My experience with FUE method

[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.

[Bill - Seemiller]

Dr. DeReys,

 

I appreciate the time and energy you put into explaining your position on FUE.

 

I have one comment/question, if I may. If I recall correctly from our phone interview a few months ago, though you reject that hair and skin characteristics plays a role in FUE candidacy, your extraction rate of 400-600 follicular unit grafts hourly does depend upon skin and hair characterisitcs. am I correct in saying that certain skin characteristics such as "mushy" skin may slow down this process, even though you believe transection rate is not affected?

 

Also, can you please describe a little bit more how your team is involved in the FUE process and how this makes possible larger FUE sessions with minimal transection?

 

I hope and trust that you will stick around and address any additinoal questions/concerns posed by the patient community.

 

At the same time, I also understand that there are varying views on FUE, and every surgeon has their own variation. The opinion of one doctor doesn't necessarily equal another. That said, I believe we ought not to expect every surgeon to agree on every philosophy. But each surgeon should be expected to well defend their philsophy with facts and proof of results.

 

I welcome our forum community to ask Dr. DeReys any additional questions that might help facilitate discussion about FUE at their clinic. I believe this discussion would certainly be helpful before we formally present Dr. DeReys for potential recommendation.

 

Best wishes,

 

Bill

[PLEASE GROW PLEASE]

Thanks for the post

Im always seeing percentages as far as transsection .

What is your graft survival percentage and how do you know?

That is if you know.

I love the concept of no ugly scar but Ive compared hundreds of fue /strip patients side by side with almost the exaxt same graft counts and characteristics and the density always seems noticably higher in the strip patients.

[wantego]

I was curious how many FUE doctors use a mechanical device and how many do not. I have heard that 1 doctor who claims he does mega sessions of fue uses a drill of some sort. I really have no idea what is true regarding that. I have seen some questions asked but never really answered.

[The Goz]

During the 70's and 80's most punch grafts were harvested with a variable hand engine. A punch was placed in the wand and the doctor used a foot switch and a knob to control speed and timing. If some doctors are using a "drill" I would imagine that is what they are using. It was a very effective tool for the larger punch grafts. I have not seen it used for FUE and don't know how the "feel" would be or how the transaction rate would change.