• Welcome to Hair loss Experiences hair loss forum.

    Free impartial hair loss advice, hair transplant advice, hair loss medications and hair loss news.
    You can contact us directly at [email protected] if you experience any problems.

FUE Donor Management

P

Philb

Member
Likes
0
#1
FUE has and is heralded as the scar free saviour of HT patients. The safety zone for FUE can be measured and sectioned in to three areas; simply both sides and the back, then the total surface area calculated. The density is then measured in each area and an average overall density taken using a magnifying densometer; the natural FU groupings measured and an average taken including miniaturisation of hair in the donor safety zone.

The number of grafts available for extraction can then be calculated; taking into consideration not over harvesting and leaving the donor €œmoth eaten €. To ensure not to over harvest there must be a limit to the number of FU that can be removed per cm2; removing much more than 30% per cm2 will noticeably thin the donor area and potentially cause obvious visible scarring over a large area of the donor and create problems for future procedures.

The punch size used will affect the number of FU that can be safely removed; incorrect punch can increase transection of the removed FU, damage surrounding FU cause larger and more visible scarring. With a small punch there is a risk of transecting the FU being removed if the group is too large to be encompassed by the diameter punch, therefore cutting the FU causing the loss of a hair from that FU and reduce the total hair numbers placed. When a large punch is used it has the possibility to cut into an adjacent FU if the density of FU is high. This either means taking two genetic groups at the same time or splitting and transecting one of them, for example two 2 hair FU or maybe a 3 hair and a 1 hair in the same punch OR maybe taking an intact 3 hair FU and dissecting another and a likely conclusion is killing a hair and traumatising the surrounding hairs.

Included in this problem is the pattern of extraction; to use a large punch and over harvest in an area will leave obvious thinning and density changes in the donor; this will result in the donor potentially being too thin for further extraction even from a relatively small number being removed; say 2000; this has been called €œhairless areas € but simply is larger scarring be it obvious or not OR over harvested areas.

The larger the incision made into skin has the potential for greater scarring; obviously the skill of the incision will have an impact but simply a larger hole is made in the skin tissue and more fibrosis is caused and greater pigmentation alteration; thus making the scarring potentially more visible and larger. If the larger punch is used and the extraction pattern not monitored to approximately 27% the donor can visibly lose density, because a €œmoth eaten € look on the scalp and make it almost impossible to harvest any amount of grafts.


Below is a section of a report made with Dr Bisanga and with great thanks and hard work to Peter Mac a few years ago discussing the FUE procedure and the pros and limitations; it shows the effect of a 1.1mm punch on the surrounding FU and smaller punch on larger FU groups; also that a .75 mm punch can surround a 4 hair FU without transection and thus cause less potential scarring.

Follicular Unit Extraction when the limitations are adhered to can be an excellent form of hair transplant. The limitations are the use of the correct punch size, not to extract a combination of FU in one punch; not to over harvest the donor to extract more FU and leave the donor thinned.




Some criteria have changed within the report since it was first published, for example the ability to be able to remove a larger hair FU with a 0.75mm tool.
 
Bigmac

Bigmac

Administrator
Staff member
Likes
9
#2
Great post Phil.

Very informative.

You say at the very bottom- quote (Some criteria have changed within the report since it was first published, for example the ability to be able to remove a larger hair FU with a 0.75mm tool).

Does this mean that the follicles need to be close together as in the diagram the 0.75 punch is very close to the bulbs of the outer follicles and therefor they may get damaged upon extraction.

Thanks bm.


 
P

Philb

Member
Likes
0
#4
Hi bm,

A number of aspects changed, time moves on and a greater understanding of hair hair splay and skin character is developed. Obviously if the person's hair in an FU are spread wider than normal this would make it harder/impossible to remove with a 0.75, but if that was the case in some respects it may mean them not being a candidate because their density would be lower than ideal...maybe; but in some circumstances it may need to be 0.8 if the hair characteristics are strong and the FU area is wider. That said it is possibly to remove larger FU with a 0.75 as long as you understand what is going on within the skin, the direction of the FU takes below the surface.
 
Bigmac

Bigmac

Administrator
Staff member
Likes
9
#5
Thanks Phil for that.

Can i ask does Dr Bisanga prefer waved or rounded fue punches.

Cheers bm.