Problems starting to be seen with new FUE technique

[Smoothy]

I've been reading some information on the new FUE technique that has been used for a year or so in the States (Dr. Woods has been doing it a little longer in the land down under).

 

FUE has it's place for smaller procedures and for those previous HT patients with limited donor or correction patients with scarring.

 

BUt recent results on larger FUE sessions are starting to show what many TOP NOTCH surgeons have expected as a risk-- That is the Donor depletion resulting in "mothball" apperence-- similiar to the "OLD PLUG tech. in the 70's 80's" but on a smaller scale.

Patients who are having 3,000 or so FUE procedures are having problems with donor apperances like the old plug techniques.

 

Just like anything new, people will jump on it because it's "advancement" but it probably FUE results from megasessions are starting to show some problems with donor area.

FUE is great for cases outlined about but it is looking more and more not a techinque for megasessions.

I'm sure over the next year as doctors try to stretch FUE into larger sessions, we will hear more about this potential risk/problem.

[Smoothy]

I've been reading some information on the new FUE technique that has been used for a year or so in the States (Dr. Woods has been doing it a little longer in the land down under).

 

FUE has it's place for smaller procedures and for those previous HT patients with limited donor or correction patients with scarring.

 

BUt recent results on larger FUE sessions are starting to show what many TOP NOTCH surgeons have expected as a risk-- That is the Donor depletion resulting in "mothball" apperence-- similiar to the "OLD PLUG tech. in the 70's 80's" but on a smaller scale.

Patients who are having 3,000 or so FUE procedures are having problems with donor apperances like the old plug techniques.

 

Just like anything new, people will jump on it because it's "advancement" but it probably FUE results from megasessions are starting to show some problems with donor area.

FUE is great for cases outlined about but it is looking more and more not a techinque for megasessions.

I'm sure over the next year as doctors try to stretch FUE into larger sessions, we will hear more about this potential risk/problem.

[arfy]

I haven't seen the problems you are referring to. Which patients are you referring to? I've never heard of a patient having problems from 3000 FUE, and I've been paying very close attention.

 

Hair transplants have limitations no matter what method you choose. The biggest limitation is probably the small amount of donor supply isn't enough to restore a full head of hair. Supply can never keep up with demand. You only have a finite amount of donor supply available and that is true of strip and FUE.

 

You can certainly "over-harvest" the donor area using strip OR using FUE. It takes experience to avoid that. Pick an experienced doctor.

 

FUE is a good option, but it takes time for new techniques to catch on. For example doctors started talking about a donor strip in the late 70s, but it didn't catch on until the early 90s. Until the donor strip caught on, doctors continued to use big punches (the doll hair look).

 

You can't compare FUE with old fashioned punch grafting. I've had both techniques, and the difference is night and day.

[Bill - Seemiller]

Ok...from a complete novice...what does FUE stand for? And what is it?

[HairBeThere]

Bill,

"FUE" is Follicular Unit Extraction.

It is the process of removing a single graft at a time from area's of the head and body (BHT).

This is done without harvesting a donor strip to extract grafts under a microscope.

 

This is a newer technique that is being strongly looked at, as well scrutinized, and is still in it's early stages of a procedure type.

 

You can search Follicular Unit Extraction on this site or google to learn all about it.

[Smoothy]

Slight correction on FUE, yes you remove single FU's at a time from the body and scalp but it is not in a Strip disection form. It is basically by a "plug" or small drill type instrument--- that's how you avoid a strip scar.

[gillenator]

FUE is the abbreviation for Follicular Unit Extraction and FIT is Follicular Isolation Technique.

 

Both technologies are based on a harvesting method which removes FUs independently from the donor area without utilizing the traditional linear strip harvest method. In other words, this is sutureless technology or so to speak whereas a micro-punch is used for the extractions. The result after post-op healing is supposed to be "no visible" scarring in the donor area.

 

The technology is in some regard like the old punch-out graft approach except the punches are much smaller. Most of the standard punches used by FUE surgeons measure 1mm in diameter which is quite a difference from the larger punches of the stone-age plugs. Some FUE surgeons have tried punches at .75 mm and I even heard of an attempt as micro as .50 mm.

 

I too have been keeping a watchful eye on this technology and I have seen many patients both in pics and in person. I have seen some great results in donor area healing and a few with in my opinion, not very good results or what Smoothy referred to as an over-depleted appearance. Arfy is correct in that the amount of donor rarely meets the demand side, if ever in a lifetime. I believe most FUE/FIT patients choose this technology over strip for the reasons Smoothy mentioned but also for the benefit of not having a strip scar that would show in the donor area if one were to cut their hair very short, number one guide or a shaved look. Anyone who had a bad result resulting in a wide strip scar can relate to this. As many of us know, FUE/FIT technology is being utilized more and more to implant hair into scarred areas where laxity no longer exists. Body hair extractions are being used to fill-in scars and to do other repair work. It seems whenever a FUE/FIT patient posts there pics, there are "varying" opinions. What one sees as magnificent work for post-op healing, another sees spots or redness, over-depleted areas, etc. Just read the comments whenever someone posts their pics and I was not necessarily referring to this forum. FUE/FIT may end up being the answer for the young patient over 25 years old who really has no idea of where his hairloss is headed and may end up buzz-cutting their head someday. Obviously he would not be able to do this with the linear scarring left with strip or could he? Could he later go back and have the linear scar(s) filled in with FUE/FIT? Or could the FUE/FIT patient who had 3,000 to 5,000 scalp grafts extracted and possessing a "wide" color contrast be able to shave their head and not have what appears as a patchy or moth-eaten appearance?

 

Here's the burst in the bubble. Where are the clinical evaluations and findings regarding re-growth?!? Who is tracking the yield with some hard core proven reliable data? The biggest area of risk in FUE/FIT is TRANSECTION! In the hands of an experienced, skilled FUE/FIT surgeon this should be minimal and the good ones claim 10% or less. Based on what? That's the part we never hear or rarely hear about. I CAN tell you that punches under 1mm in diameter have proved to be disasterous regarding transection! Even the most experienced FUE docs like Dr. Feller will advise you that strip harvest WITH dissection of FUs under scope provide the lowest transection rates. And as Arfy pointed out, DONOR IS FINITE. Dr. Feller is continually looking for ways to improve transection and continues to improvise the instrumentation as is Dr. Rose with dermal depth analysis, and Dr. AP with donor area sealing, etc.

 

All three of these FUE/FIT surgeons have produced some phenomenal results (scarring and yield) so like anything else, results speak for themselves. Drs Woods and Campbell also do very good work and pioneered the technology.

 

FUE/FIT is very time intensive and typically costs twice that of strip so one has to really weigh all of the benefits of both approaches, strip or FUE including the cost implications. Dr. Poswal charges as less as $3.00 US per FUE graft and is located in India. He wrote me the other day and would like to do some seminars in the US however that will be some time in the future as more interest manifests in his work.

 

Patients with what is considered as a "mushy" derm, DO NOT make good candidates for FUE/FIT procedures and are better off doing strip. Patients with a "tight" curl characteristic run a high risk of unacceptable transection levels.

 

My advice on BHTs? Doing smaller cases seems to be the prudent approach especially when there is little to no published reliable data in this arena. BHT grafts can cost as much as $12.00 US per graft. OUCH! Can you imagine if the yield was poor? DOUBLE OUCH!!

 

The patients must decide for themselves which approach, that being strip or FUE benefits them the most. I do believe this technology has its merits but so does strip and I do not believe it is a one or the other issue. They both have their place providing the patient chose a competent surgeon.

[HairBeThere]

Bill,

 

forget the search option..

 

Just ask gillenator, he just cracked my nut shell wide open..

 

GREAT POST GILL!!!

[Robert_]

Yes, Gill, great post as always. I also watch FUE with great interest. Punch size always seems to be a hot spot. Like Gill said, smaller punch sizes can, indeed, increase transection rate exponentially which is unfortunate. However, if you think about the way the follicle lies under the scalp, it is definitely a wonder that all units excised aren't transected - this is a wonder of modern science to me. At the risk of an FUE vs. strip thread, some interesting points come to mind:

 

- What many people do not think about is the existance of all of the follicular units in a strip that cannot be utilized due to them being in their resting phase. This percentage of hairs can be up to 10% or more. I do not see this mentioned that much on the forums, but it is interesting.

 

- My greatest interest is why FUE does not seem to produce the yield that strip consistently produces. True, there is good yield at times, but one would think that the extraction method would only account for so much as the implantation method is the same.

 

- Donor area is, unfortunately extremely finite. I hate to sound like a broken record, but this is where the medications come into play as well as a good plan (just like everyone posted earlier). Any ethical physician will not hesitate to point out the limitations of hair tranplant surgery at this stage of the game.

 

-Robert

[Smoothy]

Gil the encyclopedia-- welcome with detail insight and explanation for some of the newer posters. I think too many people here something "new" and jump on the band wagon before it has been given time to perfect to a level of better results than current methods.

 

Yes, regrowth is starting to become an issue probably due to what you pointed out with transections, also, I've seen donor depletions with larger sessions look scary-- Just imagine when one is in their 60's 70's when your hair naturally becomes more coarse and finer-- if you had big sessions of FUE-- you going to look like a pok-a-dot board? I've personally already seen one case like this with 2K FUE.

[Guest]

So are you vets saying that strip is lower cost, better for larger sessions, and now finding out that the strip scar may be better than a bunch of holes?

[gillenator]

Robert,

 

Yes, you indeed are absolutely correct regarding the telogen follicules and you hit on an area that most of us do not think about. Both strip and FUE have their discarded waste and any way you look at it, there is more than 10% waste "thrown" out in the biohazard waste bucket! One of the big issues with strip is "time out of body", whereas the strip specimen is removed and then passed to the surgical team for dissection. A process known as ischemia reprofusion begins whereby free radicals begin to magnetize to the tissue which simply lies in saline to keep them hydrated. All the while and sometimes for hours, the tissue begins to deteriate and reduce potential for survival. The quicker that grafts are placed in the recipient area the better, however I have heard and seen the "assembly lines" where the clinic has multiple procedures that day, but few experienced techs who cut the tissue into grafts. Henceforth they jump from OR to OR and the tissue and cut grafts remain in the dish, sometimes for hours. This is not an ideal scenario so stay away from the assembly lines, and do not enroll with anyone who is more interested in how much revenue they can generate in one day in multiple patients.

 

FUE is supposed to boost the yield because the extracted grafts usually are placed in the recipient area within seconds of extraction "unless" more single hair grafts are needed and then the extracted FU still has to be dissected.

 

Robert, you are also correct in your reference to the angles and "j" formations at the base of the hair sheath in the dermis layer where alot of potential transection can take place. Does everyone see now why the 1mm punch is favored? In addition, the standard stainless steel punch does not allow the graft to slide out very easily so "crimping" of the grafts can take place. Some are so bad that they are often damaged when an attempt is made to remove them from the punch. Dr. Feller's punches have an interior wall which I believe can be removed allowing the graft to easily slide back out of the punch. Dr. Rose' dermal depth analysis allows his punches to precisely set the depth of extraction to minimize transection vertically speaking.

 

I can only speak for myself Fabe, but yes from the many cases I have seen, and in my own personal experience of three strip procedures, cost is favored with strip, transection is far lower providing the surgeon and the techs who cut are good and they are properly staffed. Many FUE docs agree with this assessment as well including Drs. Rose and Feller. Dr. Rose has mentioned to me several times that strip is still the best yield when a patient is in the right competent hands.

 

Most HT patients that I have experience with do not buzz cut their hair once it grows out, including FUE/FIT patients. The fine scar in my donor area does not bother me in the least because it is always covered and I never intend to shave off the hair that I so painstakingly waited to get back! I have had just over 4400 grafts in my lifetime and the last thing I'm going to do is cut it all off. That does not mean what is right for me is right for the next patient who may want the buzz-cut style.

 

Either way, patients must understand that you cannot have your cake and eat it too with hair transplants. When you harvest hair from an area, the outcome is less hair either way you look at it whether there is a strip scar or the dots, spots, whatever. The recipient area gains coverage and looks better and more restored because it is indeed hair that covers the scalp. Most of us if not all of us get hair transplants to improve coverage where there is little to no hair left. That's the premise behind the procedure for most of us. Unfortunately there will be some level of scarring in either approach of harvest so each and every patient must think ahead and then decide which method best serves their goals.

 

Smoothy, there are many, many patients who are on the sidelines with FUE. They just have not seen enough consistent results because as you said, it is still relatively new technology. If it were me as a new patient and needed lots of coverage, there's no question that I would favor strip to get the best yield and corresponding coverage. I could always go back and get hair placed in the linear scar as many FUE doctors claim a strip patient can do right? Still it is a personal decision for every individual. Best wishes to all!

[Kez]

I have to say I'm impressed with the level of expertise ( way ahead of mine), and the time you guys take with your posts on this forum.

 

Not so long ago, someone was suggesting this forum might be "going downhill". In my experience, it's the best forum for this kind of thoughtful in-depth discussion, in a slow-moving thread that stays around for enough time for people to give it thought.

[Robert_]

Gill,

 

I am definitely in the same opinion in that I think the most resourceful approach for a NW3+ is to utilize strip then FUE later IF they can live with the linear scar.

 

All in all, just like everything else in the hair industry it is a calculated measure of pro's and con's.

 

By the way Gil, do you have a "Dictionary of Great Terms" over there? Because I am now DYING to incorporate "ischemia reprofusion" into a casual conversation .

 

-Robert

[mathew]

I think Gil has mentioned most of the facts, except that dr.arvind's donor sealing protocol has effectively dealt with the pinpoint dots that many say may occur with fue.

I speak from experience even though I have been recently introduced to this forum.I have had fue as well as bht by dr. arvind and am going for another sitting soon.

 

,edited for promotional website content - Robert>

[Guest Gunner1886]

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>Most HT patients that I have experience with do not buzz cut their hair once it grows out, including FUE/FIT patients. The fine scar in my donor area does not bother me in the least because it is always covered and I never intend to shave off the hair that I so painstakingly waited to get back! I have had just over 4400 grafts in my lifetime and the last thing I'm going to do is cut it all off. That does not mean what is right for me is right for the next patient who may want the buzz-cut style.

 

This is probably the most un-answered question on the net, on HT's.

 

It involves, if a person has been using minox 5% all over 2 years previous to getting a HT.

 

My question being, how on earth would/can that person continue to use minox all over the scalp, once his hair has grown out?

 

Surely someone must have experience with this?

 

Example - a person who had a shaved head for 2 years, used minox all over - with the application being simple.

 

Then he gets a HT.

 

Once it grows out, he has to continue to use the minox because he will lose all the hair he saved etc.

 

The application becomes almost impossible.

 

Hard.

 

Difficult.

 

Because the HT is mixed in with Minox hair.

 

How?

 

Cheers.

[Smoothy]

Hombre,

Like any medical procedure, you will have patients with good results-- the question is the %percentage rates of donor quality. I dont think anyone will argue in a skilled surgeon's hand the receipient areas turn out good. The question now that FUE has been around a year or so, it the donor results in many patients are starting to show some challenging that need to be perfected (either with technique or procedures). I've personally seen 15 FUE patients and about 8 of them had good looking donor but 7 were starting to difuse a little and thus the "thinness" of the donor was revealing. (that is only a little over 50% success?). I'm glad you and your friend have had good results.

I myself will probably be a FUE patient due to limited donor availablity in the future. However, just like any new technique/procedure it will take a while to increase the successes. When FU came out over the micro grafts, it took about 4 yrs or so to perfect the success.

Hopefully the doctors you listed will continue to improve the quality and technique so that it will evolve into the next generation of HT. Right now, I believe their are challenges still to be worked out (in the donor/harvest area) before more surgeons adapt the approach for virgin scalps.

[Robert_]

Gunner,

 

Great question. I realize that I had never shared my own concerns with this topic before. I try to stay away from hawking anyone's products on here, but I feel that this applicator that I use from Spencer Forrest handles the situation of applying minoxidil to the scalp with longer hair rather well.

 

Applicator side

 

 

 

Backside

 

 

 

This is how I use it:

 

1) I apply 1/2 mL to the crown using the dropper. I then rub it in using the applicator.

 

2) I apply 1/2 mL to the hair line in three sections: middle, left, right. I then rub that in using the applicator.

 

3) Do other things for about 5 or 10 minutes.

 

4) I then come back and repeat the process with another 1/2 mL for each area.

 

That's right, I use 1mL for the hairline and 1mL for the crown. What can I say? I'm a rebel .

 

 

Keep in mind that you will still get minoxidil in your hair and you will have to blow dry it or towel dry it after giving it sufficient time to absorb into the scalp. At first implemeting this strategy into my morning routine was a pain, but after a while it became second nature.

 

I do the exact same at night also. At aroung my 6 month post-op point I will switch to 2% minoxidil in the morning and keep 5% at night.

 

I think the applicator cost $7, but it was worth every penny to me to keep the minoxidil off my hands, out of my hair, and on the scalp as much as possible.

 

Hope this helps. I realize that its probably not the best solution out there, but it has worked for me.

 

-Robert

[Bill - Seemiller]

Wow....thanks all for all the great responses. I don't think I have to search on google not thanks to Gill! I appreciate all the time and effort you took to share all that information. Now I am no longer ignorant as far as what FUE stands for and then some. Personally, I think I would still stick with strip (although I am still only 3 weeks out of surgery) so I have nothing to compare it too, but I don't mind a scar in the back, and we'll see because I've seen a lot of people here with the scar so undetectable with buzzed hair. My scar is undetectable right now because it is a little longer in the back, so I'll keep you all posted on that with pics. But thanks so much for the information!

 

Bill

[EastCoast]

I was told that the sides and back of the head has 30k to 40k of grafts. Taking 10% (3000 grafts) should not affect the donor area. Up to 10% is in telegon anyway.