N/T
» yourself. Do you ever here from strip docs “Top ones” tell you they can
» transect grafts when doing the strip? Well it can happen. Just go for a
» consult in person demand to see patients not technique that will tell you
» all you need to know from any doc you chose. Good luck
Thanks for the thoughts. I have been to a few consultations but they always bring their poster boys with them not their patient who are suing them;-)
I here you Marco. If I can offer some advise. Pick a doc you are interested in. And try to make some contacts online in a low key manner. That is what I did and you would be suprised that a lot were willing to share there experience with you through e-mails photos and phone calls too. Some if they are in your part of town will even meet up. Not a doctors rep or anyone working for a clinic. Just regular guy’s looking to talk ht’s with you. As long as this field is not regulated it’s business first.
Doc once again. And with no disrespect. I have a problem with the graft for grat comparison. Yes we went through the doc angle before . I was the one that brought that up. But no one doctor or anyone else when making these blanket statements clarify’s this. I am not talking meggasessions. Or any of that. I am talking if a person was to get Fue(from top doc) and a person got strip (top doc). Remember same balding areas and number of grafts used.2000 example. That the strip will 100% yield better all the time? (For the record I am not a true beliver of meggasessions as of yet 3000-plus in a day just because I have not seen enough long term results.) That is why for now I am using the 2000 grafts for the example. Not concerned either about how long the procedure took. Can you tell me where I could have gotten a better result with strip in 2003 to rival my results? Thanks
Franklin, I think you and I are on the same page. You absolutely could not have gotten better FUE surgery in 2002-2003 than Dr. Woods for the amount of work you needed. Without question that is true. I would say Dr. Woods only lost his lead in late 2004 when FUE cases of 400 or so were becoming routine.
The irony here is that I happen to agree with Dr. Woods that FUE surgery really should not exceed about 500 grafts per sitting. Dr. Campbell actually told me that herself at a meeting in NYC when I was starting my own “self imposed residency” in FUE years ago. I subsequently found out on my own that 500 was indeed the max I could do before getting tired, so it confirmed Dr. Woods public position and Dr. Campbell’s friendly advice she gave in private. That’s why I’m so confident and vocal about that being about the max FUE that should be done in a sitting.
As the number of grafts taken via FUE increases, the percentage of grafts actually growing decreases. That is readily evident through the photos posted on the internet over the years. And it doesn’t matter if the surgery is spread out over several days. The best grafts are going to be taken on that first day. As the days wear on, the premium pickings get less and less. That’s why you will see so many large FUE cases invading and even crossing the fringes of what we would call “acceptable” donor area.
COMPARISON BETWEEN TOP FUE DOC AND TOP STRIP DOC:
If all things are equal. Top FUE doc vs. Top Strip doc in a 2,000 graft procedure. Yes, most of the time the strip procedure will look better because of a better yield and fewer injured grafts. Just compare the results of each from any patient who has posted results on the web.
All patients should be informed as to the extra risk of lower yields due to the 3 detrimental FUE forces: 1. Torsion 2. Traction 3. Compression.
STRIP TRANSECTION VS. FUE TRANSECTION:
One is visible, the other is not.
There is no question that strip grafts undergo far fewer destructive forces than FUE grafts. The number of grafts actually transected during STRIP removal is negligible in even mediocre hands because the pressure wave in front of the scalpel pushes them away. Besides this, unlike FUE surgery, transected grafts in strip surgery are VISIBLE as obviously cut follicles, and therefore not transplanted. Such is NOT the case for FUE where a graft can be FUNCTIONALLY transected, but not actually cut in half, and therefore wrongly planted.
DIFFERENCE B/W LARGE AND SMALL FUE CASES:
The smaller the FUE case, the less difference a lower yield will make. If you implant 500 FUE grafts and there is a 20% loss due to FUE trauma forces, then the final result won’t look that bad as 400 growing grafts out of 500 will still produce a beneficial cosmetic change that may elicit a “wow” response. BUT, if 20% of 2,000 FUE grafts don’t grow, you are looking at a loss of 400 grafts, and that IS significant. Having only 1,600 out of 2,000 grafts grow is a deficiency the eye will definitely catch. No question about it.
For some people, that is an acceptable trade off. But that should only be for people who have been INFORMED that the chances for lower yields are greater with FUE than STRIP and why: 1. Torsion 2. Traction 3. Compression
» John,
» Thank you for posting that video. Now we have something substantive to
» talk about.
»
» Did you see how the doctor stabbed the skin and twisted vigorously? THAT
» is problem number one with FUE. That twisting may functionally transect the
» graft even if the graft LOOKS intact afterward. The more the graft is
» twisted back and forth, the more damage is done. I believe this is the
» number one reason for poorer FUE yields compared to strip where no such
» force is encountered.
»
» The second area is where the graft is pulled out of the skin with
» forcepts. In this particular patient the grafts came out without much
» difficulty and that DOES happen in a number of lucky patients. But MOST
» patients are not that lucky.
»
» In most patients the amount of traction is much higher than in this video.
» You will not see an edited video demonstrating this. The problem is that in
» some patients, if the doctor cuts too low with the punch it will cut the
» graft. So to insure that happens he cuts a bit more shallow. When that
» happens, however, it’s harder to remove the graft from the skin because
» there is still too much lower skin anchoring it. To overcome this problem
» the doctor has to pull HARDER with the forcepts and SQUEEZE harder to keep
» a grip.
»
» Those are the three forces that I believe have limited FUE with comparison
» to strip:
» 1. Torsion
» 2. Traction
» 3. Compression.
»
» This is a UNIVERSAL fact of all FUE to date. Notice that NO FUE doctor has
» come on here to SPECIFICALLY refute this truth. They know that if they did,
» they would not be offering “informed consent” and would therefore be
» breaking the law and opening themselves up to lawsuits.
»
» Forget about the rest of the noise, those 3 forces are all that count.
Oh my goodness, Dr. Feller! I can see now why you are convinced that FUE cannot produce results. What are you doing to those poor grafts!?! If you would at least try a little bit to overcome some minor difficulties, you will see that these things are really non issues with proper technique.
Twisting motion is minimized if not non existent with better instrumentation and taut scalp, rather than lax.
With proper incision technique, you will not require pulling with any kind of considerable force at all to extract the graft. They come right out easily. If they do not, then try a little deeper incision.
So, you feel like you can’t cut any deeper for fear of transecting the graft? Why? What is your transection rate? Calculate it with every graft you punch and document it. Try a modification. Compare your calculations. Did it work? It takes practice, time, acquired skill and the ability to look at yourself and decide that you can do better without getting upset and giving up on the whole process.
And, I have to say that I positively cringed when I watched your video and saw you put that poor graft you extracted on an absorbant paper towel. Grafts CANNOT dry out or they will die! It is a basic fact of cellular function. You sucked the life out of the very cells that are needed to grow that graft in the recipient area.
With strip grafts, they have more tissue around the follicular cells to protect them. When you are dealing with FUE grafts, they are much more delicate and should be handled differently.
I’m sorry. Dr. Mwamba may be disappointed that I am being so blunt and so boldly confronting a doctor, but I just can’t let you stay ignorant about why your results are lacking. After reading Franklin’s story, how can I stay silent when the answers are obvious to me?
Perhaps this is exactally why FUE doctors are hesitant to video tape their procedure. With a video, any one can try to reproduce the technique, but without knowing the intricate details you can really do some damage to the patient, or at the very least waste their money and blame it on “the failure of FUE” rather than yourself.
torsion traction and compression
torsion traction and compression
torsion traction and compression
torsion traction and compression
torsion traction and compression
torsion traction and compression
Is this an infomercial? Why would anyone want to buy your instruments if you designed it without even knowing the basics of how FUE works and how to handle grafts?
» For now the “sound barriers” of FUE are the three destructive FUE forces-
» no matter what level of personal skill has been attained. The problem goes
» beyond what a human can do, even with an ideal “perfect” punch tool.
» Revolutionary new tools must be designed and developed to move forward. I
» absolutely believe the obstacles will be smashed, but it hasn’t been done
» yet. Maybe next year?
Its not about your tool you are selling. It’s about a mindset that prevents you from moving forward with your skill. No human can solve these problems? How dramatic. The solutions are SO easy. And free. Its called effort and hard work. The reward is skill and pride in your accomplishments.
For the innocent guys just trying to reasearch hair transplant, let me explain. His target market is newer HT/FUE surgeons who are struggling to gain the skills they need and want an easy way out. How better to attract attention to himself than to deliberately start fights with others? Bad press is good press, he probably says to himself. Its people like him that help give the rest of the industry a bad name. You should have gotten a degree in sales instead of a medical degree.
Aqueous,
Why so hostile? As you are not a doctor and don’t perform FUE yourself, you would do better to read and learn than make sophomoric attacks on me.
The towel the graft was put on in my video was soaked in saline solution. If you didn’t know that, then you really have a lot to learn.
I agree that most docs who can’t do FUE is because of self limitation. If you check my online book on FUE I published on my website years ago you will find that I dedicated a section to physician “mind set”. I encountered “the mental barrier” to FUE long ago and overcame it, just as all competent FUE docs had to. I’m not exactly an amateur in the field as you seem to think.
If your doctor is using standard instruments, then his FUE grafts are suffering from all three FUE forces. Period. Non-debatable issue.
I don’t SELL my instruments. I give them away. Never sold them. Not interested in selling them.
If you think grafts aren’t affected by Torsion, Traction, and Compression in your clinic by virtue of experience, then you really have no idea what you’re talking about. If your doctor uses standard punch tools, the graft DOES get twisted within the punch and often injured. This is more pronounced in some patients, less pronounced in others, but it happens to ALL FUE grafts. Your clinic included, unless you claim to be using different tools that minimize or eliminate these detrimental forces. This would have to mean that you don’t use a punch and don’t use forcepts…and I highly doubt that.
You are a front man for an FUE outfit. Naturally you attack anything that might take the glow off the rose. But if you are telling us all here, in public, that you are not informing patients of the increased trauma and lower yields of FUE compared to STRIP, then you are not providing INFORMED CONSENT to your patients. And you are not providing important information for readers of this board.
» Aqueous,
» Why so hostile? As you are not a doctor and don’t perform FUE yourself,
» you would do better to read and learn than make sophomoric attacks on me.
»
» The towel the graft was put on in my video was soaked in saline solution.
» If you didn’t know that, then you really have a lot to learn.
»
» I agree that most docs who can’t do FUE is because of self limitation. If
» you check my online book on FUE I published on my website years ago you
» will find that I dedicated a section to physician “mind set”. I encountered
» “the mental barrier” to FUE long ago and overcame it, just as all
» competent FUE docs had to. I’m not exactly an amateur in the field as you
» seem to think.
»
» If your doctor is using standard instruments, then his FUE grafts are
» suffering from all three FUE forces. Period. Non-debatable issue.
»
» I don’t SELL my instruments. I give them away. Never sold them. Not
» interested in selling them.
»
» If you think grafts aren’t affected by Torsion, Traction, and Compression
» in your clinic by virtue of experience, then you really have no idea what
» you’re talking about. If your doctor uses standard punch tools, the graft
» DOES get twisted within the punch and often injured. This is more
» pronounced in some patients, less pronounced in others, but it happens to
» ALL FUE grafts. Your clinic included, unless you claim to be using
» different tools that minimize or eliminate these detrimental forces. This
» would have to mean that you don’t use a punch and don’t use forcepts…and I
» highly doubt that.
»
» You are a front man for an FUE outfit. Naturally you attack anything that
» might take the glow off the rose. But if you are telling us all here, in
» public, that you are not informing patients of the increased trauma and
» lower yields of FUE compared to STRIP, then you are not providing INFORMED
» CONSENT to your patients. And you are not providing important information
» for readers of this board.
Why am I hostile? I am extremely concerned over your misinterpretation and lack of understanding of FUE that you are trying to perpetuate. But, I will ignore my emotion to respond based on fact.
Your towel was soaked in saline? I guess that is something that is not known just by watching a video - a crucial detail that can greatly affect a patient’s results. Thanks for demonstrating why FUE doctors are hesitant to video tape their procedure. With a video, any one can try to reproduce the technique, but without knowing the intricate details you can really do some damage to the patient.
We offer BOTH strip and FIT at our clinic. We inform our patients of the pros and cons of their options and allow them to decide what they want. So much for your theory about me being an “FUE front man”.
We use customized FIT instrumentation with techniques that very nearly eliminate torsion, traction, and compression. How can I make such claims? Because we have amassed objective data for years that demonstrate these facts.
For example, our transection rate today was under 1% over the course of over 1400 FIT extractions.
As another example, we offer test sessions for patients that are concerned about growth, either because they have scarring in the recipient, or very limited donor areas, or are just plain nervous because of the misinformation they read on the internet. During these test sessions, we have a specific area in which we graft a specific number of grafts and hairs. After allowing the grafts to grow in, we assess the result. Our FIT growth rates are well above 90% consistently.
You make great points AqueousSoln. Thank you for speaking up. Too bad you’re dealing with a brick wall…
To everyone on the forum, I do appologise.
The subject matter for many probably distracted them from noticing, and of course, one just hits the post reply button automatically.
I spelt it as HYPOCRICY
The correct spelling is HYPOCRISY, according to the Shorter Oxford.
Dr Ray Woods
» » To all doctors performing FUE, with total commitment and hard work. I
» » wish you all great success and great results
» »
» » Dr Ray Woods
»
»
» O.K but with all the secrecy and lack of sharing whether necessary or not,
» we as punters want to know whether FUE in the best hands is a replacement
» for strip under all circumstances; whether FUE can achieve the 5000-7000
» aka top strip docs or whether in all hands FUE has its limitations vs
» strip. You may have to be secretive but you should at least be capable of
» stating your opinion on these issues.
In most patients, a single strip can give 3500 to 5000 FU grafts (depending on density of follicular units and laxity of scalp).
In most patients, 3000 grafts can be extracted from the scalp donor area (and the patient can still shave/buzzcut hair). In most patients, 5000 grafts can be extracted by FUSE, and they can buzz their hair to #1.
In many patients, >5000 FU grafts can be extracted, and the patient can still buzz cut to a #2.
Regards,
Dr.A
» » » To all doctors performing FUE, with total commitment and hard work. I
» » » wish you all great success and great results
» » »
» » » Dr Ray Woods
» »
» »
» » O.K but with all the secrecy and lack of sharing whether necessary or
» not,
» » we as punters want to know whether FUE in the best hands is a
» replacement
» » for strip under all circumstances; whether FUE can achieve the
» 5000-7000
» » aka top strip docs or whether in all hands FUE has its limitations vs
» » strip. You may have to be secretive but you should at least be capable
» of
» » stating your opinion on these issues.
»
» In most patients, a single strip can give 3500 to 5000 FU grafts
» (depending on density of follicular units and laxity of scalp).
»
» In most patients, 3000 grafts can be extracted from the scalp donor area
» (and the patient can still shave/buzzcut hair). In most patients, 5000
» grafts can be extracted by FUSE, and they can buzz their hair to #1.
» In many patients, >5000 FU grafts can be extracted, and the patient can
» still buzz cut to a #2.
»
» Regards,
» Dr.A
Thank you for your clear statement. Much apreciated!
Aqueous,
Cool down my friend. Let’s do as you said and take the emotional out of it. Let’s get back on track.
I do not know your doctor, but by the use of the term FIT, I assume the custom tools you are referring to is Dr. Cole’s patented punch holder. IF that is what you are referring to, then it should be made clear to you and the viewers that this device was only designed and used to limit the depth of the punch. It does nothing as far as minimizing:
- Torsion
- Traction
- Compression
If you are using customized punches, as I do, I’ve never seen any mention of it by you. What do you use? I would be happy to send your doc a few Feller Punches if he would send me a few of his. You are welcome to critique it and describe it online. Even videotape it. As for your technology, I could critique it publicly or give you private feedback. If it is proprietary, I’d be happy to sign a non-disclosure.
Innovative FUE doctors need to start working together, not against each other. There is plenty of business out there for everyone, and the more transparent we all are, the faster and stronger the FUE industry will grow.
It is very good that your clinic offers BOTH strip and FUE. By virtue of that fact alone I would think that you are much more open in describing the pros and cons of each procedure.
It is the “FUE only” clinics that I suspect are less than forthright in their disclosure of the differences between Strip and FUE. I applaud you and your doctor for doing BOTH as I know it is not easy to perform both regularly.
I have to take issue with your claim of 90% success rate though. Perhaps a little hyperbole? While there are definitely some patients that approach and exceed that number, it isn’t many. Your claim that it is so on all patients doesn’t jibe with your claim that you do “test cases”. Why do test cases if you are consistently getting 90% or higher FUE success rates? It would seem superfluous.
I will only allow an FUE surgery to dip down to a 70% success ration before I call off the surgery. It is rare indeed that you can get a 90% success ration, ESPECIALLY in a big case. You must be using different tools indeed!
Perhaps I’m not being clear though. When I talk about a “success rate” I mean the ratio of FUE attempts to successful extractions. If it takes 1000 attempts to successfully extract 600 grafts, then FUE is clearly not the best procedure for that patient…even if every one of those 600 grafts ultimately grows.
I just looked on your site and saw an FIT patient in your photo gallery. Personally, I think the results are marvelous. But I still think the result pales in comparison to strip graft procedures of the same number that have been posted. I thinking anyone making such a comparison would agree.
Your doctor should be very proud of that result as long as the patient knew well before hand that an FUE result may not be as good as an equal number of strip grafts. I would personally be very happy to showcase an FUE result like that on my website so don’t take it as a negative criticism. What makes that result even more outstanding is the significant cosmetic difference the patient enjoys even though he has fine hair. That’s a real challenge for an FUE doc, and your doc has clearly risen to the occasion.
Again, the fact that your doctor does both strip and FUE proficiently you are excluded from much of the criticism I have been offering the “FUE only” clinics on this thread.
I believe, however, that you and your doctor will agree that there is room for improvement in this field, even for the most proficient doctors. Let’s remain in touch and share information and tips. Who knows, maybe your doctor and I can come up with the next generation of instruments and protocols.
Contact me if your doc would like to trade instruments and tips and let’s see if we can take this field to the next level.
Dr. Feller,
I am very impressed that you have the passion to open up the debate and ask other surgeons to defend their claims. Claims are easily made as are counter claims but… you have injected the reasoning and logic behind your concerns and that demands that those with other views can counter these issues. I hope that those practising exclusive FUE/FUSE/FIT/Umar technique/SAFE/whatever are correct and we can all live happily ever after but they need to address the issues that you raise or it would not be safe to go with these techniques and assume equivalence with strip in terms of outcome.
how do you docs have time to spend so much time on the board arguing
» how do you docs have time to spend so much time on the board arguing
Sometime come on here to argue. Some come on only as a marketing tool. Some do a little of both. But some come on here to learn and educate. That’s my primary motivation-besides, I love to debate.
It doesn’t take that much time to write up a viewpoint and post it. It is every doctors obligation to educate the public and defend his positions. It keeps us sharp and makes us accountable. It pushes us to excel.
There are always natural 5 minute breaks during the work day where there are a few minutes to read and write a post.
» Dr. Feller,
»
» I am very impressed that you have the passion to open up the debate and
» ask other surgeons to defend their claims. Claims are easily made as are
» counter claims but… you have injected the reasoning and logic behind
» your concerns and that demands that those with other views can counter
» these issues. I hope that those practising exclusive FUE/FUSE/FIT/Umar
» technique/SAFE/whatever are correct and we can all live happily ever after
» but they need to address the issues that you raise or it would not be safe
» to go with these techniques and assume equivalence with strip in terms of
» outcome.
Thanks Macro, I find your questions to be well thought out and probative as well. Put our (the doctors) feet to the fire whenever you can. That’s what cleaned up this dirty industry in the first place, and it will continue to force us to improve.
Posters like you, using sites like this one, have done more to improve this industry than any government law or regulation could have ever done. Please keep posting.
Dr. Feller
» There are always natural 5 minute breaks during the work day where there
» are a few minutes to read and write a post.
agreed. I have a busy schedule too but enjoy this board. BTW, If I leave the board angry or frustrated I might might be distracted, make a poor analysis in my work or upset someone. You might stab someone in the head with a sharp needle so be careful:-)
Actually by that analysis, Ray woods would be in danger of massacring an entire nation when he leaves the board sometimes (Dr. woods, this just an amusing thought. I am not accusing you of genocide, honest)