with strip or donor area has to shrink 1:1 with the width of the strip and the recipient has to enlarge. The latter was partly denied by you before if I remember correctly.

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I'm afraid the entirety of your post is misinformed.

 

FUE does not hold the record for most grafts implanted, FUT does by a wide wide margin:

You are being fooled by the fact that FUE clinics misleadingly use the term "in one procedure" to refer to multiple days of surgery, whereas FUT clinics always mean a single day.

 

In order to approach the density and growth success of FUT, FUE doctors NEED to take more grafts to make up for the lower yields and thinner hair shafts. FUT doctors have no such disadvantage and thus fewer grafts are needed by comparison.

 

Furthermore, when FUE megasessions are performed almost all of them take hair from OUTSIDE the safe donor areas. FUT practitioners do not need to.

 

You are correct that there are bad FUT procedures out there. But almost all of them were performed by amateur practitioners seeking to perform HT on a part time basis. That's why patients NEED to look for clinics that perform FUT fulltime and have a full staff. Unfortunately, many patients find out AFTER their procedure that their clinic was amateur.

 

FUE has it's place, but only for smaller procedures or AFTER the strip procedure can no longer be performed.

 

And your statement about FUT techs is also incorrect. Of course there is some wastage during dissection, but orders of magnitude less than FUE. Furthermore, none of the FUT grafts get traumatized whereas ALL FUE grafts are traumatized all the time. Then you have to pray that the grafts tolerated the FUE procedure and hope they grow. This is why FUE yields and results are poorer compared to FUT and why so many more grafts are needed to achieve the same results.

 

The public is getting wise to the realities of FUE megasessions.

 

Hi Dr. Feller,

I respect your opinion, and I must assume that they are based your your skills.

 

I have personally witnessed many FUE sessions with no or less then 3 percent transections. And this not only at Prohairclinic, but also at other world class Belgian clinics.

 

So let's agree to disagree, that is fine.

 

I am not looking for the LW.

 

bart

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Hi Dr. Feller,

I respect your opinion, and I must assume that they are based your your skills.

 

I have personally witnessed many FUE sessions with no or less then 3 percent transections. And this not only at Prohairclinic, but also at other world class Belgian clinics.

 

So let's agree to disagree, that is fine.

 

I am not looking for the LW.

 

bart

 

I'm sorry Bart, I can't agree to disagree.

 

What I wrote was not opinion-but clinical fact based on 17 years experience in FUE and 23 years experience with FUT.

 

What you wrote was simply not true or confusing at best.

 

The word "transection" is used very loosely by the FUE community and it's time that it stopped.

 

FUE clinics seem to want the public to believe that transection is the only injury visited upon a graft during FUE surgery. But this is not true. The damage from the twisting, compression, and yanking of partially freed FUE grafts inflicts damage in far greater numbers than transection does AND it is invisible to the eye.

 

If it is your contention that all FUE grafts that appear intact (not transected) grow as well as FUT grafts then you are sadly mistaken. If you were a doctor and actually performed the FUE procedure you could appreciate the amount of force and trauma applied to the graft to get them out of MOST patients. When I say "most" I mean the vast majority of patients meaning 85%. Probably higher.

 

If FUE clinics started to use the more accurate "Damaged Graft" percentage instead of the so-called "Transected Graft" percentage the public would understand the true and unpredictable nature of the FUE procedure and few would take the gamble to have it performed on them if the gold standard of FUT were available.

 

In the United States patients must be given informed consent. Failure to disclose the" graft damage percentage" while offering only the "graft transection rate" would be failure to give informed consent and would seriously threaten that doctors license. It would also be grounds for civil action. This is why you don't see "hair mills" and "FUE mills" in the United States. In fact, you see almost no FUE- only clinics at all in the United States for this reason.

 

As I recall, years ago you sent a few doctors to Dr. Jones to learn the FUE techniques Dr. Jones and I developed together. I'm in contact with Dr. Jones on a regular basis and nothing significant has changed in that time on his end. Nor mine. Nor anybody else's as far as I know. Are you claiming that your current staff of doctors are performing FUE significantly different from what Dr. Jones and I developed and passed onto your doctors ? If so, how does it significantly differ ?

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Dr. Feller as you came up with it, I would appreciate if you could answer my request for clarification for the sake of education of the forum members.

For the record:

 

Dr. Feller, do you say that there is typically (!) no (long term) donor thinning with strip? If yes, please explain how this is mathematically possible.

 

And yes, I am well aware that thinning with FUE is much worse.

 

Well, I have a hard time understanding your new comment as well. Where does this 85 % come from? A study or guessing from your side? What does it mean? In 15 % of all patients FUE grafts are as healthy as FUT grafts? Is assume that is not black and white, but there is a big grey area (where grafts are only slightly/partly worse with FUE to FUT), or am I misled?

 

And how do US doctors (or yourself) give information about “damaged grafts” with FUE if the damage is unvisible according to your words? You just guess a number? Or you tell before an average number? If so, which number do you give?

 

I also fail to understand what this has to do with FUE mills in the US. There are no FUE mills cause technicans aren’t allowed to do the majority of the work.

 

The damage from the twisting, compression, and yanking of partially freed FUE grafts inflicts damage in far greater numbers than transection does AND it is invisible to the eye.

 

If it is your contention that all FUE grafts that appear intact (not transected) grow as well as FUT grafts then you are sadly mistaken… When I say "most" I mean the vast majority of patients meaning 85%. Probably higher.

 

In the United States patients must be given informed consent. Failure to disclose the" graft damage percentage" while offering only the "graft transection rate" would be failure to give informed consent and would seriously threaten that doctors license. …

This is why you don't see "hair mills" and "FUE mills" in the United States. In fact, you see almost no FUE- only clinics at all in the United States for this reason.

Thank you for clarification.

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After reading Bverotti's post Dr. Bloxham and I began a discussion between ourselves about how confused people are about the realities of FUE surgery. So we decided to film it and share it online. If any FUE doctor cares to chime in, please do.

Dr. Alan Feller

Feller and Bloxham Medical, PC

Great Neck, NY

NYC Hair Transplant | NY Hair Restoration | Feller & Bloxham Medical

 

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And here are videos shot specifically to present what FUT scars really look like. Not the rare and shocking scars that FUE clinics mislead people into believing are common.

 

The scar results we show are representative of the TRUE typical strip scar.

 

All of the skin above and below the scar are completely untouched and undamaged. When FUE is performed, in contrast, the entire donor area is damaged well beyond necessity and limits the numbers of grafts available for future use.

 

 

 

 

 

 

 

 

 

Feller and Bloxham Hair Transplant

Great Neck, NY

http://www.fellermedical.com

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