Hello Dr. Rassman,
One of your patients just checking in to say hi and ask a simple question:
Its been 10 years since your famous article on FUE (you link it frequently on this site)
How have your transection rates improved since then?
Back when we originally defined this procedure and published it in a peer reviewed journal (see here), we classified patients in 5 different categories defining the difficulty in doing FUE and the transection rate. These groups still apply and there are occasional patients (under 10%) who are still not good candidates for FUE. In other words, the human physiology has not changed over time.
Some patients may NEVER be good FUE candidates. We still strive for improvements, and with Dr. Pak’s engineering and clinical background we have changed our technique with a much better instrument that we pioneered to minimize transection. We recently received a patent on this instrument. When we made the breakthrough years ago, we called it the FUE2. This technology combines injecting fluid into the wound around the punch simultaneous with the extraction. The actual instrument has an injection needle welded to it. This has allowed us to decrease our transection rate in most of the patients years ago that we called “FOX negative”. The instrument design also allows us speed in the extraction process. Thanks to these innovations, the procedure is more practical, more efficient, and just plain better than most other instruments available (at least in our hands). Note the quality of the grafts in this link. The grafts are beautiful shaped and clearly show no transection.
Transection rates of under 10% should be the norm and when the transection rates go up above this number, we address with each patient who is impacted by a less efficient process. We still occasionally perform our infamous FOX test, which is essentially a test of up to 10 grafts extracted and the transection rate examined in this test group so we can anticipate the transection rates in advance. Unfortunately, not many doctors offer this test and the world continues to believe FUE is the best way to go about surgery (without taking transection into the equation).
Worse still, many doctors may misrepresent their transection rates and claim numbers that are unrealistic in their hands, but for marketing reasons they make claims suggesting they are as good as the best doctors out there. I know of a few doctors that live in an illusion which reflects technical skills that are way beyond their reach… and we see their patients frequently in the office for a second opinion.