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  1. #1
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    Default What to do after it's been done...

    What do we do with it once it's done?

    Attached below are images taken of several donor areas of patients who had strip (FUT) harvesting performed prior to coming to our clinic. You may observe that each patient has moderately long hair in the donor area and that a considerable amount of thinning in each donor area is evident. It has been said that the average strip scar is 2 – 3 millimeters in width and that strip method is the common method of hair transplant surgery of today. Today, the most important question for a patient to have in mind before having a strip procedure is what to do with the scar after a strip procedure is performed.

    Strip harvesting can have more adverse effects in the donor area than most patients are told. From a patient’s standpoint, strip harvesting is said to be more economical on the wallet than non-strip methods. Many clinics offer strip as a way to transplant more hair in less time. We see strip method as more costly to patients’ donor resources and a procedure that fails to meet today’s standard of aesthetic results in the donor area. Patients seeking strip method all have one thing in common. They do not know how visible the linear scar will be once it’s done. It is a fact that the donor areas heal differently from patient to patient. One thing is for sure: These patients will have a linear scar! Among other drawbacks are loss of sensation, tingling nerve damage, and a hypertrophic scar. To compound the problem, often times the pressure of the scalpel used to harvest the strip will destroy a percentage of nearby FUs and distort the direction of the hairs above and below the incision. These undesirable and disabling effects can be seen and felt even at a year or more after the strip procedure is performed. Some patients have scar revisions performed to see a percentage of the scar’s appearance decrease. The last photo attached shows a patient’s donor area trimmed with a #3 guard. About 1 year ago, this same patient went to a well-known clinic for a scar revision. In the photo, the patient’s hair in the donor area is > 1.5 centimeters in length. At the current length, the hair in the donor area fails to conceal the strip scar. This shows that a strip scar must have hair density around the scar to be non-visible.

    All hair transplant methods have pros and cons as any surgical procedure. The difference is what to do with it once it’s done! Patients who elect to have a hair transplant may more than likely need more than one hair transplant procedure in their lifetime. Many patients believe that the appearance of the linear scar is easily remedied via CIT or FUE, which is not the case. Grafting into the scar can be an option for many patients to minimize the appearance of the linear scar. Patients should also be told that the cons of non-strip methods can be hypo-pigmentation occurring at the extraction sites in the donor area. We have seen that transferring follicles into the extraction sites can stimulate pigment to these areas. The second con associated with the non-strip method of hair transplant surgery is that most clinics typically offer it at a slightly higher upfront cost per follicular unit.



    Who performs the repair if the linear scars always widen after each scar revision? Who performs the corrective work on these scarred patients who go to strip clinics from around the world? We thrive to educate patients so that their quality of life improves and their satisfaction lasts for a great period of time. At any rate, we want to give our patients the opportunity to obtain the best aesthetic result in the donor and recipient areas.


    Tel: 1 678 5661011
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    Last edited by CIT; 02-24-2015 at 07:24 AM.

  2. #2
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    Hi Dr. Feller,

    My big fear has been having a transplant and then having to correct the scar or for the scar to be visible. Logically FUE seemed to make sense until I began doing more research.I've heard you on The Bald Truth show so I know that you are someone who stands behind what they believe in and I appreciate your honesty.

    Maybe you can explain the difference between fue, fit and cit and tell us which is better?

  3. #3
    Senior Member gillenator's Avatar
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    Quote Originally Posted by Dr. Feller View Post
    I agree that FUE into scar should not be relied upon BEFORE strip surgery to hide widened strip scars after the fact. Neither should trichophylic closure for that matter. Both can HELP break up a strip scar, but they will never make the evidence of a strip surgery completely disappear as if it were never done. As a practitioner of both STRIP and FUE some patients come to my office with that very concept in mind, but a few minutes of discussion usually disabuses them of that false sense of security.

    Fortunately, MOST patients presenting for hair transplantation in my office, and those of my closest “strip-only” colleagues, are not nearly as concerned with concealing a strip scar as they are with covering as much scalp as possible as densely as possible in as few procedures as possible. In this arena, strip surgery is the undisputed king and FUE/FIT takes a distant backseat.

    FUE/FIT (same thing) simply does not enjoy the success or consistency of high yields that strip surgery does. This is mainly due to the three main detrimental forces that act on all FUE/FIT grafts:
    1. Torsion- Twisting force
    2. Traction- Pulling force
    3. Compression- Squeezing force.

    There are other detrimental FUE/FIT forces, but those are the main ones. Strip grafts, in sharp contrast, undergo a fraction of that trauma.

    The cost to the individual graft is very high for FUE/FIT and explains why we see very few FUE/FIT megasession successes reported on the internet. On the other hand, very successful strip megasession results are plentiful and commonplace.

    While some strip doctors may downplay the possibility of prominent strip scar formation, it doesn’t even come close to the level of omission practiced by some FUE/FIT clinics.

    Indeed, FUE/FIT causes FAR more scarring and physiologic damage to the donor area than strip surgery ever could on a graft for graft basis. This is because the amount of skin cut during FUE/FIT is TEN times that of strip surgery. EVERY time the skin is cut, no matter how small, nerve endings are damaged, blood vessels are cut, and the skin and the structures around it become distorted. After a few months, the dermis will solidify into a solid sheet of scar tissue due to “confluence of scar” whereby the scar from each FUE/FIT hole radiates out and connects to its neighbor. As the dermis hardens, each subsequent FUE/FIT procedure usually gets progressively more difficult to perform.

    I don’t see FUE and Strip as being at odds with each another. On the contrary, I think if both are applied and performed responsibly that they actually supplement one another. But it’s up to the doctor to become proficient at BOTH procedures and to fully understand the strengths and weakness of both. Only then can they truly give their patients the education and the choices necessary to come to a fully informed decision.

    Dr. Feller
    Great Neck, NY
    Great post Dr. Feller and in layman terms. Thanks for your honesty too because I agree completely with your comments regarding FUE and the implications of torsion, traction, and compression. Many patients do not realize that these traumatical effects on the grafts can and will affect the yield.

    And if the yield is substandard, it can defeat the primary goal of hair restoration, that of providing coverage!
    "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. Bob True & Dr. Bob Dorin

  4. #4
    Senior Member gillenator's Avatar
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    Quote Originally Posted by Jkel View Post
    Hi Dr. Feller,

    My big fear has been having a transplant and then having to correct the scar or for the scar to be visible. Logically FUE seemed to make sense until I began doing more research.I've heard you on The Bald Truth show so I know that you are someone who stands behind what they believe in and I appreciate your honesty.

    Maybe you can explain the difference between fue, fit and cit and tell us which is better?
    Jkel,

    Hopefully Dr. Feller will reply to your question. IMHO, FUE, FIT, CIT are basically the same things. FUE being the primary description for "follicular unit extraction". And unless I am mistaken, that term was introduced by Dr. Ray Woods who in my viewpoint is the pioneer and grandfather of this technique. He never practiced strip methods.

    FIT represents "follicular isolation technique" and CIT I believe represents "cole isolation technique".

    However, IMHO, they are all primary the same method and approach to removing FUs from the scalp utilizing extraction tools. FIT and CIT are more marketing labels than anything else in my opinion.
    "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. Bob True & Dr. Bob Dorin

  5. #5
    Administrator SpencerKobren's Avatar
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    Quote Originally Posted by gillenator View Post
    Jkel,

    Hopefully Dr. Feller will reply to your question. IMHO, FUE, FIT, CIT are basically the same things. FUE being the primary description for "follicular unit extraction". And unless I am mistaken, that term was introduced by Dr. Ray Woods who in my viewpoint is the pioneer and grandfather of this technique. He never practiced strip methods.

    FIT represents "follicular isolation technique" and CIT I believe represents "cole isolation technique".

    However, IMHO, they are all primary the same method and approach to removing FUs from the scalp utilizing extraction tools. FIT and CIT are more marketing labels than anything else in my opinion.
    The complete history of FUE still needs to be accurately written. Unfortunately, because of the entrepreneurial nature of the hair transplant industry, an honest account of this technique’s history and evolution is difficult to find. From what I understand, a true account is currently being written for publication, and since I’ve been asked for my input, I’m hoping that the public will finally have the opportunity to learn about its true origin and evolution.

    The term follicular Unit extraction(FUE) was coined by Dr. Robert Bernstein, but there is no doubt that this type of extraction technique was pioneered by Dr. Ray Woods of Sydney Australia.

    Sadly, The Woods Technique is nothing more than a footnote in the entrepreneurial online history of Follicular Unit Extraction. There are several reasons for this, none of which has anything to due with Dr. Woods’ level of skill or his technique.

    On a personal note, while Dr. Woods and I have had some issues in the past, I have a tremendous amount of respect for his ingenuity, his commitment and his passion for his profession. Dr. Woods is good at what he does, and deserves the respect of his colleagues and the hair loss community.

    Both Dr. Cole and Dr. Feller are well respected in this field. They were two of the first in North America to embrace The Woods Technique and to develop their own methods of extracting grafts in a similar way as Dr. Woods. They both have their own personal experiences with this type of technique, and I think it’s important that these types of honest, open and respectful debates are available for prospective patients to learn from.
    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. #6
    Administrator SpencerKobren's Avatar
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    Quote Originally Posted by Dr. Feller View Post
    Jkel,
    If the graft undergoes the three major detrimental forces:
    1. Torsion
    2. Traction
    3. Compression

    Then by definition the procedure is FUE regardless of the letters the marketing department of different FUE clinics make up and use.

    The proper nomenclature in my opinon is FUE. It is the most descriptive, the most generic, and the most widely understood.

    There have been several clinics who have claimed publicly that THEIR procedure is superior to FUE. Of course when asked NONE of them, and I mean NONE of these clinics, have come forward to disclose just HOW their version of FUE is different, much less superior. All the more suspicious when you realize that in medicine "peer review" is the standard method of gaining recognition and credibility for new procedures.

    Gil,
    Thanks for the kind words.
    I think there is too much B.S. in the HT field, and that goes double for the FUE end of it.

    FUE has it's place, but only after the patient has been fully informed of it's ups and downs. If after that conversation they still want FUE, then that's the only kind of FUE patient I'm interested in.

    Spencer,
    I need to make a small correction in your previous comment. Neither I nor Dr. Cole "embraced the Woods technique" because Dr. Woods chose not to disclose even a hint as to what he was doing.
    Rather, we early FUE doctors had to re-invent the FUE wheel based on common sense, hard work, and experimentation. To my knowledge the very first FUE players in the western hemisphere were Dr. Rassman, Dr. Bernstein, Dr. Jones, Dr. Cole, and myself.
    Thanks for taking the time to respond Dr. Feller! Gillenator your input is always appreciated as well.
    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.

  7. #7
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    Thank you Dr. Feller, Gllienator and Spencer!

    I appreciate your replies. Making a decision to have a hair transplant is very confusing with everything I read on the internet. There is so much puffery. One doctor says he can do 4000 grafts in one session and then I hear that doctors who say that are splitting grafts in order to achieve these numbers to rip patients off. I read about FUE, Fit, Cit, Fusse, my head is spinning. I just read this morning about FUE2. What the heck is that?

    What I like about reading this forum is that I can see that I am getting the answers I need form professionals and you guys have really giving me an education. I would feel completely lost and alone without this place.

    By the way, one more quotation if you don't mind. What is FUE2?

  8. #8
    IAHRS Recommended Hair Transplant Surgeon Jeffrey Epstein, MD's Avatar
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    What a pleasure to see such an honest, respectful, and fact-based debate.
    I have little to add, other than a few points.
    1. With the newest instrumentation, most FUE grafts are extracted using a 0.8 mm punch.
    2. Dr. Jim Harris needs to be added to the list of doctors who were at the forefront of FUE techniques. Having personally seen several of Dr. Harris' results, I have been performing more and more FUE procedures, and find them to be, in the appropriate patient with limited hair loss patterns and the right motivation, to be a good procedure. I still, however, prefer strip procedures, and with my experienced large team of assistants, find that our resutls with these 2800 plus graft strip procedures are, with few exceptions, without an equal in terms of density and naturalness.
    3. Why do I say that strip grafts are more natural in appearance? Because there is greater reliability in the growth of strip obtained rather than FUE obtained grafts. In hair transplantation, the top surgeons will tell you that every single hairline graft has a particular role in achieving the appearance of naturalness, and the extra ability to have the control over knowing that a single hair graft will in fact grow out as a single hair graft makes strip procedures truly the highest aesthetically.

    Jeffrey Epstein, MD, FACS
    Miami and NYC
    www.foundhair.com
    Jeffrey S. Epstein, MD
    Foundation For Hair Restoration

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