Dr.De Reys MD

My experience using the FUE hair transplant technique ??“ Dr De Reys - Prohairclinic I was introduced in the field of FUE hair transplantation back in 2005 by Bart, manager and co owner of Prohairclinic. He setup training sessions with Dr. Ilter who had been doing FUE since 2003 and has become one of the worlds leading FUE experts. Since 2005 I have been performing FUE exclusively on an almost daily basis. Instruments and setup. After performing about 10 FUE sessions using a surgical steel 1 mm punch I quickly moved to 0,7-0,8 mm instruments. I find that I am able to extract intact grafts with smaller instruments without increased transection rate. Since FUE is about minimal damage to the tissue I discard the use of any instrument larger than 0,8 mm for the extractions. During the extraction process I make use of a 5,5* magnification loupes. I prefer a sitting position behind the patient, scoring the grafts. I do not make use of any mechanical driven device to help the scoring process. A mechanical device would distort the finger feeling that is needed to ensure quality extractions. In fact, no special tools need to be invented to execute an FUE procedure without problems, all it needs is freely available on the market today. The punches used are of the shelve, available to any drs who wishes to use them. I select the punch size based on the patients graft/hair thickness. Since the patients pays for hairs to be transplanted we take great care to select the best grafts in the donor area. Therefore a graft must contain 1 up to 4 hairs, in rare cases 5 hairs. Our average hair/graft is 2,3, for non hairline work it can go up to 2,8 hairs per graft. The procedure After selecting the right size instrument it takes a few trial scores to determine the angle and depth. The scoring is performed in a twisting motion with virtually no downward pressure. The rotation speed is preventing the grafts to adhere to the punch and suffer from any twisting motion. This has been verified under microscopes by ourselves and other surgeons. The sharpness of the punch is a critical choice in respect to the patients tissue characteristics. Sometimes a sharp punch is needed, sometimes a blunt and most of the time something in between. Depending on the patient skin characteristics more saline is used to harden the treated area, in other times less to no saline is used. Furthermore I use finger pressure if needed to stabilize the scoring area. A correctly scored graft does not require any real traction force that could harm a graft, they literally almost pop out. It is unnecessary to use brutal force of any kind to properly extract viable grafts. Mind that hair follicles are very strong tissues and can withstand great forces. Most major damage is caused by improper handling grafts outside the body. FUE grafts have virtually no protective fat tissue. Therefore extreme moisturizing protocols are used to keep them from drying out. Another factor is squeezing the grafts to death. The solution to this problem are basically : limit grafts handling to an absolute minimum, thorough training for the technicians and wearing magnification at all times. The key issue however is that with experience a certain FUE fingertip feeling is developed. In my opinion this special feeling counts for 70 percent of a well executed FUE extraction with virtually no transection. It is scientifically not possible to explain how this finger control is felt. I guess it is like learning how to drive a bike. At first the gravitational forces are uncomprehending. After a while most can drive a bike, but some people become experts and drive like mad on any terrain without falling. Donor area limits The limit of the donor area has been shown in a document by Petermac and dr. Bisanga. It is possible to harvest about 25% of the donor grafts available without having to harvest adjacent grafts. If we go higher than this limit we inform the patient that at extremely short hair length some visible aspect of FUE extractions may be visible. By now we have several patient where 4000+ grafts were harvested without causing visible thinning at 5 mm hair length. Patient selection FUE as practiced by myself can be offered ANY patient who is a hair transplant candidate, regardless of hair/skin type characteristics. FUE Mega sessions We believe that it is better to have less but larger treatments for the benefit of the patients. It means less time off and faster results. However it takes an HIGHLY trained team to accomplish FUE mega sessions. It is not just the drs that is responsible for a well executed FUE, it is a team effort. I am glad to have worked with my unchanged team for many years now. Our routines have been perfected over the years. My extraction speed of 400-600 grafts per hours is achievable with a transection rate of less than 5% (usually about 1 percent on most patients). Therefore we can perform 2500 FUE grafts in one day on non transplanted patients. FUE on previously strip operated patient In many cases it is difficult to extract grafts from the area surrounding the strip scar. This is caused by underlying tension that shifted the grafts natural position. In most cases reducing the extraction speed and compensate for the angle/depth changes is sufficient to solve the problem. In some cases however it is extreme underlying scar tissue that makes it virtually impossible to extract those graft. FUE on previously FUE operated patient In general there are no problems going back to harvest more graft if the punch size used was 0.8 mm or less. The existing scaring does not interfere with the new extractions, nor has there been angle changes or underlying scars for the new grafts to be scored. Additional information. Our mega sessions are build upon our experienced and routines and do not exceed 12 hours. We have disclosed our technique and instruments for anyone who is interested and will continue to do. FUE is not a technique that is learned in a matter of weeks. FUE is best performed on a daily basis since it is the only way to get enough experience to handle each and every patient characteristics. We are aware some disagree with us, but if you look further you will notice that they either have limited skill, limited endurance, or are not practicing FUE on a daily basis. We understand that is very difficult for non FUE experts to handle every FUE case. We urge surgeons who run into trouble with FUE to resort to FUT. It makes no sense to needlessly wreck a patients donor area as bad FUE can be as devastating as bad strip surgery.