FUE questions

[P.J]

After having one FUE procedure to restore my hairline - about 1050 grafts.

 

My thoughts were to build up my mid section with another 1500 - 2000 grafts - but this time using just 2s, 3s and 4s

 

I think this would give me more bang for the buck = more hair less grafts.

 

Has anyone ever tried this or is possible to pick just the larger groupings?

 

I know there is a big deal about these smaller punches (.7mm) but common sense would say the transection rate is higher with these smaller tools - I am willing to have a larger dot vs damaging valueable grafts.

 

Any thoughts would be appreciated?

 

PJ

[Bill - Seemiller]

P.J,

 

From your post, it seems obvious that you have a good understanding of FUE. Use of smaller tools do increase the possibility of follicle transection while larger tools increases the risk of larger scarring.

 

I will let a physician comment on whether or not selecting greater haired follicular unit grafts can be cherry picked however, keep in mind that if you do not want to add larger haired FU grafts into the hairline. But if you are only targeting the mid-section, this sounds like a potentially good strategy and certainly more affordable.

 

Bill

[the B spot]

Yes, you can target larger groupings for mid-scalp work and 1-2 hair grafts for hairline only.

 

Your plan sounds very reasonable and well thought out--as long as you understand the potential scarring aspect of larger punches.

 

Take Care,

Jason

[NervousNelly]

This sounds like a great strategy and from what I understand should not be a major issue for a surgeon should the grafts be available. Ofcourse as stated it brings up more potential for scarring, but negligible as you would likely still have relatively small punches and in the midsection.

[TheHairLossCure]

It is very unusual to see a doc using a .7mm or smaller. I would say the range for competent FUE is .75 to 1mm.

 

You can isolate the 2s and 3s to get more hairs with FUE, which as a big plus.

[Dr. Alan Feller]

By and large, cherry picking grafts using FUE is a myth.

 

The simple truth is that when you target a follicular unit you really have no idea what's under the skin and what you are going to wind up with.

 

Even if you do target what you think is a one hair graft, it may really be a two or even three hair graft with the other hairs in the sleeping phase.

 

Or, you may target what you think is a 3 hair follicular unit, but in reality is a two hair FU with an extra hair coming from a neighboring follicular unit.

 

Another problem with multi hair FUE targeting is that not all the follicles may come with the group when it's targeted because of the size of the punch and the splay of the follicles under the skin.

 

I will agree, though, that the use of a larger punch will increase the chances of getting all the follicles when targeting multi-hair FUs.

 

If, however, the punch exceeds 1mm in diameter, then in my opinion you are no longer performing FUE, but rather the old style plug work.

 

Some patients cannot tolerate the thought of a strip procedure, so for these people we WILL use larger punches as longs as the ACKNOWLEDGE that they understand that it will leave depigmented and sometimes raised dots within the donor area. But again, this is NOT true FUE.

[notgoing2gobald]

well, so much for that then...

[chucky]

i like your reply dr feller on this but could you answer this for me.

 

are there particular parts of the scalp in the safe zone where different groupings of hair follicles grow ie do you get more singles from just above the ear or are they randomly mixed all over.

ps shouldn`t you be working this time of the morning and not surfing the net

[TheHairLossCure]

Dr. Feller,

 

I understand that what looks like a single hair, superficially, may in fact be a multi-hair follicular unit. On the other hand, I really never thought, with FUE, that a multi-haired follicular unit may turn out to be 2 separate units within extremely close proximity. Since I am not a physician, I've never extracted. Still, I would think that pulling a double unit via FUE is a rare thing. Would you agree?

[P.J]

Dr feller,

 

Your honesty is appreciated

I am not willing to go above a 1mm punch - as I have seen what that can do and its not pretty

 

 

Hairloss Cure,

 

I have contacted your office and they stated a similar opinion to Dr. Feller

 

 

The price of FUE is already high and if it was possible to get better hair count per graft it would defintely be more appealing

 

IF there is a DR that has achieved this I really would like to hear about it

 

 

PJ

[TheHairLossCure]

PJ,

 

Firstly, like Dr. Feller, Dr. Rose would not use large FUE tools unless 1) there was some special reason and 2) you understood the reason and gave consent. In other words, it does not happen that much.

 

Perhaps I am misunderstanding Dr. Feller, but I think it is reasonable to isolate 2s and 3s without assuming the groups are double follicular units. I also don't think this approach requires that the physician uses a 1mm+. But, again, I may be missing some of the nuances of his stance.

 

Since you did hairline work in your initial procedure you necessarily had a higher percentage of singles. This is simply how natural hairlines are built. I think it is safe to say you will get a higher hair count if you aim to build up the core area.

 

I will run this by Dr. Rose, though, and I'll be in touch.