No matter what narrative the device makers are trying to sell to both vulnerable consumers and physicians just entering the field, not every patent is a candidate for FUE hair transplant surgery. In some cases patients can benefit much more from either having strip (FUT) surgery alone or a hybrid of FUE and FUT. Spencer Kobren speaks to IAHRS accepted member Paul Rose, M.D. about the reality and the limitations of FUE hair transplant surgery and that while it has its place and can provide incredible results for many, it simply is not for everyone and those who are ignorant to this fact, both patients and practitioners, are not making truly informed decisions.

Paul Rose, MD:  You know I was in Prague and also in Poland. In Poland, there was a conference a few months ago, and there were some people who only do FUE at that conference. When you listen to them talk about FUE in the donor area, and you ask them, "Well, what happens when you go back in the second or the third time, and now you create these adjacent hits, and you have to have some concern about thinning out the donor hair? What do you do?" And they say, "Oh, well, we tell the patient to grow their hair longer, and we tell them to consider scalp micropigmentation." There's nothing wrong with scalp micropigmentation. I think it has its place-

Spencer Kobren: It does.

Paul Rose, MD: but if you're telling me that the whole purpose of FUE was for the person to be able to wear their hair extremely short I think-

Spencer Kobren: Or to even shave their heads, yes.

Paul Rose, MD: you've defeated the purpose. 

Spencer Kobren: A hundred percent. A hundred percent, and that is something that ... Listen, I've been preaching this for a long time. Sometimes I feel, I'm not going to say guilty, but I feel that I really pushed everybody, especially at the beginning when Ray Woods came to me, to really take a close look at this procedure because I felt that it wasn't going to be a procedure that should eventually eclipse the traditional strip harvesting, but I thought it would be a great adjunct procedure. Great for guys who are stripped out, great for guys needed repair, great for guys who are maybe terrified of having hair transplant surgery but could still benefit from it because they were so concerned about having the strip scar. 

I never thought it was going to turn into the monster that it's turned into. Honestly, I think that it's ... The fact that strip is going by way of the dodo is really terrible for the industry and terrible for future hair transplant consumers because they are never going to have the ability to get as much hair moved in the best and safest fashion than they would if strip was still available. Listen, you're not an old guy yet, but listen, you've been doing this for a long time. Eventually guys like yourselves are going to be dinosaurs and no one's going to be doing strip.

Paul Rose, MD: Oh yeah. My feeling is that to be a complete hair restoration surgeon, you really need to have as many tools in the toolbox as you possibly can. I worry about that old adage that if you only have a hammer, then everything looks like a nail.

Spencer Kobren: Yes.

Paul Rose, MD: That worries me about some of the people who are only doing FUE when there is a place for strip surgery. Quite frankly, we go over with patients all the techniques, all the advantages and disadvantages, everything from cost to cosmesis about each one, and what their needs are. There are some people ... By the way, I think that you did us a great service, though, in promoting FUE because I think it made people realize how important it is to do strip surgery well and to try to get a scar that is a good scar, hopefully a great scar. I think it led to things like the trichophytic closure and, for me, the ledge closure. That's helped me tremendously. 

I can show you patients who you'd have a difficult time finding a strip scar, but I think that, unfortunately, for many years, physicians were concerned about how much tissue they could take out. The donor scar was of little concern because the whole point was to move hair from a place you had it to a place you didn't have it. Patients were delighted, and they could cover the scar with their hair by growing it longer in almost all instances. Now, I think that was a bit rash on the part of some physicians, and I think they were too aggressive. There were times when people actually, horrendously, threw tissue away. It's hard to believe, but I'm sure people threw tissue away- 

Spencer Kobren: I actually just heard, I just heard a-

Paul Rose, MD: and would go to a patient and say, "You know, I've got this extra tissue, what do you want me to do? Do you want some more grafts, for which I'm going to charge you X for, or I'm just going to throw the tissue out?" It's sacrilege, but unfortunately- 

Spencer Kobren: That's exactly why ... It's funny, you talking about that is being something from the past, but I spoke to a technician just last week who said that there are some of these traveling techs, if the day is over, and they want to go home, they will throw away tissue. 

Paul Rose, MD: I believe it. I believe that people who are getting vast numbers of grafts are either going into the unsafe zone or splitting up grafts, and they're able to charge the patient more money for that. Look, I mean, every field has their problems. I think that-

Spencer Kobren: Yeah, but come on this field has more problems-

Paul Rose, MD: the burgeoning field is [crosstalk 00:04:59]. Yeah.

Spencer Kobren: This field has more problems, and more people are willing to, in my view, kind of not even walk the tightrope, but just completely cross over that threshold and just say, "You know what? Screw it. I'm able to make this happen. Patients have no idea what's happening to them. It's-"

Paul Rose, MD: Well, and patients have to wait a year before they actually can tell what grew and what didn't grow.

Spencer Kobren: That's right and it's the Wild West. 

Paul Rose, MD: And by that time, the technicians are long gone. 

Spencer Kobren: A hundred percent. A hundred percent. Now, I had a question for you, and I don't know if you want to record this or not, but we'll see if it's something you're interested in. I know the ISHRS has just made this terminology change, and they're making a big deal out of it. I said that I would support it, but between me and you, and I'm not going to put this up until you say it's okay. We'll start recording from the top in a second, but between me and you, A, it's too little too late and it really is not going to make a difference as far as the consumer truly understanding that this is a real surgical procedure. I don't think most consumers are going to understand the difference between extraction and excision. I don't think that ... It's great that they're starting to maybe give it a shot, try to make some sort of difference, but out of everything, I think this is just a really weak attempt.