Dr. Lindsey VIDEO Mfue case repairing previous FUE work, surgical technique shown

[Dr. William Lindsey]

Here is a video of an MFUE case in progress. I've had lots of requests to show how the grafts come out, and how the incisions are closed. Also included is postop day 9 suture removal. Regular viewers of my MFUE cases will note that we wait until day 10 to remove sutures to get the best scarring....however this guy is unique. When we did a strip on him to repair his no-growth FUE (done elsewhere a few years ago), he wore a bandanna immediately after leaving the office...staff saw him in his jeep...and really did no care. Despite that his strip scar was fine, good actually, and he probably auto-extracted several HUNDRED grafts along the hairline. So he said we need to take the sutures out today..or he'd get a friend to do it...thus they came out a day early.

 

Today's goals are to work on new MPB, and bolster his hairline...from where he almost certainly pulled his own grafts out last time. And to wind up with minimal donor scarring and no significant tightness of his scalp. He had complained of SIGNIFICANT long term burning sensation after his FUE but had none after his strip. So we'll see how this is with MFUE.

 

Again he did no cleaning but looks pretty good. He doesn't appear to have pulled out grafts and I expect to see him in a month for a scar check.

 

The video link is:

 

Dr. Lindsey McLean VA

[newbie33]

Thanks for sharing.

 

Few questions: on the average virgin scalp, how many grafts do you think you can extract using that method alone?

 

The closure - did you just use a single stitch per punched out area? Also, any pictures or descriptions of what those scars will look like when matured after a year or so? (I can't really picture how they would look).

 

And, finally, why did you blindfold the cameraman? ;-)

[PupDaddy]

Thanks for posting that fascinating video, Dr. Lindsey. I'm starting to get a better idea now of the mFUE process. I look forward to seeing followups showing mFUE patient's fully-healed donor scarring following significant sized procedures. Based on your videos and my understanding of the technique, I see no reason not to expect the same consistent growth percentage of grafts harvested via mFUE as is achieved with grafts harvested via strip since both use visual, microscope-assisted dissection of the fu's from the excised tissue and both methods maintain the supportive tissue surrounding each fu graft. Correct?

 

I counted about 26 elliptical segments extracted that yielded the 1692 follicular unit grafts for this case. You seem to punch out the segments in "rows" to form sort of a broken horizontal line, is that right? How many "rows" of extracted segments did this case entail, if you recall?

 

Would you say that the benefits of mFUE scarring v. strip scarring come from (a) a pattern of broken/dotted "lines" of non-continguous short scars rather than a solid linear scar, and (b) less tension on the closures of these short, punched out elliptical sections versus the tension along the upper and lower edges of a solid linear strip wound?

[Dr. William Lindsey]

Hey Newbie

 

Good question. I'd guess if we could get say 6000 grafts out of a guy with 2 strip cases, with MFUE, trying to keep the scars good, we can probably get 4000. Honestly I don't know but I think that if you really need 6 or 7 thousand...do a strip or 2, keep them skinny so the scars are ok, then finish off with MFUE.

 

Here are a few videos showing scarring at different stages..there are multiple threads on this forum showing several of these at a week, a month, 2 months and a few at a year or so.

 

 

 

 

and this was the first one: and pics at 364 days postop of donor area shown in the video.

 

 

And Stefanie did the videoing, not me this time as I was cutting. She's a good cutter but I agree, not a great video person during the punches.

 

Finally I've tried lots of ways to sew these boys up... one per punch works best.

 

Dr. Lindsey

[Dr. William Lindsey]

Pupdaddy

 

Good question. I think you can get the same number of grafts out of a head with mfue and strip...BUT you'd have more scars... so see the answer I gave newbie. If you need a TON, do strip and tune up or finish with this so that you'd have 1 good strip scar and really good mfue scars...

 

If you need say 3000 or so tops, I think you could do either.

 

I have tried staggering punch sites and keeping them in a line. Seems like its easier on most patients to keep them in a 1 inch band but not so close together that you are just getting a strip...

 

My only concern would be doing a bunch in a row down low, then above that the blood supply might be a little diminished.

 

Given that we're staying under 2000 grafts/case right now, its not a problem. With more experience on healing I'll have a better answer on that.

 

Thanks

 

Dr. Lindsey

[home1212]

really interesting to see you perform the mFUE technique Dr. Lindsey, thanks!

[Dr. William Lindsey]

Thanks

 

You know, its just another option for guys to consider. I personally think you get essentially strip quality hair with no linear, but multiple small, scars.

 

And its doable even it pretty tight scalps...like old plugged out guys needing 1000 up front to fix the plugginess.

 

Dr. Lindsey

[Dr Blake Bloxham]

Dr L,

 

Awesome video! Seems like this was a good mFUE candidate and a great case. Look forward to seeing the results mature!

[Dr Blake Bloxham]

Newbie,

 

I think the best way to describe the scars is "little dashes" spread throughout the donor. That's how Dr F and I have been discussing it, at least. I call the scarring from mFUE "FUE-like" because it is non-linear scarring spread throughout the donor. But the scarring itself is actually a bit different: FUE produces thousands of small, circular, scars tightly packed and spread all over. Each mFUE "dash" (and this shape is especially true when we've been closing the circular punches -- opposed to the elliptical ones Dr Lindsey is using here) is larger than an individual FUE scar, BUT they are spread MUCH farther apart and there are a hell of a lot less of them. This not only creates, from what I've seen thus far, a very nice result cosmetically, it doesn't compromise the donor in the same manner.

 

Here are a few examples:

 

 

 

 

 

Edited October 1, 2015 by DrBlakeBloxham

[Dr Blake Bloxham]

Pup,

 

Good questions!

 

Yes, the yield should be absolutely the same. The grafts in the mFUE punches are beautiful, and we dissect them in the same microscopic protocol that we do traditional FUT.

 

We've done both very sporadic spreading (like traditional FUE) of the punch sites, and more of a linear plan like Dr Lindsey outlined above. There are advantages and disadvantages to both, but it does seem to be advantageous to create an "organized chaos" sort of game plan with respect to harvesting. What this means is that it is not a completely random spread, and it does have some overarching linearity to it. BUT, you can still create a very random pattern within this overall design and make it look very scattered. When you do this, it's very difficult for the eye to pick up any patterns or focus in on any continuation of the scar. And it results in the wide spreading of the sites like I've described before. This seems to be the key to a really successful mFUE: punches larger than traditional FUE, spread far apart, with lots of healthy tissue between -- to break up any scarring, facilitate good growth, and leave us with lots of healthy donor to utilize in the future.

[newbie33]

Thanks Dr Lindsey. Thanks Dr Bloxham.

 

Questions for either of you. On the average, how many total grafts could you get from stripping out, then getting mFUE? How does that compare with stripping out then FUE (I know you'd argue the yield from such grafts wouldn't be the same - but just humour me!). And would it be possible to strip out, get mFUE, then also some fue?

[Dr. William Lindsey]

I'm not sure I fully get your question. I think that 2 identical heads would yield x grafts by strip and 0.7x grafts by mfue, figuring the inefficiency of multiple little scars. By contrast having done 400 or so plug repairs I'd say that you can get 0.4x grafts with old plugged out guys scar filled heads.

 

If a guy has say 10k grafts in his donor area, say a class 5 or 6 with dense hair, well you can't take everything or he'll look ABNORMAL. So figure maybe you can harvest 6 or 7 k of that. Well, I suppose that would be 2 good sized strips, then wait a spell and see if any areas need refinement... IF so, or if he needs a little more, then yes, either FUE (assuming you could work above or below the strip scar without donor depletion) or MFUE could probably get you another 1000 or two but you'd have to be careful.

 

Remember, perfection is the enemy of good. Don't take a B+ result and tweak it into a C-. Advice I give patients AND my kids.

 

Dr. Lindsey McLean VA

[newbie33]

Thanks Dr Lindsey.

 

Yes, my question was basically about maximum number of grafts you could take and what combination of strip, fue and mfue would give you the max amount.

 

I'd wager there's more chance your patients would listen to that advice than your kids!

[Dr. William Lindsey]

Haa.

 

Not a chance. As you may have seen in other posts...I have 2 problems with a significant number of patients every year.

 

First...cleaning. I am SURE that if you let crusts build up enough that they'll pull out grafts. And guys are afraid to clean for fear of pulling out hair or pain... We offer people to come in as much as they want to make sure they are cleaning but still most guys don't clean enough, even when I'm fussing or griping at them.

 

Second...resuming normal activities on day 8 (10 for MFUE). When I take the sutures out on day 7 of our patients....they can do anything except stretch my scar with crunches or bench pressing on my scarline.... They can clean normally, run, sweat, party...anything. I ask that they stay out of helmets til day 12 but really anything. Nevertheless, 25% email me at 2 or 3 months asking if its ok to exercise.

 

Now that second one is not really a problem...but does illustrate that people more or less do what they think is best no matter what I say.

 

And at least until my kids are making a living on their own...yeah they listen to me. Both are good kids. Daughter answered the phone in the office this summer, son did his 4th summer of graft cutting and is superb.

 

Dr. L

[Dr. William Lindsey]

So he stopped by today, now about 6 weeks out. You'll see in the photos that his MFUE sites are tiny and that on the left most one, there is an ingrown hair...which prompted him to stop in unannounced this morning.

 

Dr. Lindsey McLean VA

[Dr Blake Bloxham]

Nice! The sites look really good. Especially for 6 weeks.