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

[JayLDD]

Don't know how to make it any clearer for you.

 

On June 10 you posted claims about me which are demonstrably and undeniably untrue. What you "believe" is immaterial.

 

As someone who has studied law, can I just say please cut the total bullshit here Doctor Feller. There is no legal retribution you can claim for him calling a bluff and legally and objectively it is not undeniably untrue, it is entirely unfalsifiable at this point. You have no legitimate case if there are no damages and what he is saying is not demonstrably false, as at the current moment he is neither correct or incorrect. You made a claim you would do something, and as of yet have not followed through, despite having your conditions met.

 

He also says, "and if he did, they will never in a million years agree to the interview" in his comment and therefore he is not offering his comment as a statement of fact, which is the most important point to note that this is not defamation.

 

You're embarrassing yourself. Did you suddenly become a lawyer now too?

Edited June 12, 2017 by JeanLDD

[bandersnatchi]

As someone who has studied law, can I just say please cut the total bullshit here Doctor Feller. There is no legal retribution you can claim for him calling a bluff and legally and objectively it is not undeniably untrue, it is entirely unfalsifiable at this point. You have no legitimate case if there are no damages and what he is saying is not demonstrably false, as at the current moment he is neither correct or incorrect. You made a claim you would do something, and as of yet have not followed through, despite having your conditions met.

 

He also says, "and if he did, they will never in a million years agree to the interview" in his comment and therefore he is not offering his comment as a statement of fact, which is the most important point to note that this is not defamation.

 

You're embarrassing yourself. Did you suddenly become a lawyer now too?

 

JeanLuc, sent you a PM.

[Dr. Alan Feller]

I agreed with Dr. Feller in another thread on this point, and I'll do so again here. This is absolutely true for me, even if I sound like a tinkerbell for admitting it.

 

Never having had any type of surgery at 40 years old now, strip just scares the hell out of me. Getting my head carved into seems pretty extreme for the sake of vanity. The procedure just appears so archaic, like how they would have performed a hair transplant on The Knick (excellent show that ran for a while set in 1900 NYC hospital).

 

I'd club a baby seal to have Chris Cornell hair (RIP...wtf?), so even a bad scar would probably be a total non-issue for me...

 

 

-HairLostFears

 

Thank you for your honesty. You are in VERY good company.

 

The real reason FUE holds any appeal to the masses is that when visualizing the actual act of the surgery it SEEMS less drastic than it's FUT counterpart. To some that's all it takes to opt for it EVEN IF they are made aware that the consequence of the procedure are poorer growth, poorer results, and greater donor damage.

 

mFUE addresses the TRUE issue by minimizing the envisioned act of the surgery yet preserving the growth yield. It's a middle ground that got overlooked about 17 years ago which was the logical time it should have been realized. Better late than never.

 

[mav23100gunther]

What you "believe" is immaterial.

 

Well that something "immaterial" sure did invoke a very big reaction from you then.

[mav23100gunther]

As someone who has studied law, can I just say please cut the total bullshit here Doctor Feller. There is no legal retribution you can claim for him calling a bluff and legally and objectively it is not undeniably untrue, it is entirely unfalsifiable at this point. You have no legitimate case if there are no damages and what he is saying is not demonstrably false, as at the current moment he is neither correct or incorrect. You made a claim you would do something, and as of yet have not followed through, despite having your conditions met.

 

He also says, "and if he did, they will never in a million years agree to the interview" in his comment and therefore he is not offering his comment as a statement of fact, which is the most important point to note that this is not defamation.

 

You're embarrassing yourself. Did you suddenly become a lawyer now too?

 

Well said mate. You nailed it absolutely perfectly!

[Edsarn2017]

When I first read Dr Feller's claim about the fear of surgery with an FUT operation, I completely dismissed it out of hand. At the time of my first operation I was a semi-professional rugby union player, so an FUT at that time would have been out of the question, because I only had short time to have the operation, before resuming pre-season training.

 

In hindsight, I think that might have been an excuse, and I must admit that the thought of an FUE was much less frightening than the FUT method. I've had 6000 grafts spread over 3 FUE operations (and 5 days in 2013, 2014, and 2017):

 

http://www.hairrestorationnetwork.com/eve/186690-6000-fue-grafts-3000-dr-de-reys-2013;-1800-dr-de-reys-2014;-1200-dr-reddy-2017-a.html

 

I wonder how different my results would have been had I opted for an FUT. That said, I am happy with my results so far, and am awaiting the results of my third FUE. But I can't help wondering (a) the difference between the two methods and (b) whether I would have had the bottle to have an FUT if FUE was not available. I am not sure about that!

 

Interestingly, I asked Dr Reddy about his yield, and he said it was around 85%, although that seemed to decrease with older people (mid-40s).

[JayLDD]

When I first read Dr Feller's claim about the fear of surgery with an FUT operation, I completely dismissed it out of hand. At the time of my first operation I was a semi-professional rugby union player, so an FUT at that time would have been out of the question, because I only had short time to have the operation, before resuming pre-season training.

 

In hindsight, I think that might have been an excuse, and I must admit that the thought of an FUE was much less frightening than the FUT method. I've had 6000 grafts spread over 3 FUE operations (and 5 days in 2013, 2014, and 2017):

 

http://www.hairrestorationnetwork.com/eve/186690-6000-fue-grafts-3000-dr-de-reys-2013;-1800-dr-de-reys-2014;-1200-dr-reddy-2017-a.html

 

I wonder how different my results would have been had I opted for an FUT. That said, I am happy with my results so far, and am awaiting the results of my third FUE. But I can't help wondering (a) the difference between the two methods and (b) whether I would have had the bottle to have an FUT if FUE was not available. I am not sure about that!

 

Interestingly, I asked Dr Reddy about his yield, and he said it was around 85%, although that seemed to decrease with older people (mid-40s).

 

At this point though, of course you're still waiting on your last surgery results but wouldn't it be fair to say that you achieved your goals you had with hair restoration surgery, and that your donor is still cosmetically strong after 6000 grafts?

 

If you had the option of an extra 5-10% growth would you go back and choose FUT? De Reys is also significantly cheaper than any competent FUT surgeon, so you would have spent more if you went FUT.

 

Even with the knowledge of the benefits of FUT, would you want a big strip cut out the back of your head? As we see more and more cases like yours of FUE moving int 6-7-8000 grafts and achieving full coverage the question is whether FUT is NECESSARY for the average patient to achieve good results in the long term.

[Mick50]

When I first read Dr Feller's claim about the fear of surgery with an FUT operation, I completely dismissed it out of hand. At the time of my first operation I was a semi-professional rugby union player, so an FUT at that time would have been out of the question, because I only had short time to have the operation, before resuming pre-season training.

 

In hindsight, I think that might have been an excuse, and I must admit that the thought of an FUE was much less frightening than the FUT method. I've had 6000 grafts spread over 3 FUE operations (and 5 days in 2013, 2014, and 2017):

 

http://www.hairrestorationnetwork.com/eve/186690-6000-fue-grafts-3000-dr-de-reys-2013;-1800-dr-de-reys-2014;-1200-dr-reddy-2017-a.html

 

I wonder how different my results would have been had I opted for an FUT. That said, I am happy with my results so far, and am awaiting the results of my third FUE. But I can't help wondering (a) the difference between the two methods and (b) whether I would have had the bottle to have an FUT if FUE was not available. I am not sure about that!

 

 

Interestingly, I asked Dr Reddy about his yield, and he said it was around 85%, although that seemed to decrease with older people (mid-40s).

 

Actually I think the down time factor is a big deal for a lot of guys that is a definite plus of

FUE , my summary of this thread is Dr Feller has just redressed the balance of the FUE hype

no scar, comparable yield etc ,maybe a bit strident but then again he's been up against a pretty formidable on line hype , where FUT is presented as an archaic procedure and FUE

as an ultra modern state of the art replacement .

I remember about 11 -12 years ago looking into hair transplants and that is exactly what I read online same for a lot of guys, I remember thinking great thats what I'll go for.

Unfortunately its the wild west in this industry so I really don't have a problem with a respected Doc coming on here and giving his opinions surely thats better than the deafening silence regarding this matter from most of the other Docs.

Find the other stuff about calling Bluff a bit childish to be honest form both sides , but would of course be nice to hear other Docs give their honest opinions on FUE yield etc.

Just to add this is how FUE has been presented by online media , I'm not saying recommended Docs on here were part of that campaign but they possibly felt the need to go with it to a certain extent for fear of loss of business

[Edsarn2017]

At this point though, of course you're still waiting on your last surgery results but wouldn't it be fair to say that you achieved your goals you had with hair restoration surgery, and that your donor is still cosmetically strong after 6000 grafts?

 

If you had the option of an extra 5-10% growth would you go back and choose FUT? De Reys is also significantly cheaper than any competent FUT surgeon, so you would have spent more if you went FUT.

 

Even with the knowledge of the benefits of FUT, would you want a big strip cut out the back of your head? As we see more and more cases like yours of FUE moving int 6-7-8000 grafts and achieving full coverage the question is whether FUT is NECESSARY for the average patient to achieve good results in the long term.

 

I guess if it would only be a 5-10% difference in outcome, then I would stick with FUE and not change my mind, because the thought having a strip removed and the resultant scar was always a worry.

[HairsGone]

When I first thought about a HT I didn't know much about it and just assumed FUE was the latest method and therefore the best, and there's no way I would want the old fashioned FUT. I did two online consultations with recommended FUE only surgeon's on this site from Turkey and both thought I didn't have enough donor capacity given I was NW6 and with a thinning donor. I was advised to start Finasteride and then to reevaluate my situation in 6-12 months. At that point I think they should have advised me to consider FUT, but I guess they didn't as it wasn't in their interests. Thankfully Mr Ball persuaded me to have FUT and I'm very pleased I did as there's no way I could have received >7000 grafts just from FUE.

 

Now if family and friends ask about my HT they almost always ask why I didn't have FUE and seem surprised I had FUT. I think this is the biggest problem in that laymen don't understand the pro's and con's of each procedure as both have a role in certain patients. I appreciate this thread in helping people being more informed of the type of surgery they choose.

[JayLDD]

When I first thought about a HT I didn't know much about it and just assumed FUE was the latest method and therefore the best, and there's no way I would want the old fashioned FUT. I did two online consultations with recommended FUE only surgeon's on this site from Turkey and both thought I didn't have enough donor capacity given I was NW6 and with a thinning donor. I was advised to start Finasteride and then to reevaluate my situation in 6-12 months. At that point I think they should have advised me to consider FUT, but I guess they didn't as it wasn't in their interests. Thankfully Mr Ball persuaded me to have FUT and I'm very pleased I did as there's no way I could have received >7000 grafts just from FUE.

 

Now if family and friends ask about my HT they almost always ask why I didn't have FUE and seem surprised I had FUT. I think this is the biggest problem in that laymen don't understand the pro's and con's of each procedure as both have a role in certain patients. I appreciate this thread in helping people being more informed of the type of surgery they choose.

 

Will you post a 12 month result for your last surgery?

[HairsGone]

Will you post a 12 month result for your last surgery?

 

Yes in the next 2 weeks

[Spanker]

When I first thought about a HT I didn't know much about it and just assumed FUE was the latest method and therefore the best, and there's no way I would want the old fashioned FUT. I did two online consultations with recommended FUE only surgeon's on this site from Turkey and both thought I didn't have enough donor capacity given I was NW6 and with a thinning donor. I was advised to start Finasteride and then to reevaluate my situation in 6-12 months. At that point I think they should have advised me to consider FUT, but I guess they didn't as it wasn't in their interests. Thankfully Mr Ball persuaded me to have FUT and I'm very pleased I did as there's no way I could have received >7000 grafts just from FUE.

 

Now if family and friends ask about my HT they almost always ask why I didn't have FUE and seem surprised I had FUT. I think this is the biggest problem in that laymen don't understand the pro's and con's of each procedure as both have a role in certain patients. I appreciate this thread in helping people being more informed of the type of surgery they choose.

 

 

Wow. You had a great result and came a long way. Congrats!

[Bill - Seemiller]

Guys,

 

I'm still in the process of reading this mamouth of a thread but I just wanted to point out a few things.

 

It's clear that every time FUE is pinned against FUT/Strip that there is going to be some controversy and dissenting opinions. I truly appreciate Dr. Feller and Dr. Bloxham's willingness to tackle such a sensitive subject however, from what I see, they are approaching FUE in a similar way those who used to overhype FUE in the old days approached strip - which is by pointing out the worst case scenarios.

 

Let me address a few things.

 

1. I know I am not a doctor and in saying that, as educated as I am, I cannot say with any degree of certainty what it feels like to harvest grafts nor am I qualified to look at a prospective patient and tell them which procedure is right for them. What I can do is make suggestions based on obtaining information from the patient and then suggest they consider that particular procedure (whether it be FUT/Strip or FUE)

 

2. I absolutely can't stand that we still reference this as the FUT Vs. FUE debate. Why? Because FUT and FUT are both...wait for it...FUT! The real debate is about two donor excision methods which are FUE and FUSS (follicular unit strip surgery). Both FUE and FUSS use follicular units and thus, they are both technically FUT (follicular unit transplantation). One could argue therefore, that FUSS and FUE are not two distinct procedures, but distinct donor harvesting methods that could be used in an FUT procedure.

 

3. FUE produces scarring. That's all there is to it. It is not scarless. That said, many of the FUE donor scar examples that Dr. Feller and Dr. Bloxham are presenting are some of the "worst of the worst" cases. Back when FUE came out and was starting to be marketed throughout the discussion forums as a "scarless" procedure, those promoting FUE would post the worst of the worst FUSS scars as an (unfair) comparison to FUE which supposedly produced no scarring. Dr. Feller and Dr. Bloxham, you both are excellent physicians and great guys. But I hope you can produce more "regular" examples of FUE scarring rather than some of the worst cases to show what one can most likely expect when they undergo FUE donor excision.

 

4. This entire topic "Why NOT to get an FUE" is very controversial and just by the topic alone, is likely to produce some very emotional responses. For instance, I read through the discussion of Yaz89's results and towards the end, was feeling bad for him. He is happy with his hair transplant and frankly, he should be. Dr. Feller and Dr. Bloxham are right in that we don't know what the scarring looks like in the donor area because it's pretty well concealed by the hair from the fade. I too can see the scarring in the shortest area but it's not anything I would suspect anyone would notice as overly unusual.

 

5. FUE scarring, when optimal is preferred by most patients because even if it is visible, the scarring is spaced out and scattered in a strategic way so it still looks natural. It's similar to how hair transplant surgeons strategically place transplanted hair in the recipient hair so that the result is natural and dense looking even if only 50% of the density has been restored. Now I know one of the keen differences is that the recipient area hair is longer and thus, the feathering affect helps with density and naturalness. But placement of the grafts is exceptionally important just as where extractions are taken is important to keep the appearance of scarring minimal.

 

6. FUE is here to stay. Not only that, but it's continuing to increase in popularity.

 

7. I wish physicians and patients alike would stop comparing the two donor harvesting methods in a way to show which one is better but instead, discuss how they can both be used together to produce the most dense and natural looking result. After all, someone with advanced balding has the greatest chance of restoring the greatest amount of hair by utilizing BOTH FUSS and FUE, not just one versus the other.

 

8. FUT doesn't "suck" as some are saying. I understand that some are posting an emotional response based on the title of this topic but for over 15 to 20 years now, men and women have been getting some of the most natural and dense looking results with FUSS with minimal scarring.

 

9. For some reason, the need to "shave one's head" after hair transplant surgery has become the cornerstone to have FUE. However, most surgeons (and educated patients alike) would advise patients NOT to undergo hair transplant surgery if they intend on simply shaving their head anyway. What's the point? A hair transplant is for the purpose of growing hair. Otherwise, why not just shave your head all the way down to zero clip! Or today, why not get temporary SMP and shave down to a 1 guard/clip. Most patients can still wear their hair pretty short on the sides and back whether they get FUSS or FUE. And yes, it may take longer to see the scarring with FUE the shorter you shave down. So if that's important and appealing to you, then FUE may be something to seriously consider.

 

10. In my opinion and based on what I've seen on our internet forum and in discussing the procedure with various doctors, growth yield with FUE has increased over the last decade as physicians have been working hard to improve the procedure. However, it is still the general belief that FUSS will produce more consistent growth yield overall and on average. FUE is great in some cases, but harvesting follicular units will always be via blind dissection and thus, doctors will have to operate on the "feel" of the donor excision tool rather than by sight via microscopic dissection.

 

11. Dr. Feller and Dr. Bloxham can speak based on their own expertise and surgical experiences. However, they cannot speak for all doctors and what they experience in their surgery room. Yes, there are some universal truths and hindrances that make FUE more challenging in some ways, in particular regarding getting growth yield to be as consistent as strip. However, other surgeons may have experiences that differ from Dr. Feller and Dr. Bloxham where consistency in their hands may be higher. On the other hand, some may see even lower consistency. While I truly appreciate and encourage Dr. Feller and Dr. Bloxham to continue posting their experiences, opinions and facts, I'd like to hear from other leading surgeons who regularly perform FUE such as Dr. Erdogan, Dr. Bisanga, etc. It would be interesting to hear what some other top notch surgeons say and see what they do and don't agree with related to what these two surgeons say.

 

So what's the bottom line? FUSS and FUE are both great and should be used in various circumstances. Sometimes a conjunction and combination of both procedures is the best way of obtaining the most dense and natural looking result.

 

I also ask that patients and physicians alike discuss this topic respectfully with one another. Patients should understand that physicians actually perform the procedure and as a result will have more hands-on experience and knowledge than patients. On the other hands, doctors should understand that many patients are very knowledgeable thanks to internet forums and websites such as ours. Internet forums do have their share of problems, but they should not be downplayed as an excellent resource for information, support and for finding an outstanding surgeon.

 

Best wishes,

 

Bill

[HairDew]

Bill,

 

I agree with all your points. But what gets me the most is the fact that what us "laymen" say "the proof is in the pudding". Although Dr. Feller talks theories that he personally encountered, we "laymen" see the result.

 

To be honest, I see some FUE results from top doctors and they look better than FUT from most reputable clinics, including Dr. Feller's results. Now, I don't want to claim that I've seen all Dr. Feller's results, so I judge them by what was posted by him and his patients on this site. Also please correct me if I'm wrong but does Dr. Feller still perform surgeries? I thought this task is not handled by Dr. Blake.

 

P.S. Bill, did you have a chance to read my PM yet?

[Dr. Alan Feller]

Bill,

 

I agree with all your points. But what gets me the most is the fact that what us "laymen" say "the proof is in the pudding". Although Dr. Feller talks theories that he personally encountered, we "laymen" see the result.

 

To be honest, I see some FUE results from top doctors and they look better than FUT from most reputable clinics, including Dr. Feller's results. Now, I don't want to claim that I've seen all Dr. Feller's results, so I judge them by what was posted by him and his patients on this site. Also please correct me if I'm wrong but does Dr. Feller still perform surgeries? I thought this task is not handled by Dr. Blake.

 

P.S. Bill, did you have a chance to read my PM yet?

 

This was a low blow and uncalled for.

 

Of course I still perform surgery. I never stopped.

 

If you genuinely wanted to know something about me, why not just call or visit my office? Why the need to cast aspersions on an open forum ?

 

Wasn't too long ago you were singing my praises on this very site and had me at the top of your short list. Now my work isn't good enough for you ?

 

Guess I had better sharpen my skills.

 

By the way, it is posts just like this that explain why doctors will not participate on chat forums. Congratulations.

[Bill - Seemiller]

HairDew,

 

Thanks for your input. I just added a point 12 that I meant to add but with everything else I started posting, I forgot. Please read that as well.

 

I'll take a look at your PM, sorry for the delay in getting back to you.

 

Best wishes,

 

Bill

[Bill - Seemiller]

Dr. Feller,

 

I don't think that HairDew's post was overly offensive although I understand that you want to be considered one of the "best of the best" by everyone. But you know what they say about opinions right? They're like a**holes - everybody has one :-).

 

That said, I don't see anything wrong with HairDew asking if you still perform surgeries. The majority of results we've seen recently have been presented by Dr. Bloxham. So the question is legitimate and I appreciate you clarifying that you still perform surgeries.

 

Best wishes,

 

Bill

[HairDew]

This was a low blow and uncalled for.

 

Of course I still perform surgery. I never stopped.

 

If you genuinely wanted to know something about me, why not just call or visit my office? Why the need to cast aspersions on an open forum ?

 

Wasn't too long ago you were singing my praises on this very site and had me at the top of your short list. Now my work isn't good enough for you ?

 

Guess I had better sharpen my skills.

 

By the way, it is posts just like this that explain why doctors will not participate on chat forums. Congratulations.

 

Dr. Feller, I still think you are a great surgeon. But judging by FUE results by top doctors, some of the results at least on "paper" (pictures, videos) look better than your FUT results. Why the hostility?

 

My question about you performing surgeries was put in a form of a question not a statement. This is what I said: " Also please correct me if I'm wrong but does Dr. Feller still perform surgeries?"

 

Please notice the key phrase please correct me if I'm wrong. Doesn't that look like a question to you?

[Dr. Alan Feller]

"Please correct me if I'm wrong but does HairDew get paid by an FUE clinic to disparage FUT doctors in public forums ?"

 

Get my point ?

[HairDew]

You absolutely CAN and probably SHOULD ask me that question and I will not get offended. My reply would be: I appreciate your question Dr. Feller, the answer is NO, I do not work for nor represent ANY FUE or FUT clinic.

 

Get my point?

[Dr. Alan Feller]

That's because my question was not an offensive question and, by your own admission, a valid one.

 

Your question about me, however, was offensive.

 

You designed it to cast an aspersion on me. No other reason. You couldn't care less if I'm performing surgery or not. After all, you said you wouldn't come to me. So why should you care ? You don't.

 

You wrote a statement in the form of a question to get away with malice. Nothing more.

 

This is why doctors will not come onto chat forums and interact. I know this for a fact because I speak with them behind the scenes. And who loses ? Everyone.

[HairDew]

Dr. Feller, you are displaying thin skin, it's disappointing. What motives do I have to "disparage" you in particular? Do I agree that you are a good HT practitioner? Of course. Do I think you are right? No.

 

I can easily reverse the question and say, why would an FUE doctors I have talked to do not come here to debate you? Because your aggressive and opinionated rhetoric makes them not to want the debate.

 

Who loses? Everyone.

[Dr. Lupanzula Emorane]

I can appreciate that there are opinions about FUE and FUT that vary and the discussions have been quite passionate. I have performed both procedures for over ten years so I understand both sides of the argument quite well. However, the main argument against FUE here and elsewhere, as presented by Dr. Feller, is that there are three detrimental forces that act on the follicle during an FUE procedure that prevent said follicle from growing as well as a follicle harvested with the FUT technique.

 

These forces are:

 

Torsion

Compression

Traction

 

Dr. Feller is 100% correct that these forces exist during every FUE procedure, on every follicle. I think that it is only common sense that such forces will exist on a follicle during an FUE procedure. However, I do not agree that these forces cannot be overcome nor should they automatically be expected to lead to a subpar result when compared to an equal size strip surgery.

 

Torsion - This is the reference to how follicular units are subject to the torsional forces of rotation as the punch presses through the skin in order to free the follicular unit from the scalp. I believe that this is a problem mainly with the continuous rotation FUE tools on the market. With an oscillating rotation driven by the thumb and forefinger, torsion is not an issue if the rotational distance traveled is short and performed with an experienced hand. Torsion still exists, but it is greatly reduced in it’s severity thus having an equally reduced degree of trauma.

 

Compression - This is in reference to forceps and how they are used to pull the follicular unit from the scored tissue. As I see it, you either understand how to handle a graft or you do not. Compression is a very real problem and technicians, and even doctors, will routinely squeeze the graft far too hard, and too far down the length of the follicle, to allow for consistent and healthy growth. This occurs not only with extraction but it is a problem with recipient site placement as well, for both FUE and FUT respectively. When I extract each graft after I score, I use reverse traction by holding the top of the graft at the very upper edge of the tissue thereby avoiding most of the follicle. This is safe to do because we all know that the follicle, even slightly below the epidermis can be safely cut through and regrow without permanent damage, as is seen in trichophytic closures in strip surgery that have been performed for the past decade.

 

Traction - This has perhaps the highest chance of causing real damage to the follicular unit but with practice and experience it is not an issue of debilitating circumstance. The bulbs are usually intact as long as the arrector pili muscles have been cleanly severed (best with a very sharp punch) and they come out fairly easily. This is of course not always the case but a proper surgeon will take their time at the beginning of the procedure to properly assess the patient, their grafts, the supporting tissue, and how it all works together. In most cases, the patient is a candidate with very few limiting factors.

 

Skeletonization is one stated side effect of traction but I believe that this is no different than the skelontization that occurs from subdividing follicular units (turning multi-hair grafts into singles and doubles) during strip surgery. It is well known in the community that this is routine procedure for some strip clinics, and the pros and cons of such procedures have been debated before, in forums and in the ISHRS.

 

As with anything in medicine, practice makes perfect. I believe that no man is an island and that when working together with like minded practitioners, the problems we cannot overcome alone, can be overcome together. This is why in my early career I spent a lot of time working with and observing many other doctors to learn their techniques so that I could incorporate the best of their techniques into my own, along with my own modifications of course. I still make sure to attend every ISHRS annual meeting where improvements and ideas are shared and learned, and now the World FUE Institute (WFI) meetings where we are constantly sharing and pushing to improve not only our tools but our techniques in surgical workshop settings. Our next meeting is this month in Athens, Greece.

 

In the end, good FUE is performed by good hands that understand the challenges inherent to FUE but have worked with peers and colleagues to figure out that these challenges cannot be overcome with brute force, but rather a combination of approaches and ideas to coax each follicle out in the safest manner possible. This is an evolution representative of our current time in history, in that practitioners are no longer toiling away in secret, with the blinds pulled down over their windows, to find the perfect solution, but instead are now collaborating with like minded professionals and industry leaders in the interest of advancing the field as a whole. That is why the WFI was formed and it represents the philosophy that I and the other founding members have shared for several years. We share with each other and we learn from each other.

 

In my practice, I very rarely perform strip surgery as it is no longer indicated for the majority of my patients and, quite frankly, no one wants it. The procedure is scary for patients, of course, but no one wants the linear scar, regardless of how fine it may be because they know that this cannot be guaranteed. I score and extract each and every graft myself as I believe it is my responsibility to my patient. My technicians place into recipient sites I create and they examine and refine all of my grafts under microscopes, as it should be, before they are put into a solution of Hypothermosol. I do not take shortcuts and I have taken the time to learn my craft well. For this I believe my results are just as good as any comparable size strip surgery and I believe I have the track record to support this opinion. Again, I understand and agree with Dr. Feller that these three forces he lists do exist, indeed, but I do not agree that these forces automatically spell disaster of any degree for one’s final result. Thank you.

[HairDew]

I can appreciate that there are opinions about FUE and FUT that vary and the discussions have been quite passionate. I have performed both procedures for over ten years so I understand both sides of the argument quite well. However, the main argument against FUE here and elsewhere, as presented by Dr. Feller, is that there are three detrimental forces that act on the follicle during an FUE procedure that prevent said follicle from growing as well as a follicle harvested with the FUT technique.

 

These forces are:

 

Torsion

Compression

Traction

 

Dr. Feller is 100% correct that these forces exist during every FUE procedure, on every follicle. I think that it is only common sense that such forces will exist on a follicle during an FUE procedure. However, I do not agree that these forces cannot be overcome nor should they automatically be expected to lead to a subpar result when compared to an equal size strip surgery.

 

Torsion - This is the reference to how follicular units are subject to the torsional forces of rotation as the punch presses through the skin in order to free the follicular unit from the scalp. I believe that this is a problem mainly with the continuous rotation FUE tools on the market. With an oscillating rotation driven by the thumb and forefinger, torsion is not an issue if the rotational distance traveled is short and performed with an experienced hand. Torsion still exists, but it is greatly reduced in it’s severity thus having an equally reduced degree of trauma.

 

Compression - This is in reference to forceps and how they are used to pull the follicular unit from the scored tissue. As I see it, you either understand how to handle a graft or you do not. Compression is a very real problem and technicians, and even doctors, will routinely squeeze the graft far too hard, and too far down the length of the follicle, to allow for consistent and healthy growth. This occurs not only with extraction but it is a problem with recipient site placement as well, for both FUE and FUT respectively. When I extract each graft after I score, I use reverse traction by holding the top of the graft at the very upper edge of the tissue thereby avoiding most of the follicle. This is safe to do because we all know that the follicle, even slightly below the epidermis can be safely cut through and regrow without permanent damage, as is seen in trichophytic closures in strip surgery that have been performed for the past decade.

 

Traction - This has perhaps the highest chance of causing real damage to the follicular unit but with practice and experience it is not an issue of debilitating circumstance. The bulbs are usually intact as long as the arrector pili muscles have been cleanly severed (best with a very sharp punch) and they come out fairly easily. This is of course not always the case but a proper surgeon will take their time at the beginning of the procedure to properly assess the patient, their grafts, the supporting tissue, and how it all works together. In most cases, the patient is a candidate with very few limiting factors.

 

Skeletonization is one stated side effect of traction but I believe that this is no different than the skelontization that occurs from subdividing follicular units (turning multi-hair grafts into singles and doubles) during strip surgery. It is well known in the community that this is routine procedure for some strip clinics, and the pros and cons of such procedures have been debated before, in forums and in the ISHRS.

 

As with anything in medicine, practice makes perfect. I believe that no man is an island and that when working together with like minded practitioners, the problems we cannot overcome alone, can be overcome together. This is why in my early career I spent a lot of time working with and observing many other doctors to learn their techniques so that I could incorporate the best of their techniques into my own, along with my own modifications of course. I still make sure to attend every ISHRS annual meeting where improvements and ideas are shared and learned, and now the World FUE Institute (WFI) meetings where we are constantly sharing and pushing to improve not only our tools but our techniques in surgical workshop settings. Our next meeting is this month in Athens, Greece.

 

In the end, good FUE is performed by good hands that understand the challenges inherent to FUE but have worked with peers and colleagues to figure out that these challenges cannot be overcome with brute force, but rather a combination of approaches and ideas to coax each follicle out in the safest manner possible. This is an evolution representative of our current time in history, in that practitioners are no longer toiling away in secret, with the blinds pulled down over their windows, to find the perfect solution, but instead are now collaborating with like minded professionals and industry leaders in the interest of advancing the field as a whole. That is why the WFI was formed and it represents the philosophy that I and the other founding members have shared for several years. We share with each other and we learn from each other.

 

In my practice, I very rarely perform strip surgery as it is no longer indicated for the majority of my patients and, quite frankly, no one wants it. The procedure is scary for patients, of course, but no one wants the linear scar, regardless of how fine it may be because they know that this cannot be guaranteed. I score and extract each and every graft myself as I believe it is my responsibility to my patient. My technicians place into recipient sites I create and they examine and refine all of my grafts under microscopes, as it should be, before they are put into a solution of Hypothermosol. I do not take shortcuts and I have taken the time to learn my craft well. For this I believe my results are just as good as any comparable size strip surgery and I believe I have the track record to support this opinion. Again, I understand and agree with Dr. Feller that these three forces he lists do exist, indeed, but I do not agree that these forces automatically spell disaster of any degree for one’s final result. Thank you.

 

 

 

Finally, grabbing popcorn.