Follicular Unit Extraction (FUE)
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How it all began
In 2002, the New Hair Institute (NHI) physicians published the results of seven years of clinical research which started n 1996 that culminated in the development of a method of extracting hair follicles from the donor area without a linear incision. The technique that we developed extracted individual Follicular Units (containing beteen 1-4 hairs each) with a specialized 0.9mm punch. The technique obviated the need for a linear strip which, at time, leaves behind a linear scar in the donor area. This technique has produced a gradually increasing number of patients expressing interest in the technique and doctors began offering the procedure in their clinical practice, world-wide.
Minimally Invasive Breakthroughs
This breakthrough was similar to other minimally invasive breakthroughs occurring in surgery for the stomach and intestine, the cardiovascular system, gynecology, arthroscopy and joint replacement, etc. What appealed to patients in many of these minimally invasive procedures was the rapid recovery time when compared with the traditional approach to surgery and in those patients whose risks were higher, the risks to surgery would be lessened with a minimally invasive procedure.
New Hair Institutes FUE Publication
At the time of our breakthrough publication in 2002, we reported that every patient should be tested for their candidacy for the FUE procedure. Patients’ success varied and our clinical research suggested that differences in the collagen make-up of each patient might be a factor underlying the variability we say in patients undergoing this procedure. During the test, a small number of follicular units were extracted and they were assessed for graft transection (cutting of the hair follicles by the instrumentation). For those people who were not good candidates for FUE, we recommended the standard Follicular Unit Transplant (FUT) with donor harvesting by the strip method.
|Above: FUE performed leaving the hair long. 400 grafts were removed on this patient. These photos were taken the day after surgery.|
Follicular Unit Extraction Advantages
There are several advantages of FUE. With moderately sized procedures, it leaves virtually imperceptible punctuate scars in the donor area once healed. During the post operative period, there are only a few limitations placed upon the patient for the first week or so. Patients rarely report any donor area pain from the excision area. The donor area can be washed as vigorously as necessary to obtain a clean wound. Hair grows out from the donor area fairly quickly so by one week after an FUE procedure most donor wounds will be covered by a short beard-like growth of the hair making the donor excisions nearly undetectable.
Manual FUE Technique
The manual FUE technique is difficult and tedious to perform on the part of the physician and staff. FUE is not for everyone and it takes a skilled, trained doctor to differentiate who is a candidate for FUE and who is not. From the outset, the public’s reception of FUE was positive and a quick demand for the technology sprung up worldwide by individuals wanting a minimally invasive hair transplant. Some doctors announced their expertise for the procedure within days of our publication of our scientific paper with virtually no experience in performing the technique. They got terrible results, victimizing these patients. Other doctors slowly explored their options in doing the surgery, taking the time to hone their skills and technique. Over the years, more and more doctors began offering the procedure, but few have shown real expertise in this field of manual FUE. At the onset, patient successes were few and many doctors offering this technique were highly suspect. Widespread failures of FUE were not uncommon. As difficult as it was for the doctor to master the FUE surgery, it was equally difficult for the patient to comprehend what FUE procedures could and could not accomplish.
FUE is a minimally invasive, precise, technically demanding procedure that is influenced by the technical skills of the doctors, and is hindered by the absence of uniform surgical tools. Transection rates should be tracked and you should ask to see his/her documentation at the end of your procedure. Finally, to be sure you procedure will go as planned; the doctor’s technique must be replicable from one patient to another.
|Above: This patient had 5200 grafts prior to the procedure shown. The photo was taken after receiving 789 FUE grafts using a 0.9mm punch with less than 3% transection rate. What scar he did have from his previous surgery was repaired with a lower-edge trichophytic closure one year earlier.|
Best Approach to Follicular Unit Extraction
The best follicular unit extractions come when the entire follicular unit, the bulb with the dermal papillae and the capsule are removed intact and there is no amputation/transection of hairs within the graft. In theory, the more the follicular unit is stripped of its surrounding tissue, the lower the growth potential. If the outer root sheath (ORS) is not violated and some fat remains below the bulb, one can assume that the follicular unit was removed without damage. If the lower ends of the hairs of the excised follicular unit contain a glistening covering and the bulb is intact, then it can be assumed that the follicular unit came out wholly intact. If the outer root sheath is violated and stripped from its covering, one should expect some negative impact on the growth. This could result in a thinner, less robust hair from one or more of the hair follicles within the extracted follicular unit. In summary, the best preserved follicular unit is one where the ORS is intact, the hairs are covered with a glistening covering, there is fat at the bottom of the bulb where the dermal papilla is located, and there is no amputation/transection of the hairs within the graft.
For more information on the Follicular Unit Extraction technique, please see: ARTAS Robot FUE or view the following pages:
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