FUE/Repair

[omy]

I have read about FUE being used to remove large grafts. Is it possible to remove cobblestoning this way? What I mean is it feasable to use a punch to remove just the top excess portion of a big graft that lies above the skin and reduce the circular appearence while not going in deep to get the follicles out? I know that the tools used for FUE are around 1mm. But for larger plugs that have round bumps of raised tissue can the top be punched off with a larger tool and leave the follicles behind for growth and possible softening by adding smaller grafts in front of them? I wonder if this may be an alternative to dermabrasion or coring.

[omy]

I have read about FUE being used to remove large grafts. Is it possible to remove cobblestoning this way? What I mean is it feasable to use a punch to remove just the top excess portion of a big graft that lies above the skin and reduce the circular appearence while not going in deep to get the follicles out? I know that the tools used for FUE are around 1mm. But for larger plugs that have round bumps of raised tissue can the top be punched off with a larger tool and leave the follicles behind for growth and possible softening by adding smaller grafts in front of them? I wonder if this may be an alternative to dermabrasion or coring.

[arfy]

I don't want to pre-empt a doctor from replying, but I have some comments.

 

Apparently when you remove follicles with FUE, that "de-bulks" the graft and allows it to lay flat.

 

I've had coring, line excision, and FUE done for graft correction. In my opinion FUE is the superior method, and when it can be used it should be.

 

Coring destroys precious follicles, I believe the number is something like 50%. Coring is a random technique that does not preserve precious hairs for recycling. It also creates a slit scar when the hole is stitched up. You create a new problem when you solve an old one- that's not good. One small slit scar is not that bad, but most patients have dozens (or even hundreds) of grafts that need to be corrected, not just one.

 

Punching out the whole graft probably preserves almost all the hairs for recycling, but (again) the hole is too damn big. The biggest problem with pluggy grafts is the dense tuft of follicles. And by removing follicles, you reduce the graft volume and the graft will lay flatter.

 

You can get dermabrasion done, but there is a chance that the dermabraded scalp will not be an exact match in color or texture when you're done. If it was me, I would recommend that you try to use FUE (removing follicular units one-by-one) FIRST and only resort to dermabrasion if absolutely necessary. See if FUE will help with your 'cobblestoning'.

 

Even though I am not a fan of 'coring' I suppose there may be cases where that could be preferred, and coring will also remove bulk and the remainder of the graft will lay flat.

 

Short answer: get the grafts revised, and dermabrasion could very well be unneccessary.

[Miami]

Does FUE leave any type of scarring? Most doctors say "No" but wanted to hear first hand. If not, is there any explanation why?

 

I was told sutures would not scar and now I have two rows of dotted scars...

[Dr. Glenn Charles]

Yes, FUE transplantation can cause scarring in the donor area. Certainly, after having only a few hundred taken from the donor it will be almost undetectable. However, try having several thousand units removed from the donor area, and it may start to look a bit moth eaten. Sometimes removing parts of older bigger grafts that left an unlevelness to the skin can improve the appearence. Dermabrasion is only an option in certain cases, and has its negatives also. Probably the best way to conceil older plug type grafts and cobblestoning is to revove part of the graft and surround the remainder with smaller follicular units.

[Nobel Victim]

HI Dr Charles,

 

I'm interested in the use of dermal abrasion in ht reapairs. What circumstances do you think it would be a useful tool?

 

I can see how it may flatten out the coblestoning effect, but how about the deeper slits of deeply placed micrografts.

 

Also what effect might abrasion have on skin tone? My recipient site is whiter than my forehead, which makes my pluggy grafts look worse, would any abrasive help in equlaising this tone difference?

 

 

With thanks

 

NV

[Dr. Glenn Charles]

There are alot of factors that are important in your case. Hair color, skin type, and healing properties. In cases like yours there is a bit of a catch 22. The deeper pits need to have more aggressive dermabrasion which can cause skin color changes and does not even guarentee leveling of the skin in those areas. I personally do not perform dermabrasion. You would probably be better suited contacting a doctor who has alot of experience with this technique. Unfortunetly there are some pitting/cobblestoning situations that cannot be compltely corrected.

[Nobel Victim]

Thank yo Dr Charles,

 

I think it will be the camoflarge route for me.

 

Very best

 

NV