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  1. #21
    IAHRS Recommended Hair Transplant Surgeon Dr. Feller's Avatar
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    Spencer,
    You wrote:

    "asserting opinions is important for obvious reasons, asserting them in a doctrinaire or dogmatic manner usually creates a less than comfortable environment".

    To your mind, what is a "doctrinaire or dogmatic manner", and how does that concern apply to this topic and discussion?


    Incredibly, you also wrote the following:

    "In my view, until it’s proven that the the Neograft machine damages grafts, terms like “detrimental forces”, “torsion” and “desiccation”, are simply words used to make a theoretical point"

    Those key terms are not merely "words" at all. Anyone who has successfully practiced FUE can attest to that. But here is a quick layman example that makes the point:

    Lick your lips and whitsle. When you can no longer whistle, feel how dry your lips are. They are dry because that thin stream of air you subjected your lips to dried them out. Grafts are much smaller and don't possess the kind of moisture protection your lips do, so if you had simply blown that stream of air over a graft, that graft would be dessicated. Even a weak suction device will produce a continuous stream of air far greater than your whitle. This isn't theoretical at all.

    All FUE techniques deal with these same challenges, and NONE are perfect. I have my own instruments and protocols for FUE and I'll be the FIRST to admit, as I often do, that my attempt to success ratio can be as low as 70% depending on patient physiology. This is the honest reality of FUE and I have yet to read of any physician who would dispute this.

    To move forward we need to identify what it is about the FUE procedure that's holding it back- only then can we come up with VIABLE and practical solutions.

    Torsion, Traction, Compression, Dessication are only a few of the very real limitations of FUE surgery, and such forces MUST be addressed directly by each and every new innovation. These forces are no more "theoretical" as they apply to FUE as gravity and drag are theoretical to aerodynamics. Indeed, they are AXIOMATIC.

    Please remember Spencer, it wasn't I who challenged the neograft tool at the start of this thread by making reference to the three detrimental FUE forces. I didn't even know the device existed until sunday night. You promoted your upcoming show with Dr. Bauman yourself by specificially claiming that the new tool's ability to counter the detrimental forces would be addressed by Dr. Bauman.

    Dr. Feller

  2. #22
    Administrator SpencerKobren's Avatar
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    Thanks for stating your opinion Dr. Feller. Again your insight and your passion for the profession is what makes your online participation so invaluable.

    My question at that start of this thread was:
    Will the NeoGraft device help to eliminate these possible detrimental graft destroying forces and allow more hair transplant surgeons to offer FUE to patients who qualify for the procedure?

    Itís simply a question. At this point until I see more results this entire thread is simply a vehicle to share our thoughts and ask questions about the Neograft machine. Iím hoping we can continue this dialogue without pointing fingers or eluding to the unethical marketing of FUE by well respected members of the field.

    Thatís it, no big deal. Weíre just having a friendly discussion, and I think itís fair to state that it should be conducted with professionalism and courtesy. I know this is a foreign concept to our online world, but I think itís time the we begin setting some higher standards for the profession.
    Spencer Kobren
    Founder, American Hair Loss Association
    Host, The Bald Truth Radio Show

    I am not a physician. My opinions and knowledge concerning hair loss and its treatment are based on extensive research and reporting on the subject as a consumer advocate and hair loss educator. My views and comments on the subject should not be taken as medical advice. Always seek the advice of a medical professional when considering medical and surgical treatment.

  3. #23
    Senior Member gillenator's Avatar
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    Cool

    bspot, I don't know how I missed this before, but I just noticed something classy at your signature. You're a Cubs fan!

    Now, back to the issue. Not that I am any expert on FUE instrumentation, nor a licensed physician, but in the past 29 years, I have seen alot of these come and go. Several years or more ago, there was a big hype about the FUE implanter, remember? Where is it now? Where are the published findings? In the New England Journal Of Medicine? No. In the education arm of the ISHRS? No. Any other society or affiliation, association, not to my knowledge. It's just my opinion but this has that sort of laser comb smell to it.

    And some of you have brought up some of the valid points that Dr. Feller mentioned in another thread and noted below. Yet if you consider the dynamics of torsion, traction, and compression in the extraction process, are they not ultimately controlled by the tooling as well as the surgeon's feel? What is going to replace the feel in the extraction process? What about dermal depth analysis? Oh, I know someone is going to say, "that's what this new machine is supposed to do".

    It's just very difficult for me to imagine that a machine, albeit "cutting edge" technology can make all of the adjustments on every FU targeted for extraction concurrently. And then with the same extraction size for every FU regardless of size. Same size for a single hair FU as a five hair FU extraction? Really? What about extracting MUGs? One size fits all? Really?

    I have a hard time believing that any prudent FUE surgeon who also is considering the lowest degree of invasiveness "per patient" is not going to utitlize a combination of punches and extraction tools. How does the FUE surgeon balance out the level of invasiveness (post-op scarring) with transection? Or is the issue going to be pursued and confined to "speed and efficiency" of the extraction process? Give me a break.

    Who's ever publishing transection rates or let's be positive about this, FUE YIELDS regardless of the methodology? NO ONE, extraction equipment or not. And before anyone speaks up to dare challenge what I am saying, be ready to present your verifiable and substantiated clinical findings.

    Don't get me wrong, I am all for scientific research and technological advancements in this field of surgical hair restoration, and yes there are some docs who always seem to jump on the bandwagon and really push these new devices. Is it really to advance the field or advance one's bank account? And really, I mean no offense to anyone in particular. But ultimately, who is really benefitting from speed and reduced OR staffs? The patient? Really? Really? Or could it just by chance be the clinic or the ones who hold the patent? And why most of the dialogue in the economics and proficiencies of the procedure? What happened to yield?! Every HT patient cares about yield right?

    What happened? Did I miss something? What happened to the patient?
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    NOTE: I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice nor are they the opinions of the following endorsing physicians: Dr. Glenn Charles, Dr. Jerry Cooley, Dr. James Harris, Dr. Bob True & Dr. Bob Dorin

  4. #24
    IAHRS Recommended Hair Transplant Surgeon Dr. Feller's Avatar
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    Gil,
    In the end, as you've already eloquently noted, it's all about RESULTS.

    The device is described as making extraction FASTER, but not a word was said about extracting grafts SAFER.

    I do not see where this mega-machine improves graft safty by lowering graft trauma. In fact, I see the opposite with respect to that spinning punch and the gauntlet of suction tubing the graft must travel through.

    This is why I am so adament about articulating and describing the forces working against us: Torsion, Traction, Compression. Any proposed FUE advance must address either one or ALL of these forces to be of any use.

  5. #25
    Administrator SpencerKobren's Avatar
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    We’ll be continuing the NeoGraft discussion tonight on the live broadcast. If you don't subscribe to XM Satellite Radio, you can watch tonight’s program here:
    The Bald Truth Live!

    Feel free to call in to join the discussion. The toll free number is 1-877-885-0007. The program airs at 5pmPST/8pmEST.
    Spencer Kobren
    Founder, American Hair Loss Association
    Host, The Bald Truth Radio Show

    I am not a physician. My opinions and knowledge concerning hair loss and its treatment are based on extensive research and reporting on the subject as a consumer advocate and hair loss educator. My views and comments on the subject should not be taken as medical advice. Always seek the advice of a medical professional when considering medical and surgical treatment.

  6. #26
    Senior Member PayDay's Avatar
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    Default Great Show!!!

    Great show last night guys. You guys sounded like you were having a blast. Vey informative as usual too! How come TeeJay got to do the show with you guys. I want in.

    Paul

  7. #27
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    The show was very entertaining , I enjoyed listening very much. Hairloss stuff can be so dry when I read about it, but itís cool to listen to the people in the know talking about it.

    I still donít know however if the Neograft is a good thing or a bad thing. Spencer seems to be on the fence about it and Dr. Law said it had some value, but Dr. Feller makes it out like itís worthless. Whatís the answer?

  8. #28
    IAHRS Recommended Hair Transplant Surgeon Dr. Feller's Avatar
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    Do you want to know why the FUE results from motorized spinning FUE punches are poor to moderate? It's not just the destruction secondary to the three detrimental FUE forces, but simply because such devices COOK the grafts.

    During use, the inside wall of a standard punch rubs right up against the graft. This close approximation often results in a significant cohesion force that causes the graft to dangerously twist within the punch as it spins.

    As the punch continuously rubs against the graft at high speed, a huge amount of heat is produced secondary to friction-the result is similar to an indian "rub-burn" which will not only cook the graft, but dry it out as well.

    To get around this problem I designed and patented the first Feller Punch manufactured specifically to reduce friction between the inside wall of the punch and the graft. Decreased contact with the graft means less twisting force, less trauma, less heating, and less dessication.

    This is just one reason why motorized spinning punches for FUE are non-starters and shouldn't be used IMO.

    Dr. Feller

  9. #29
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    I'll throw in my 2-cents as a pure layman and as a happy hair transplant patient (strip method). I even had a chance to say this on the show last nite. (Thanks Spencer, you're THE MAN!).

    If I am going to undergo cosmetic surgery (and I have), then I am going to do as much research and due diligence beforehand as possible. When I put all of the information that I have learned regarding the strip method next to all of the information that I have learned regarding FUE (regardless of how the FUE is performed, machine, or no machine), I conclude that the strip method has a substantially greater knowledge base attached to it and is significantly more time-tested, trusted, and "doctor approved". I also conclude that the strip method produces consistently, very well-known high yield rates (meaning that the % of transplated grafts that grow in their new area is 90% or more). The FUE method, on the other hand, and again based on what I have read and learned, seems to produce very sporadic yield rates, sometimes as low as 50%.

    The mere fact that "yield" is a focus point in HTs means that when a patient undergoes an HT, he/she is actually reducing the total # of hairs on his head. He/she is simply creating the illusion of a fuller head of hair thru the cosmetic redistribution of hairs across the head. If I am going to pay my money to reduce the total # of hairs on my head, then I am going to go with the method that offers the best possible guarantee of the minimization of this reduction, and the strip method seems to be the clear winner. I'm too conservative and I'd be too nervous to undergo FUE of any type, not knowing what % of my precious grafts were going to survive the surgery. And I'd be on "pins & needles" for the 6 months or so that are needed to get some idea of the HT results. So, as a pure layman, FUE isn't something I'd even consider, irrespective of how the grafts are extracted (machine, or no machine).

    I say this, and at the same time have complete and total admiration for Dr. Bauman. If I lived in Florida, there is not a doubt in my mind that I'd choose him to be my physician. His results are incredible and I love the fact that he is so leading-edge in his practice, using the latest tools and technologies in an effort to make patients happy and advance the surgical HT field. I like to be leading-edge in my own work, too, using the latest tools and technologies, even if they aren't time-tested yet, or accepted entirely by my peers and colleagues.

    I guess the dividing line here is this: as a doctor, charging ahead with new tools and technologies, as well as challenging them, ultimately benefits HT patients, even if it may not seem so at the immediate moment, and it certainly endears me (and probably other patients) to the doctors that use and/or challenge these new tools and technologies. But as a patient that is altering his physical appearance (quite expensively, too!) and undergoing the risks of surgery, I am just not interested in the additional risk that FUE seems to come with, no matter how it is performed, even if that means the strip method is slightly more invasive and produces a linear scar, both of which in my opinion (as a veteran HT patient) are no big deal.

    TeeJay

  10. #30
    Senior Member gillenator's Avatar
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    Quote Originally Posted by Dr. Feller View Post
    Gil,
    In the end, as you've already eloquently noted, it's all about RESULTS.

    The device is described as making extraction FASTER, but not a word was said about extracting grafts SAFER.

    I do not see where this mega-machine improves graft safty by lowering graft trauma. In fact, I see the opposite with respect to that spinning punch and the gauntlet of suction tubing the graft must travel through.

    This is why I am so adament about articulating and describing the forces working against us: Torsion, Traction, Compression. Any proposed FUE advance must address either one or ALL of these forces to be of any use.
    I could not agree more Dr. Feller. I just shuddered when I read about the dynamics of how it works and the additional trauma the grafts would sustain. I mean I don't know how it could be avoided considering the mechanics.

    Where is the scientific evidence regarding lowered transection and improved yields? Because without that, I am trying to figure out what benefit it has for patients.
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    NOTE: I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice nor are they the opinions of the following endorsing physicians: Dr. Glenn Charles, Dr. Jerry Cooley, Dr. James Harris, Dr. Bob True & Dr. Bob Dorin

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