Dr. Jean Devroye

For some years, a list has been created explaining the different best doctors’ FUE skills. As far as I am concerned, I often read that if a patient is looking for the best in the FUT, I am the Doctor but regarding the FUE, the level would be inferior. I am introducing here under a case which, I hope, will change definitively this absurd and inappropriate rankings. * This is my FUE experience: * My first interest in FUE was during the ISHRS Annual Meeting in Sydney in 2005 (9 years ago). Then, in 2005, I went to US to observe and be initiated into manual FUE technique. In 2006, I attended Dr James Harris’ meeting. Back in Belgium, I worked in collaboration with Dr Patrick Mwamba (manual FUE) during two years. Since 2009, I have developed a motorized system characterized by a very high sensitivity of the pedal. Thanks to this system, I can obtain the same precision as the manual system. For some years, I have been developing my own range of punches too. Their softened design allows reducing drastically the transection level. On an international level, I am considerably recognized by my peers for my FUE skills. Some examples: I have been chosen to take part to a limited group of 20 persons: the ISHRS FUE Research Committee. I am in charge of a research regarding the consequence of the transections. In 2013, I was part of the Faculty at the 2nd FUE Mediterranean workshop in Madrid hosted by Dr Lorenzo. I was in charge of several lectures and a surgical demonstration. Recently, I have been chosen among a twenty of so worldwide specialists to redact a chapter in a book exclusively dedicated to FUE which will be published in 2015. My chapter is about the best ways to promote the quality of the technique. During the next ISHRS Annual Meeting, in Kuala Lumpur, in October 2014, I have three interventions regarding the FUE including a lesson with demonstrations and learning for beginners and another one regarding the best medical instrumentation to use in FUE. In 2015, I will be part of the Faculty of the workshop organized by the Indian Society of Hair Restoration Surgeons. This workshop will be exclusively dedicated to the FUE. Regarding the patient of my post: He has his surgery performed in January 2014, we are at 6 months post-operative. His surgery took place in two days: 4205 FUE grafts for 9750 hair (details: 629 FUE1, 1881 FUE2, 1419 FUE3, 275 FUE4). His current result is simply astounding. After only six months, his donor area has recovered an almost normal aspect and density.

This patient has already had two surgeries in another Clinic. The result was good but the density was weak and it was not very natural. The anterior area was not very rich and was limited because of the tension. Also, we have reached 1538 grafts for 3089 hair. Details : FUT1:**410 FUT2:**773* FUT3:**303* FUT4:**52* FUT5:**0 The anterior line and the central anterior area were reinforced. The final aspect is extremely natural, thanks to the fineness of his hair and the white color of his hair.

Here is a very interesting patient. He is 34 years old, he began to lose his hair at 18. In spite of the use of Finasteride, the evolution was fast but it has led to a quite disadvantageous situation with a superior area completely bald and a donor area quite poor : less than 80 follicles per cm2. The skin is visible throughout his hair. He wants to continue to keep his hair short, between 3 and 5 mm. So, the situation was quite bad : poor donor area, large recipient area. Anyway we decided together the try a FUE hair transplant and the result was extremely positive. The FUE hair transplant was realized in two days. And we obtained 3063 grafts for 6780 hair. So more or less 2.2 hair per graft. All the anterior area was covered by a density of more or less 40 grafts per cm2. We have planned to complete the surgery during the workshop I organize in Brussels on the 15th of June 2014. (HTS Workshop) And we will use the hair of the neck and also take some beard's hairs which will be disperse in the middle of the current grafts.

Beautiful result after 1 year and a half by a woman of 65 years old. The pictures are quite clear : for a intervention the factor time is very important. 7 months after the surgery, the situation has improved very well, but the structure of the hair stayed hard and not very enjoyable. After 1 year and a half, the hair got longer and flexible. It is always remarkable to notice that a limited number of grafts can change the aspect of a patient. Front pictures illustrate it perfectly. This patient is very pleased by the result and her everyday life has changed with the new appearance. We transferred 2879 grafts for 5654 hair. Details : 898 FUT1, 1347 FUT2, 550 FUT3, 84 FUT4.

When we performed the surgery the patient was 40 years old. 15 years ago, he has performed a little intervention (more or less 50 grafts were transferred). First of all, I removed more or less 30 grafts. One month later, we decided to perform a surgery with the FUT technique because there was already a scar in the donor area. Thanks to a good elasticity and a good density the number of grafts placed was important : 4060 grafts for 9778 hair. Details : 634 FUT1, 1711 FUT2, 1138 FUT3 et 577 FUT4 The regrowth was excellent. The situation at 6 months was encouraging. At 9, it was very good. And 2 years after the surgery the density was apparently important.

The patient is 32 years old. He began to lose his hair at 25. As he was wearing long hair and because the density of his donor area was very good, he has decided to perform a FUT surgery with the maximum number of grafts possible. Finally, we have collected 2999 grafts (...3000!) for a number of hair of 5954 thanks to the high number of 2 hair's grafts. Details : 412 FUT1, 2089 FUT2, 336 FUT3, 62 FUT4. The hair has grown very fast. The situation 6 months after the surgery was already very encouraging. Between 6 and 12 months the diameter of the hair increased. And that's why there is a big difference between the two situations. Next step will consist in treating the crown area.

Thank you David !

Hello BeardedOne, The patient began to use Finasteride at 20. Sorry for the mistake !

This patient of 33 years old has already had 3 FUE interventions. The total was of 4144 grafts for 9485 hair. This patient began to use Finasteride at 20. His situation is stable. The donor area stayed macroscopically intact.

The Patient is 32 years old. The donor area was excellent. He had a very good elasticity and curly hair. What else to be a better candidate ? So, he received 3700 grafts for 8224 hair with the FUT technique. Details : 558 FUT1, 1904 FUT2, 1094 FUT3, 144 FUT4. The re growth was very fast and the result is beautiful. Best Wishes to all, Dr Jean Devroye

Since a few years, the patient was hesitating about the technique he wanted to use fot the intervention and the choice of the surgeon to perform it. He had already a reduction of the anterior area in 1998 and a hair transplant of 875 grafts in 2000. The scar get wider (5mm). And he wanted to improve the density of the anterior area. He came during the month of October 2012 and opted for the FUT technique. And it was quite logical in his case, as his donor area was still flexible. And also because when a FUT scar is already there, a second FUT is recommended. In spite of the situation the gathering was very good : the results of the intervention were the following : 2844 grafts for 5827 hair (646 FUT1, 1534 FUT2, 543 FUT3, 121 FUT4). The result is very harmonious and the density of the anterior area is well better.

This patient has 43 years old. He came for a consultation for two reasons: He wanted to increase the density of his anterior area, and reduce the "pluggy aspect" due to a previous surgery. At the clinic exam, the only existing hair was the ones of the previous grafts. In this case, the technique was simple and very efficient. As the big grafts were placed quite before, it was possible to rebuilt a new hairline before these ones (with almost 600 grafts of one hair). In the other hand, as we have added smalls grafts in a big quantity with the adequate density, we have totally erased the previous unnatural aspect. The quality of the pictures is not optimal. Indeed, the patient didn't come for a consultation and took the pictures himself. Nevertheless, we can appreciate the very clear improvement of the aspect, and the increasing of the density.

This patient received 3143 grafts for 6913 hair in two days. The donor area was divided in two equal halves : right and left. The first day, two kinds of punches were used 0.9 mm and 1 mm. Indeed, I often use two different sizes. The bigger punch for the bigger grafts and then, the small one to finish the area with the smallest grafts. The result was : 1614 grafts for 3389 hair. So, 2.1 hair/graft for a FTR of 8 %. (Definition of Follicle Transection Rate (FTR or TR) This is the result obtained when the total number of transected hair follicles are divided by the total number of follicles that have been extracted, both intact and transected.) The second day, for the second half of the donor area, I increased the size of the punch to 0.95 and 1.05 mm. Result : 1529 grafts for 3524 hair, so 2.3 hair/graft for a FTR of 4 %. This is a good illustration of the influence of the punch size on the result of the extraction. A small augmentation of the punch size resulted in an increase of the hair number per graft (2.3 instead of 2.1) and a decrease of the transection rate at a very low level (4 % instead 8 %). I'm not favorable to using the micro punch (0.7 mm). I think that it’s better to adapt the punch size to the size of the follicles to obtain as much hair as possible per graft, and in the same time less transection. The reason is simple, the patient wants hair. And he wants a good result at the first surgery! The picture of the grafts shows the quality of these ones. The picture of the donor area was taken immediately after the surgery and showed the size of the gaps for a punch of 1 mm, with a density of 15 grafts extracted per cm2 (square of 4 cm2). I will send you an update of this patient soon.

This patient is 43 years old. She began to lose her hair, Five years ago. Since then, the situation stabilized. The biopsy did not show anything especial. Finally, the diagnostic was an Alopecia Areata, but without absolute certainty. The patient agreed to make a test : consisting in two procedures of 20 grafts FUE. The grafted hair grew normally without any loss. Also, in agreement with the patient, the surgery was performed this way : 230 grafts on the right side and 242 grafts on the left one. It was a mix between FUT1 and FUT2. The regrowth was perfect. On the second picture, it is interesting to compare the situation 0+ and the one at 1 year : it clearly shows that there is no big difference between both. Of course, there is a small risk of recurrence and the patient knew it. Nevertheless, she decided to go ahead.

This 36 years old patient has been suffering from trichotillomania for many years. * Trichotillomania is a disease that consists in an irrepressible need to pull out your hair, one by one, patiently. This illness often begins during the childhood or the adolescence. According to the studies, it affects from 0.5% to 2% of the population at different degrees of severity. * When the disorder is important and the snatching is repeated, hair will permanently disappear. At this time, an intervention can only replace lost hair. * Of course, we have to be sure that the mania is cured. Because if it is not, the risk of failure of the transplant is extremely important. * Previous pictures do not fully show the severity of the situation. This last year, she has strongly reduced pulling out hair and requested a surgery. * I performed the surgery 8 months ago. The transplant was extremely dense in order to reach a sufficient density in a single time. The relative small size of the recipient area allowed it. * The work was of course performed without shaving existing hair. * The result is perfect. There is no trace of her trichotillomania. She does not pull out her hair anymore.

Hello, thank you for your comment. The article will be published very soon. So, it is more fair for me to wait his publication before showing it at the public. Of course, when it will be edited I will post a link on the Forum.

Thank you for your comment. The management of the crown is indeed a subject scarsely discussed, although it is extremely interesting. It is also a challenge to the skill of the surgeon and his team. I thought a lot about the best way of obtaining a good result at this level. Dr Konior and Glabel have asked me recently to write a chapter on the " management of the crown " to be published soon in "Facial Plastic Surgery Clinics of North America". I have already presented other examples of treatments of the crown right here: - Hair transplant surgery to the vertex before and after images with 2631 - Hair transplant surgery results photos from 3033 graft procedure to the crown - Hair Transplant patient of Dr. Jean Devroye, Male Class 2, 2628 Grafts - Hair Transplant patient of Dr. Jean Devroye, Male Class 3, 2368 Grafts

The patient is 49 years old. The donor area was very beneficial with a very good laxity and a density of 105 FU per cm2. It has allowed to reach a high number of grafts with 4324 grafts for 10342 hair. Details : FUT1 438 FUT2 1969 FUT3 1356 FUT4 472 FUT5 2 As usually, I've respected the original orientation. That explains the result extremely natural. The result at 6 months after the intervention is already very encouraging. I'm sure that the result will improve in the next 3 months.

This patient of 44 years old, wanted to have two FUE surgeries. The goal was to cover the first half part of the scalp for the first two days. We will proceed to another surgery soon to complete the work on the vertex. The donor area is still very dense. It will be probably possible to extract the same amount of hair during the second surgery. The size of the punch was 0.8 and 0.9 mm. The scars (white dots) are very small. Details:1860 Grafts the first day, 2145 grafts the second day. 521 FUE1, 1481 FU2, 1475 FU3, 281 FU4.

This patient is 30 years old. He began to lose his hair when he was 22 years old. Since 3 years, the situation is stable, probably thanks to the use of minoxidil. The project was to achieve a number of 2500 to 3000 grafts. The technique chosen was the FUT because the patient didn't want to cut his hair and had a limited budget. During the last July, we extracted 2918 grafts for a quite low total of 5809 hair. So, 540 FUT1, 1913 FUT2, 417 FUT3 and 48 FUT4. The proportion of grafts of two hair is high and the number of grafts of one or three hair is similar. The average number of hair per graft is of 1.99. Despite this "relative" poverty of the donor area, the result is impressive and very early. This patient is probably a good candidate for a second intervention on the crown. I will take this opportunity to fill again a little bit the center area. And maybe the final density obtained will be sufficient.

I can't resist the envy to post this eyebrows result. I know that in this forum there are mainly men who wish to see results of hair transplants but in my opinion the transplant of eyebrows is the supreme transplant. If we master it, we are also capable of the best in terms of*hair transplant. To make it a success, it is necessary to mix an excellent cut with a good control of sections, an very precise placement and orientation of the grafts. As usual, to have an excellent result, you should not skimp on the quantity. Given that the surface to be transplanted is very small, we can aim to a very dense packing. 
In this precise case, the patient did not have eyebrows hairs anymore. They had all been plucked. The transplant thus consisted of a mixture of grafts with one and two hair, for respectively the periphery and the center of the eyebrow.

The intervention was performed on July 2012, 6 months ago. This young patient received 3856 grafts for 9436 hair. The recipient area was shaved and the grafts were distributed from the front area until the vertex. The pictures with the wet hair, taken 6 months after the intervention, show an excellent result which will probably improve in the coming months.

To answer the question of scars If I may ask. When removing hair that was previously transplanted - say mini-plugs or just misangled follicular units, do you find that these are a challenge to extract and do you use a different approach in respect to punch size or scoring technique? Yes of course. The transplanted hair tend to diverge inside the skin. So the classic use of punches often causes numerous transections. I often use a long but effective manual technique. It is a matter of realizing a very superficial scoring by means of a punch and then of using a fine needle to remove the hair of surrounding tissues. And if I may also ask. Can you re-plant them nearby or is the damage to the skin in that area mean you have to replant them in an entirely different part of the scalp? When their state allows it, I reimplant the hair that is recuperated. It is sometimes necessary to have them retouch under the microscope. I often practice also the repair in two steps. During the first step, I remove grafts at first. Two weeks later, I transplant the same zone. It is also possible to make it in one step but I do not reimplant the hole made by the punch. I prefer to make new incisions. To answer the question of Mickey85 dr i just wanted to ask you your opinions on the pros and cons of manual and motorized punches and your sentiments on each. First, I am going to explain to you which was my approach. A few years ago, I was interested in the motorized systems on the market. I observed for example the work of two devices : the one of Dr Feller and the calvitron (ex neograft). They did not fit perfectly my expectations. Indeed, the basic idea was to realize exactly the same type of work with the engine as with the hand. For that purpose, I needed a system with a very big precision, capable of turning only a bare minimum of tours, just enough to make the cut. I also needed an oscillating system turning alternately to the right and to the left. I needed a mastering of this oscillation and also a fine control of the speed. I wanted also a system working on battery. I thus conceived a system using a hand piece of dentist. An aluminum heavy pedal completes the set. The punches used are the ones of Dr J.C. I've been using the definitive version of my device for three years and practically found only advantages compared to the manual technique. Indeed, the engine frees one of the hands of the rotation work. The hand so freed focuses much more easily on the orientation of the hand piece and the punch. It also allows to work in normally uncomfortable positions for the hand work. It allows to increase the number of grafts collected in one day. With the hand I reached 1200 grafts a day. With the engine I reach 2000 grafts. It has enabled me to decrease my FUE prices. I do not use any more the manual FUE except in certain particular circumstances as the removal of old punches or the work on the beard.

Concerning laxity, I often notice that hyperlaxity is interesting either for the FUE or for the FUT. Indeed, for the FUT, it allows to take a larger strip and thus to increase the number of grafts harvested. The laxity provides a different benefit to the FUE. As you know, the FUE is a two-steps technique, the more or less deep scoring and the actual extraction. I often practice the scoring for 300 to 600 grafts before extracting them at a time. For years, J.C has insisted on the importance of mastering the depth of scoring. Indeed, the graft has a cone shape, it becomes wider on its base. (see pictures above) Ideally, the punch has to penetrate the less possible into the skin. Because the deeper we go, the higher is the risk of damaged hair and the transection rate. On the contrary,* the more we remain superficial, the more difficult (or even impossible) is the extraction. This is where laxity is important. When the skin is very lax, the extraction is often possible with a shallow scoring. So, this has two advantages, a higher extraction speed (and thus a higher maximum number of grafts extracted in one day) and on the other hand, a lower transection rate.

About the FUE technique