Piloscopy vs mFUE

[Davis91]

Hi folks

 

So--

 

1. mFUE: eliminates transection rates of FUE as it is like an old punch but with new instrumentation and you sew it up and get 1 mm (hopefully) scarring; linear scar elimination, and say you need 3,000 grafts you might have about 166 (at 18 hairs each punch) 1 mm linear (or vertical) scars in your safe zone spread out, allowing you to wear your hair short. Disadvantage: still leaves (like FUE) a zone of fibrous scar tissue spreading out around the 166 theoretical scars, making getting future hairs tougher. Strip quality results though in terms of lack of transection , etc.

 

2. Piloscopy (as I understand it from Dr. Wesley): goes under scalp, grabs the fatty grafts, virtually no transection, strip quality results, no scar. 3,000 grafts still means 3,000 punches, but it just leaves a thinned out area like traditional FUE, but no visible external trauma. What about though a zone of fibrous scar tissue around each sucked out graft beneath the surface? Does it make it harder to go in around those grafts later to get more, like traditional FUE?

 

3. Strip: big scar, but still relatively virginal scalp tissue above and below scar.

 

While I personally see a very boutique approach emerging for the needs of each patient, I am wondering about the strip quality nature of Piloscopy (Scarless FUE), vs the strip quality nature of mFUE (different type scar vs. FUE). Has this been discussed??? Piloscopy was the other big new piece of technology/technique to emerge recently.

 

Thanks

[Blake Bloxham]

Davis,

 

Very interesting thread! I haven't thought about comparing mFUE and piloscopy before.

 

Let me see if I can address some of your points:

 

mFUE:

You seem to hit on a lot of the high points here. Strip-level results with FUE-level scarring. And you are right about traditional FUE causing a lot of fibrotic scarring throughout the donor area and this making subsequent extractions more difficult -- which makes yields MUCH more variable. However, the mFUE technique addresses the subcutaneous scarring issue. Granted, it will still be more than strip. However, because only a fraction of insults -- cuts -- are made to the scalp, the amount of scarring is much less. What's more, the amount of FUGs we can get from one mFUE graft allows us to leave a lot of space between the punch sites. This means more areas where there is no subcutaneous scarring -- like strip -- and none of the "confluence of scarring" Dr Feller talks about -- where the scarring from very close FUE sites comes together and forms a sheet of scar tissue under the scalp.

 

Piloscopy:

Dr. Wesley's technique set out to address two issues: scarring from FUE and FUE graft quality. Based on his studies -- which I've referenced here many times -- his yield from these grafts is much closer to strip. He also shows that this is because they contain an appropriate amount of supportive tissue. MFUE grafts fall under the same category. I don't think there is as much information about the scarring. Now, there will not be traditional scarring on the surface of the scalp because he's going underneath. However, you do still get the "thinning" you describe above, and you'll get the same fibrosis under the scalp (I can only assume, at least).

 

In my opinion, the biggest difference between the two techniques right now is the availability. The piloscopy device/procedure is still being trialed and tested experimentally. However, we are currently offering mFUE procedures. We will watch it all unfold from here. Very exciting!

 

Again, very interesting thread!

[Davis91]

Thanks Blake

 

I hoped it would be interesting but not too many replies. Really hopeful that Dr. Wesley might pop on at some point to clarify if his new technique would leave the same scarring fibrosis under the scalp and potentially limit multiple sessions.

[adonix]

 

 

mFUE:

You seem to hit on a lot of the high points here. Strip-level results with FUE-level scarring.

 

 

 

This is not proven, and until we have a decent sample of successful cases, we should avoid such claims.

 

 

 

 

And you are right about traditional FUE causing a lot of fibrotic scarring throughout the donor area and this making subsequent extractions more difficult

 

 

 

This is not true. Dr. Vories already replied to you in another thread that in his experience there was no difficulty whatsoever in subsequent surgeries.

[Blake Bloxham]

Adonix,

 

The subcutaneous scarring is simply physiology. I've explained it -- with diagrams -- many times. It happens, and one person saying it doesn't isn't proof. Until we have a decent "N," I think, as you stated, we should "avoid such claims."

[adonix]

Adonix,

 

The subcutaneous scarring is simply physiology. I've explained it -- with diagrams -- many times. It happens, and one person saying it doesn't isn't proof. Until we have a decent "N," I think, as you stated, we should "avoid such claims."

 

My comment was not about scarring itself, but about subsequent extractions. No proofs whatsoever on that statement. If you look at dr. Lorenzos surgeries for example, you may find proof of fantastic yield in subsequent surgeries - more than a decent "N".

[JoeTillman]

Regarding piloscopy, I am of the opinion that the scarring will much less than either procedure simply because there is no full depth or even partial depth (as is performed by some FUE surgeons) incision to get the follicles out. One "major" incision of about 1cm is needed to insert the piloscopic mechanism for extraction and that's it. Any scarring will, I believe, be extremely minimal underneath and non-existing superficially but of course it goes without saying, but I will anyway, that I'm not completely versed in all of the details of piloscopy.

[Blake Bloxham]

Where did Dr L say the extractions were not more difficult? What was the yield of these subsequent procedures? How do we know there were not more attempts made to failed deliveries? How do we know how many grafts were wanted versus how many they were actually able to extract?

 

So, you're free to disagree, but this isn't evidence to the contrary.

[mav23100gunther]

My comment was not about scarring itself, but about subsequent extractions. No proofs whatsoever on that statement. If you look at dr. Lorenzos surgeries for example, you may find proof of fantastic yield in subsequent surgeries - more than a decent "N".

 

Busa, is that you?

[adonix]

Where did Dr L say the extractions were not more difficult? What was the yield of these subsequent procedures? How do we know there were not more attempts made to failed deliveries? How do we know how many grafts were wanted versus how many they were actually able to extract?

 

So, you're free to disagree, but this isn't evidence to the contrary.

 

The evidence part goes both ways. Instead of proving otherwise, you resort to asking open ended questions.

 

In any case, I responded to point out to holes in your theory on "mFUE" (in my opinion should be called "mFUSS").

 

My advice, rethink your approach to marketing. Its a thin line and could backfire very quickly. Your reputation could be ruined before you even had a chance to build it.

[FUE2014]

Out of interest, why is it not called mFUT / mFUSS?

[KO]

My comment was not about scarring itself, but about subsequent extractions. No proofs whatsoever on that statement. If you look at dr. Lorenzos surgeries for example, you may find proof of fantastic yield in subsequent surgeries - more than a decent "N".

 

No, you cannot find any proof of "fantastic yield". You do not even know the yield in the first surgery.

[Blake Bloxham]

2014,

 

Dr Feller tried an "mStrip" or "mFUSS" approach in the past. He literally took out small little strips from various different areas of the scalp with a scalpel and closed them up. He was unhappy with the scarring and abandoned the idea. This is a modified strip approach. And it's not what we do with mFUE. We utilize a punch tool to remove FUGs from the safe donor region to perform Follicular Unit Hair Transplantation via a non-strip method. The technique was also created as a way to perform FUE on a patient with a wrecked donor and no real chance with traditional FUE. Hence, modified FUE. Don't know what else to call it. Haha.

[FUE2014]

Thanks for clarifying Blake.

[Blake Bloxham]

No problem! We look forward to sharing more mFUE content/cases soon as well!

[Dr. Carlos Wesley]

Here is a video summary of the lecture I delivered at last week's ISHRS Scientific Meeting in Chicago. It provides an update on the status of piloscopic hair surgery as well as a few live surgical clips.

 

The password for viewing is "piloscopy"

 

 

 

 

[Dr Blake Bloxham]

Nice! Going to watch this later today!

[Cuttlefish]

Dr. Blake

 

Quick question, as someone who underwent a 3100 FUE procedure themselves, I am curious to the MFUE. I'm very happy with my procedure and am thrilled with the results that I'm achieving so far. I'm a class 5 with the dreaded "fine haired" donor hair characteristics so I know that I can only achieve so much with a HT. However, I'd like to opt for another procedure if possible.

When you and Dr. L have done the MFUE on previous FUE patients, what were the tissues samples like regarding the previous procedures scarring? Did the MFUE offer some flexibility with the tissue samples and still allow the surgeon to "cherry pick" good grafts? Or has the result been the same as if another FUE was done? Would you say that MFUE (in your experience) offers some flexibility on previous FUE patients? Or would you advise them to stick to the procedure that they started with in order to maintain hair symmetry?

I apologize if I'm not phrasing the question correctly, I'm simply trying to see what my options are. Again, very happy with my procedure and my chosen surgeon, just curious is all.

[Dr Blake Bloxham]

Hi Cuttlefish,

 

When we've done mFUE on past FUE patients, the tissue samples were essentially as you'd expect: obviously there were less grafts per centimeter simply because they were removed via traditional FUE before; and there was more fibrotic scarring in each mFUE graft. However, we were still able to obtain good grafts from these patients because we weren't trying to pull them out individually from the toughened scar tissue surroundings.

 

In large FUE sessions, cherry picking is a bit of a myth. If you need 3,100 grafts like you had, you really don't have a lot of room to "cherry pick." What's more, FUE is a blind procedure. This means you only see what is actually growing above the skin. What you think may be a "cherry picked" single, may actually be a double graft with a telogen hair in the follicular unit (FUG) below the surface or what appears to be a dark haired single, but is actually a double with one dark hair and one of those tricky white/gray ones in the FUG. So I wouldn't say there is really any more or less cherry picking with mFUE. Of course you can't single in on one particular FUG like you can with FUE; like I said above, however, this isn't really something done in decent sized cases regardless.

 

As far as the quality of the grafts coming out of post-FUE scalp, they are without a doubt healthier with mFUE. If this wasn't true, we wouldn't even be doing the technique!

 

As far as which procedure you should seek next: tough question. You'll get better quality grafts with mFUE. However, the scarring with mFUE and FUE is slightly different. FUE creates thousands of tiny little circular scars and a general thinning of the donor region. Whereas mFUE creates dozens or hundreds of slightly larger (but we're still talking millimeters here) more "dash" like scars that are spread much farther and, therefore, don't create the same generally thinning in the donor. My concern with switching from FUE to mFUE would be exposing the mFUE scarring in the donor because it may already be thinned out with traditional FUE. Remember, however, that this is all minutiae. The scars from both are difficult to visualize, so it may not even be an issue. So I think it would be weighing better graft quality versus potentially seeing the mFUE scarring in the donor because it's thinned out from the prior FUE.

 

Can you post some images of the donor and results? This may help. You can send them to me privately or by email (blake.bloxham@gmail.com) if you'd like as well. And of course we'd always be happy to evaluate you in person if it's doable.

 

I hope this helps! Very glad you are pleased with the first procedure!