For the last several years my clinic has been performing FUE procedures only. My reason for performing FUE is two-fold: I wanted to prevent linear donor scars on patients, and I desired the theoretical advantage of the FUE donor bank. A common misconception of FUE is the that smaller cases (compared to FUT) can only be performed. With FUE the entire permanant donor bank is at my disposal. I can extract from 0% to 100% of the hair follicles. There can be no greater flexibility than this.

But devising a system that can do this efficiently is not easy. Manual extraction of FUE grafts can be very effective, but slow. In my opinion, of the devices that currently exist for extraction, the NeoGraft deive is most efficient. Much discussion of the NeoGraft device has been made, mostly concerning the marketing of "turn-key" operations that is marketed by the company. This type of marketing to physicians unfamiliar with modern hair restoration surgery is unfortunate, and ultimately time limited. The NeoGraft device is a surgical device, and should only be used by surgeons. State Medical Boards in the near future will be not be kind to physicians who cannot supervise a procedure they cannot perform.

But little discussion is made over the NeoGraft device itself. As a surgical device alone, it is very accurate, efficient, and easy to use. The negative pressure allows for minimal depth extractions, which minimizes transections, at a depth of only 2 mm, makes me wonder if there are any true consequences to the transections that do occur. I extract 100 grafts (which takes between 5-7 minutes), with constant misting with normal saline. Then the canister is passed off to my assistant, and the grafts are removed from the suction loop. Dessication of the grafts is always a concern with the vacuum, but can be prevented by being mindful. This is another reason the surgeon should be performing this procedure.

So in my clinic all extractions are performed by the surgeon- which is me. We use 0.8 mm punches, which leaves no visible donor scar. I make this statement after seeing patients for the past three years (I perform 200-250 surgeries per year), and I have yet to detect a visiable scar with this size punch. A 0.8 mm punch is almost half the size of a 1.0 mm punch, which makes a big difference in donor scarring.

Forgotten by most discussions of FUE is that FUE only describes half of the procedure. Again, in my opinion placing FUE grafts cannot be performed effectively by hand placement. These grafts are more fragile than most FUT grafts, and have to handled with care. In my clinic we use Implanter pens in a "stick and place" motion. No pre-made sites are made. This ensures that no human hands handle the dermal papilla, and grafts are placed cleanly with no trauma.

Again, since I use a stick and place motion with graft placement, all grafts are placed by the surgeon- again me. This puts a lot of burden on the surgeon during the procedure, but I do enjoy the control I have over all aspects of the surgery. I utilize one assistant during the procedure, who collates and counts grafts, and loads implanter pens.

Thanks again for the opportunity to show my procedure and participate in this discussion forum.