FUE – 10.000 hairs, complete re-growth

[Dr. Jean Devroye]

This 40-year old patient was an ideal case : the donor area was very rich and the very lax*skin have allowed the FUE extraction with a very good quality.

 

In April 2012, the transplant was performed in two days.

4037 grafts for 10,347 hairs were extracted and replaced on the entire anterior area which was totally empty. The re-growth is exceptional*and complete.

 

The punch diameter used was of 0.9 mm which has allowed to harvest this very large number of hair. Indeed, the detail of the grafts is the following :

FUE1: 777, FUE2: 918, FUE3: 1634, FUE4: 4708. So, 2.56 hair per graft.

 

The use of a punch with an intermediate diameter of 0.9 mm rather than 0.8 or 0.7 mm allows a large harvest, rich in hair and poor in transection.

 

The aspect of the donor area with long hair is perfectly normal after the first intervention.

 

Of course, the picture of the shaved area taken during the last week shows the scars of the first two days of FUE. However it only becomes visible with hair shaved very short (less than 0.5 mm).

 

I also present you two pictures that compare the situation the day after the transplant and*after 7 months when the patient came for the second intervention.*

 

He decided to come back to perform a surgery on the crown area. This new*transplant graft has gathered more than 2000 grafts.

 

The overall result of these two interventions will follow in a few months.

[Raj Jayukdht]

Dr Jean I have read a member saying on this forum:

 

"One size does not fit all and the FUE doctors who are serious about the procedure know this and won't use one gauge for the whole procedure regardless of race".

 

Your comments on this please.

[Dr. Jean Devroye]

Obviously, we have to adapt the size of punches to each patient.

 

I do not use one size punch. I almost always use two sizes of punch for each of my FUE patient, one for the big grafts and another for the smaller ones which allows to extract a bigger number of grafts.

 

I use the following principle: choosing the smaller size possible if the harvest of nice grafts of 3 or 4 hairs is possible with a minimal transection.

 

In my opinion, it is better not to choose* a too small punch by definition. Because a too small punch* requires that the surgeon has to select the smaller follicles and on the other hand, it also increases the rate of transection. For the same number of grafts, the patient receives therefore less hair.

 

This topic is still very controversial. I am part of the new ISHRS committee, the FUE research committee. And it is one of the questions we will actively discuss.

[Mickey85]

Dr Jean I have read a member saying on this forum:

 

"One size does not fit all and the FUE doctors who are serious about the procedure know this and won't use one gauge for the whole procedure regardless of race".

 

Your comments on this please.

 

I made that post

[PupDaddy]

Spectacular FUE result! And one of the largest single FUE transplants (2 days) I've seen. Very good to see another successful large FUE session, achieved through excellent planning, punch selection, and execution on Dr. Devroye's part, taking into account the patient's particular follicular and hair characteristics and donor laxity and density. One more pass for the crown and this advanced NW patient is good to go, with a result that appears to rival the best of FUT.

[Blake Bloxham]

Excellent result! Thank you for sharing.

[zenmunk]

Of course, the picture of the shaved area taken during the last week shows the scars of the first two days of FUE. However it only becomes visible with hair shaved very short (less than 0.5 mm).

 

I'm sorry, but did you post that pic, Dr. Devroye? Is that pic 4 of 7, or is that a virgin donor?

[GBU]

I love seeing these big FUE cases . Thanks for posting it .

[Dr. Jean Devroye]

Thank you all for your comments and especially to Pupdaddy and GBU for their enthusiasm.

 

When we are lucky to have a "good" case (like this patient) with an excellent donor area, it is obvious that the choice of an adapted technique together with the efforts from the patient and the long work are rewarded (more than 20 hours of surgery in two days).

 

I'm posting some complementaries pictures of the intermediate situation at the first day. 
You can notice that the front line is not finished at the end of the first day. 
Actually, I knew that on the next day I would have more grafts of 1 hair and I preferred not to create artificially grafts because of the bigger grafts to come. 
Also, we can notice the perfect integration of the graft into the skin after 24 hours only.

 

I'm also posting some pictures of transplants. First of all, the petri boxes that show an important proportion of grafts of 3 and 4 hairs compared to the grafts of 1 or 2 hairs.

Then, I show you the grafts in a close up view: they are relatively chubby which probably also explains the extremely high rate of re-growth.

 

Finally, to answer the question of Zenmunk,

The picture 4 shows the donor area, the first day of the surgery. 
Unfortunately, the patient had it shaved so I do not have any picture of the original long hair area. But, the second picture with the long hair shows the situation at 7 months post op, it is impossible at this time to detect a decrease of the visible density in the donor area. This is also due to his very good donor area quality.

 

More pictures will follow soon.

[Dr. Jean Devroye]

About the FUE technique

[bloodshoteyes]

This 40-year old patient was an ideal case : the donor area was very rich and the very lax*skin have allowed the FUE extraction with a very good quality.

 

Can somebody explain how skin laxity improves FUE?

 

I was under the impression that this was a consideration for FUT not FUE.

[GNX1]

looks great! but, results are typically posted in GRAFTS not HAIRS. 10,000 grafts would be a hell of headline. 10,000 hairs not so much. a little misleading to those who do not know better imo but nonetheless great results.

 

howbout some pics of the donor zone and how it has healed?

[Dr. Jean Devroye]

Concerning laxity, I often notice that hyperlaxity is interesting either for the FUE or for the FUT.

Indeed, for the FUT, it allows to take a larger strip and thus to increase the number of grafts harvested.

 

The laxity provides a different benefit to the FUE.

As you know, the FUE is a two-steps technique, the more or less deep scoring and the actual extraction.

 

I often practice the scoring for 300 to 600 grafts before extracting them at a time.

For years, J.C has insisted on the importance of mastering the depth of scoring. Indeed, the graft has a cone shape, it becomes wider on its base. (see pictures above)

 

Ideally, the punch has to penetrate the less possible into the skin. Because the deeper we go, the higher is the risk of damaged hair and the transection rate.

 

On the contrary,* the more we remain superficial, the more difficult (or even impossible) is the extraction.

 

This is where laxity is important. When the skin is very lax, the extraction is often possible with a shallow scoring.

 

So, this has two advantages, a higher extraction speed (and thus a higher maximum number of grafts extracted in one day) and on the other hand, a lower transection rate.

[scar5]

Dr. Jean Devroye,

 

If I may ask.

When removing hair that was previously transplanted - say mini-plugs or just misangled follicular units, do you find that these are a challenge to extract and do you use a different approach in respect to punch size or scoring technique?

 

And if I may also ask.

Can you re-plant them nearby or is the damage to the skin in that area mean you have to replant them in an entirely different part of the scalp?

[Mickey85]

dr i just wanted to ask you your opinions on the pros and cons of manual and motorized punches and your sentiments on each. great work

[HARIRI]

Mickey 85, I believe Dr. Devroye uses Motorized FUE tool. I read this somewhere online. Its an article called the evolution of FUE tools.

 

" Dr. Jean Devroye – The Proprietary Motorized FUE Tool- In early 2009, Coalition member*Dr. Jean Devroye*began experimenting with his own motorized follicular unit extraction device. After months of careful research, Dr. Devroye perfected his device, which he named the Proprietary Motorized FUE Tool. Like the Feller tool, Devroye’s device is a rotary punch and reduces graft strain by taking advantage of a small, alternatively rotating (or oscillating) arc. Furthermore, the rotation is controlled by a foot pedal (or treadle), which allows the surgeon to focus both hands on the graft extraction. Additionally, Dr. Devroye utilizes a slightly larger punch on the edge of the tool (around 1 mm, compared to the 0.7 – 0.9 mm featured on other FUE devices), which he feels keeps transection minimal without creating unnecessary scarring. The Proprietary Motorized FUE Tool allows the surgeon to remove up to 1500 grafts in one sitting, and is available to other hair restoration physicians".

[Mickey85]

Mickey 85, I believe Dr. Devroye uses Motorized FUE tool. I read this somewhere online. Its an article called the evolution of FUE tools.

 

" Dr. Jean Devroye – The Proprietary Motorized FUE Tool- In early 2009, Coalition member*Dr. Jean Devroye*began experimenting with his own motorized follicular unit extraction device. After months of careful research, Dr. Devroye perfected his device, which he named the Proprietary Motorized FUE Tool. Like the Feller tool, Devroye’s device is a rotary punch and reduces graft strain by taking advantage of a small, alternatively rotating (or oscillating) arc. Furthermore, the rotation is controlled by a foot pedal (or treadle), which allows the surgeon to focus both hands on the graft extraction. Additionally, Dr. Devroye utilizes a slightly larger punch on the edge of the tool (around 1 mm, compared to the 0.7 – 0.9 mm featured on other FUE devices), which he feels keeps transection minimal without creating unnecessary scarring. The Proprietary Motorized FUE Tool allows the surgeon to remove up to 1500 grafts in one sitting, and is available to other hair restoration physicians".

 

Oh yes, I knew of his proprietary motorized punch but I want to know what he thinks about the pros/cons about manual and motorized etc.

[Dr. Jean Devroye]

To answer the question of scars

 

If I may ask.

When removing hair that was previously transplanted - say mini-plugs or just misangled follicular units, do you find that these are a challenge to extract and do you use a different approach in respect to punch size or scoring technique?

 

Yes of course. The transplanted hair tend to diverge inside the skin. So the classic use of punches often causes numerous transections. I often use a long but effective manual technique. It is a matter of realizing a very superficial scoring by means of a punch and then of using a fine needle to remove the hair of surrounding tissues.

 

And if I may also ask.

Can you re-plant them nearby or is the damage to the skin in that area mean you have to replant them in an entirely different part of the scalp?

 

When their state allows it, I reimplant the hair that is recuperated. It is sometimes necessary to have them retouch under the microscope. I often practice also the repair in two steps. During the first step, I remove grafts at first. Two weeks later, I transplant the same zone. It is also possible to make it in one step but I do not reimplant the hole made by the punch. I prefer to make new incisions.

 

To answer the question of Mickey85

dr i just wanted to ask you your opinions on the pros and cons of manual and motorized punches and your sentiments on each.

 

First, I am going to explain to you which was my approach. A few years ago, I was interested in the motorized systems on the market. I observed for example the work of two devices : the one of Dr Feller and the calvitron (ex neograft). They did not fit perfectly my expectations. Indeed, the basic idea was to realize exactly the same type of work with the engine as with the hand. For that purpose, I needed a system with a very big precision, capable of turning only a bare minimum of tours, just enough to make the cut. I also needed an oscillating system turning alternately to the right and to the left. I needed a mastering of this oscillation and also a fine control of the speed. I wanted also a system working on battery. I thus conceived a system using a hand piece of dentist. An aluminum heavy pedal completes the set. The punches used are the ones of Dr J.C.

I've been using the definitive version of my device for three years and practically found only advantages compared to the manual technique.

 

Indeed, the engine frees one of the hands of the rotation work. The hand so freed focuses much more easily on the orientation of the hand piece and the punch. It also allows to work in normally uncomfortable positions for the hand work. It allows to increase the number of grafts collected in one day. With the hand I reached 1200 grafts a day. With the engine I reach 2000 grafts. It has enabled me to decrease my FUE prices.

 

I do not use any more the manual FUE except in certain particular circumstances as the removal of old punches or the work on the beard.

[Mickey85]

thank you so much for the detailed reply doctor.