Case performed by Dr. Feriduni – 4374 FU in 2 procedures

[L0ke]

Case performed by Dr. Feriduni – 4374 FU in 2 procedures

FUE performed on a 47-year old Caucasian male with

• NW III vertex,Clas T

• Donor density of 80 FU/cm?

• Hair diameter of ~58-62 microns

 

 

Treatment plan

• 1st Follicular Unit Extraction Transplantation to restore the crown area.

• 2nd Follicular Unit Extraction Transplantation to attain an aesthetic reconstruction of the hairline and add more density.

 

 

Performed procedures

 

1st procedure (November 11th, 2015)

Follicular Unit Extraction Transplantation with 2354 FU

* 300 single hair FU

* 850 double hair FU

* 1204 triple hair FU

 

Parallel incisions in custom-sized blades technique (Cutting Edge blades of 0.8-0.9mm).

Extraction performed with a 0.8mm FUE punch with CIT Manual Punch Handle. No microscopic preparation of the follicular unit grafts.

 

 

2nd procedure (June 6th, 2016)

Follicular Unit Extraction Transplantation with 2020 FU

* 479 single hair FU

* 400 double hair FU

* 1141 triple hair FU

 

Parallel incisions in custom-sized blades technique (Cutting Edge blades of 0.8-0.9 mm).

Extraction performed with a 0.8mm FUE punch with CIT Manual Punch Handle.

 

 

No microscopic preparation of the follicular unit grafts.

[Gasthoerer]

Very nice result and yet another example that if you care about hair you will still care above your 20s and 30s.

 

However, I do have a question regarding this sentence: "No microscopic preparation of the follicular unit grafts.".

 

As an FUT capable clinic I assume you have microscopes available. Why do you not use them in your FUE sessions? How to you make sure that:

 

1) You have enough singles for the hairline. Do you cherry pick? If yes from which areas (nape?sides?)?

2) How do you guarantee that there are no doubles in your hairlines without a microscope e.g. a double with a dormant second hair.

 

Thank you in advance.

[L0ke]

Dear Gasthoerer,

 

First of all our apologies for the late response. Our clinic was closed last week (Easter).

I will get back to you with an appropriate answer from Dr. Feriduni himself as soon as the surgeries today are done.

 

Thank you for understanding and the nice compliment you gave us.

[Bill - Seemiller]

Gasthoerer,

 

I won’t try to answer for Dr. Feriduni But with the donor harvesting technique FUE, follicular units are typically not further dissected under microscope. Sure magnification is used during the excision process which includes both making the incision and extracting the follicle. Microscopic dissection is used during strip surgery to separate follicular units from one another and possibly even trim them down further. In most cases, a graft that’s harvested via FUE doesn’t need any further trimming and doesn’t need to be separated from another follicular units because one is harvested at a time.

 

So I’m guessing, although obviously each clinic is different and I will let Dr. Feriduni describe how things work at his own clinic, that the fact that microscopic dissection wasn’t used is because it’s not typically used in this type of donor closure technique.

 

Best wishes,

 

Bill

[Gasthoerer]

Thanka L0ke an Bill!

 

@Bill, I understand you explanation. However, there is a particular reason why I ask this question.

 

1. There is a lot of buzz about this topic, due to a recent post of a "X" (Name is obviously on the black list in here).

2. Erdogan recently published that he is going to use microscopes http://www.hairrestorationnetwork.com/eve/189317-asmed-dr-koray-erdogan-mantis-elite.html

3. Some FUE clinics seem to use them (to avoid multis with dormant hair) and some not.

4. Feriduni as a FUE and (!) FUT clinic must have microscopes and the staff to use it. Still, they do not use them and "advertise" that they are not used. I think they are the only clinic doing this (have them, not using them, and advertise not using them).

 

Kind of strange for me. What happens if you do not find enough Singles?

Do not misunderstand me, this is a nice result. It is more a general question.

[Gasthoerer]

You should make a list with trigger word :-/ From my last Posts almost everyone was under Review.

[Gasthoerer]

Any update?

[L0ke]

Dear Gasthoerer,

 

Thank you for your compliment.

Considering your question: nowadays, a latest state-of-the-art hair transplant without magnification is impossible. There are different types of magnification on the market, but in our clinic we choose to work with Zeiss loupes with a 3x , 4x, 5x and 8x times magnification ability.

 

There are some misunderstandings concerning the terms microscopical preparation and microscopical control. Please allow me to explain the difference:

 

1. Microscopical preparation

What is meant by preparation of the FU’s is basically “trimming” the FU’s with a surgical blade in order to reduce their connective tissue. This is mostly not necessary, especially when the dissection is done with a small punch size, e.g. CIT Punches 0,8 or 0,85 mm. That?s why we add this information always to our case reports. In general, it is possible to create the necessary amount of single FU’s by simply splitting a FU. Having a close look at the different donor areas - occipital, parietal and temporal - we see nearly in every case a difference in density, caliber and different types of FU groups.

 

Attached an example of the 3 different donor areas: occipital, parietal, temporal

 

There are much more and finer single follicles at the temporal area. Dividing the singles in “normal” and “fine” follicles helps, together with some more important points to create a natural hairline.

 

2. Microscopical dissection:

In my opinion, stereo-microscopical inspection is a must to evade “double” FU’s in the first frontal line. There is however no guarantee which excludes these at all times as there are also obviously some of them, who find themselves in the dormant - or telogen- phase, and which cannot be perceived under any type of magnification. After being extracted and dissected, we prefer to cool the FU’s temperature down to 4° Celsius whilst classifying them into groups of single, fine and normal ones.

 

Attached two images of pre-sorting the FU's after extraction

 

Double and triple FU’s are mostly divided together under loupe magnification. They are generally not classified in separate groups, as - in my opinion- the mixture of double, triple and sometimes also quadripple FU’s gives the most natural effect. That is also exactly what the nature is doing.

 

Attached an example of the donor area with a mixture of different groups (photo DermaLite)

 

Shortly before implantation we perform a final microscopical check of the single, fine and normal FU’s with our Mantis 5,0 microscope and store them per 50 FU in small platters. Also the double, triple and quadripple FU’s get prepared on small platters with 50 FU per compress.

 

Attached an image of the FU's being prepared on small platters and an close-up of the FU's

 

 

 

My apologies for the belated answer. I hope you are satisfied with my personal reply.

 

Kind regards,

Dr. Feriduni

[Gasthoerer]

Thank you very much. A very detailed and very clear explanation which I am sure will helps many (future) patients. And maybe it will calm down the discussion in the net.