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FUE: Important Points to Consider

sl

sl

BHR Clinic Patient Advisor
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#1
FUE: Some Aspects to Consider

FUE Donor

FUE relies much more than FUT on the candidate having a good donor hair density to reach higher numbers, all round good density and not just in the occipital (back). If by splitting the safe zone into areas prior to extraction it is possible to calculate whether the donor is viable for FUE and how many grafts can be extracted now and in the future. It is unlikely FUE will ever be able to reach the same number of transplanted follicular units than FUT assuming not to over harvest. As one benefit of FUE is no linear scar it can also be said that a benefit is the hair can be worn shorter or maybe shaved, but this can only apply if the supply of the donor is not over harvested otherwise although a linear scar is not left obvious signs of surgery can be evident.

Miniaturisation

The % per cm2 of miniaturisation in the candidate €™s donor must be calculated and assessed before considering FUE as it could preclude certain areas of the donor to be left untouched and not suitable for harvesting. Most people will have a degree of miniaturisation in the donor but if it reaches too high levels for FUE can make the candidate unsuitable. Simply the hair gives less thickness so if more good hair removed and the miniaturised left it will reduce the thickness of the donor and maybe even leave it see through in places.

Hairs per FU

An under average hair count will greatly restrict the usage of FUE as a technique, regardless if the donor FU count is average to good. Low hair count can minimise the coverage and subsequent result achieved.

Harvesting Protocol

Regardless of the size of the surface area to harvest and the obvious that it is larger than the FUT safe zone does not conclude that more FU can be removed. FUE safe zone is only the indication of where the FU can be removed from and as this surface does not change in size even when the FU are removed the amount of FU will be restricted other factors so as not to leave large gaps/holes/hair less areas or visible scarring between each extraction. Dependent on hair count, density, miniaturisation and general hair characteristics can determine the % viable to remove whilst maintaining a €œclean € looking donor.

Harvesting protocol is important almost regardless of the size of procedure large or small can have a lasting effect on the donor. It can effect the long term number of FU that can be removed from the donor and literally make the difference of maybe 1000 plus less or more FU available to take.

Extraction Pattern

Allowing for an educated and well planned extraction pattern will not compromise the donor as much and give greater options for more grafts using FUE in the future. The pattern of extraction is random to the point it is has to be calculated to not leave obvious areas of no hair or any uniform signs of pre meditated extraction, €œfactory extraction € with an obvious pattern seen when short/shaved.



Punch

Diameter of punch will have a consequence on removing an intact Follicular unit, partial unit or more than one unit in a single punch. This can cause increased transection and loss of hairs in the donor that cannot be used, it can create larger scarring and peripheral damage to surrounding hair units.

The design of the punch will obviously have a role in the cosmetic and precision to punch, size, motion etc but the usage and innate skill of the Doctor extracting will override this as the tool is only the €œinstrument € of the master. Direction, depth, force, skin texture to name a few are all measured by the Doctor and the more understanding of this and more will result in low transection, less scarring and a greater number of FUE grafts available to harvest long term.

FUE Grafts

FUE grafts are generally leaner and more refined than FUT grafts, greater care must be taken with them, when extracting, cleaning and during placement to ensure they are not traumatised, damaged or killed.

Laxity

This can lead on from Extraction Pattern as too many punches adjacent or in an enclosed area can affect the laxity of the skin and in turn make future procedures harder to perform, be it FUE or FUT.

Hair Direction & Characteristics

1. Again leading on from Extraction Pattern, the skin is flexible and incisions into the skin will have a €œripple effect € across the area, too many ripples in a confined area will knock on to adjacent un touched areas and can affect the surrounding hairs, again making future extraction technically harder.

2. Variants in hair characteristics will make some candidates better suited to FUE than others, as FUE is a blind extraction technique it is only possible to see the hair exit the skin but under the surface it is a calculated assessment of the direction, especially in cases of very curly hair for example when the hair can exit one way and do a total U Turn in the scalp.

FUE & Repairs

FUE has given a real and notable benefit to those who have had procedures in the past and the typical strip option is no longer available either due to laxity or over harvesting. As FUE opens the safe zone wider it allows for hair to be removed away from the previously worked areas and can add valuable grafts to a candidate who maybe thought their donor was tapped out.

FUE for High NW cases

Although FUE will not yield in one or multiple procedures more than FUT or by combining the two techniques it can still be used on higher NW cases. Obvious restrictions apply as exampled above and of course the goals of the candidate, as in any HT. But for example, and this is becoming more asked for those that are not looking to have a €œfull head of hair € and still want to keep their hair short or even shaved especially in the donor can still benefit from FUE even NW6. This is under specific circumstances generally.
 
Bigmac

Bigmac

Administrator
Staff member
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#2
Great post and very educational.

I enjoyed reading this,thanks for posting it.

bm.
 
U

UK Chap

Member
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#3
Thankyou for posting this article on "FUE". The miniturisation aspect of it was interesting.

Best regards Chappers.

 
Bigmac

Bigmac

Administrator
Staff member
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#5
Quick question Stephen.

If a graft is extracted and you see its miniturised,do you discard this or implant it if the patient is on meds in the hope it responds to the meds.

Thanks bm.
 
sl

sl

BHR Clinic Patient Advisor
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1
#6
Hi BM,

In many ways it's an non question because Dr. B will not extract in the first place, certainly not deliberately and using loupes it is easy to see what is miniaturised and what is not. But if it did happen we would place it and not charge, waste not want not.

This is an important point with FUE because even 10% miniaturisation across the donor will make a big difference to the graft numbers that can be extracted safely and not leave larger gaps in the donor. The miniatuised hair in the donor maybe a high density but because the calibre is lower it will give less thickness and taking all the good hair will be dangerous for the future.

When we have seen high levels of miniaturisation we suggest the person to get on MSM and zinc as well as the other registered meds, in our experience continued use can make a big difference to the quality of hair in the donor in many cases, and best to wait before doing a HT.
 
Prohairclinic

Prohairclinic

Prohairclinic FUE and SMP
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#7
Good points, when high levels of miniaturasation are detected it is best to go on medication and try to reverse, otherwise the entire idea of a hair transplant may backfire at some point.
BV
 
J

JJ09

Member
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#8
How can you tell if you have miniaturization of the donor area, is there a way of home inspection or do you need to visit a doctor?

Regardless if you have miniaturization should you take msm and zinc?
 
sl

sl

BHR Clinic Patient Advisor
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1
#9
Hi JJ,

Unless there is a great deal of miniaturisation and then it would probably be obvious to the eye but it is not something you can feel really. You can buy a USB scope and plug it into your computer, they work well and then you can take a snap shot of your donor and check various positions. It's also harder if your hair is very short because you cannot always guage the calibre of the hair against other hairs, but it is possible to check yourself.


Regarding Zinc and MSM if the donor is not obviously miniaturised then the user might not wish to take additional supplements. It is a personal choice to be made after research.


 
H

hairtech

member
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#12
Let me ask you a question stephenl... Out of 100 patients that have come to your clinic, how many patients have had a donor area of miniaturization unacceptable to perform FUE? Heck even a strip procedure? In my experience since 2003 I can count on one hand how many diffuse thinners and super miniaturized donor areas that have walked into the clinics I have worked at. There are options for those who have donor areas with miniaturization. MINOX... etc... What is your opinion Stephenl and others?
 
sl

sl

BHR Clinic Patient Advisor
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1
#13
Hi Hairtech,

Well certainly more than a handful that is for sure, otherwise it would hardly be a subject worth mentioning. To say that we meet border line cases for FUE every month due to a high % of miniaturisation would not be an understatement.

Possibly your patient genre is less diverse whereas ours could be more eclectic so we are open to many more variants in hair type characteristics could certainly be a reason.

 
H

hairtech

member
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#14
Thanks for the response Stephenl. I still would like to know your opinion on how many patients out of 100 would show a donor that is miniaturized to the point of not being able to perform FUE?

This topic intrigues me. And our patient base is extremely diverse due to the number of international patients that we have.
 
sl

sl

BHR Clinic Patient Advisor
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1
#15
In answer:-

Well by definition not many of our patients will have anything like the % of miniaturisation because we vet a very large % of them prior to the procedure and if someone came for their op and the doc was concerned he would not operate on them per se. The question is best answered with the amount of consultations Dr. Bisanga does and if we equated that to a % as you suggest I would say around 10% have levels of miniatursiation making them a poor candidate; a figure we feel is significant enough to make a note of as valid to mentioning as a potential concern when performing FUE. Obviously some may not be naturally miniaturised but may be caused by previous procedures.

I'm sure a quality clinic as yours attracts many non North American patients, but obviously by definition our geographic location puts us in the centre of many countries from north to south, all having different traits with regard to their hair characteristics, in fact on an average month we have something like 7-10 different languages in the clinic, so my point was simply that we probably have more opportunity to have a wider spectrum of genre.
 
sl

sl

BHR Clinic Patient Advisor
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#17
Here we have a good example how the donor quality can change in a relatively small area. The left hand picture was taken in the middle of the occipital and the right hand picture about 2cm below the same point. You can see the quality change in the two area, the right having larger groups and stronger calibre and the left almost all miniaturised hair with less calibre and lower density. This is in a very small distance between the two measured points



 
Bigmac

Bigmac

Administrator
Staff member
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#18
Thanks for posting these pictures Stephen,it shows how important it is to harvest from the recognised safe zone.