• 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.








 

Attachments

janna

janna

Invaluable Member
Likes
2
#2
Phil,

I really like your informative posts. It seems we share a lot of the same philosophy and techniques between our clinics. I like the fact that your clinic performs FUE and Strip - and you seem to handle both appropriately and responsibly. Thanks once again for sharing your info with everyone.
 
Nervousnelly

Nervousnelly

The Coolest Member
Likes
0
#3
Very informative post. I too believe that FUE is an excellent alternative to strip in certain circumstances but I have never been one to agree that it is a replacement UNLESS the patient only requires and will only require a smaller sized session. This is ofcourse just my opinion.

Also, the figure of maintaining an extraction figure of 30% or less is certainly a good gage, but I also think that it should not be a rule of thumb. I have seen some people that had a thinner donor to begin with and even though things were harvested properly, they still looked too thin post HT. Moreover, as we all age the donor area will naturally thin as well and if a person loses 20% naturally plus 30% from a FUE HT then they are in trouble. We sometimes think that this wouldn't happen until a person is old and could care less, but it could happen in the 50's and 60's and I know that people would still be very self contious.

NN


 
P

Philb

Member
Likes
0
#4
Nervousnelly wrote:
Very informative post. I too believe that FUE is an excellent alternative to strip in certain circumstances but I have never been one to agree that it is a replacement UNLESS the patient only requires and will only require a smaller sized session. This is ofcourse just my opinion.

Also, the figure of maintaining an extraction figure of 30% or less is certainly a good gage, but I also think that it should not be a rule of thumb. I have seen some people that had a thinner donor to begin with and even though things were harvested properly, they still looked too thin post HT. Moreover, as we all age the donor area will naturally thin as well and if a person loses 20% naturally plus 30% from a FUE HT then they are in trouble. We sometimes think that this wouldn't happen until a person is old and could care less, but it could happen in the 50's and 60's and I know that people would still be very self contious.

NN
Hi NN,

I could not agree with you more on this issue and it is a very important point you make about the 30%. This is in optimum conditions and never over one procedure anyway, one point is Dr. B will not do more than 3000 in one procedure and even then may not reach that amount if he feels the donor capacity is not there.

FUE is not suitable for everyone if you feel there is a reasonable limit to what can be extracted; the average density of the donor, the amount of hairs per FU and miniaturisation as well as patterning of hair loss all have to be taken into account. We see many and refuse point blank FUE as a technique whereas many clinics would just take them and justify as there is no strip scar it is ok. The fact is FUE can cause as much long term problems as any surgical procedure and this is a point that must be understood by the potential patient otherwise down the road they can find themselves with little to no options available.

As for age, a case comes to mind that illustrates your point exactly, 47 year old man NW3, by the time he was 55 he was a NW5, no health related conditions just the late on set of MPB; not overly common admittedly but happens and so design and long term planning should always be major factors when deciding on any form of HT.
 
Nervousnelly

Nervousnelly

The Coolest Member
Likes
0
#5
Thanks for the reply Phil. I love Fue and what it can do but hope that proper management is practised with all clinics.

NN
 
A

alam13

Member
Likes
0
#8
I'm not sure where you are getting your information, but great topic. I needs to spend some time learning more or understanding more.:whatever: