• 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 Procedure Size, Tools & Protocol

P

Philb

Member
Likes
0
#1
One problem that FUE holds is the size of the procedure that can be performed either in one session or over multiple sessions. This is due to two main factors, limitations of the donor and the fact that each FU is individually removed making FUE a time consuming labour intensive technique for the doctor to perform. Within reason time should not be a factor as long as the patient €™s well being is being catered for, what is important is the result, donor and recipient.


Like Strip over the years the size of the procedures increased with an improved understanding of skin laxity and closure techniques, and the same for FUE. With safe protocols such as donor management and extraction patterns in place Dr. Bisanga has refined his technique over the years, reducing punch size and increasing his understanding of skin changes and variants in hair characteristics but with all this knowledge there will still remain limitations because FUE is and will be when performed well a manual technique and labour intensive; that is a without pushing the limitations to the technique and the body.


The idea of a hair transplant is to move genetically strong hair from one area to an area of loss and this hair will grow; with this in mind the fundamental importance (besides a natural looking result) is the growth or yield and a sustained donor area that will allow future procedures with the minimum of negative impact on the scalp. To ensure high standards there must always protocols in place, type of instrument used including size, educated extraction pattern and donor management.
Punch size is simple; it €™s not the smallest or the largest that is best, it is one that can remove only one intact FU at a time causing minimal transection or peripheral damage and minimum to no visible scarring. As the technique improves so the preferred punch size will be found; in our case that is reflected in Dr. Bisanga starting with a larger size and now preferring 0.75-0.8mm for the vast majority of his extractions.


Much of the skill to FUE is the understanding the skin and hair nuances, angle and directional changes when removing the FU. The punch tool itself may vary in style and this can be dependent of the preference of the doctor, blunt, sharp for example. Because it effectively blind invasive surgery the feel/sense between fingers and the skin through the instrument is vital, being able to gauge the correct distance, angles and skin laxity to attain minimum transection. The more resistance caused or between hand and skin be it due for example to a mechanism movement of the punch rotation or size of the punch holder will be to the detriment of being able to utilise the optimum size punch diameter for a specific FU and to being able to minimise the impact and control of the peripheral hair and skin. For example the less control or more resistance to feel or touch would require a larger punch to ensure the target FU is encompassed but that can then increase peripheral damage.


Another aspect discussed is the total number of FU that can be removed from an FUE donor but less discussed is the impact a large one off session can have on an FUE donor and the recipient area.


FUE maybe minimally invasive in respect to punch size used but that invasiveness is only determined by the size of the procedure and the harvesting protocol. Most know that Dr. Bisanga believes in not removing more than 30% per cm2 from the safe donor, and this being over multiple procedures. Another protocol in place is the total removal of FU within one session, regardless how high the donor density.


When making any incision in to the skin and especially multiple incisions it will have a ripple effect on the surrounding skin and the healing, and the closer the extraction points are will have a larger effect. This can result is miniaturising surrounding hairs in the donor due to trauma, impair the healing and increase laxity changes. This miniaturising of the donor can in extreme cases make any future procedure almost impossible and not benefiting the patient. In the recipient it can reduce the effective healing and blood flow to the placement of the grafts thus reducing the chance of survival and a good yield. This is owed to the cumulative effect of the multiple open wounds and the ability of the body to be able to repair whilst enabling the transferred grafts to receive enough blood supply in the immediate post op to sustain life. Another concern when harvesting large numbers in one session is being able to control the extraction pattern because there is a tendency to over harvest in areas even if the starting density is high. This may have the effect of reducing the total number of FU available long term again because of peripheral damage and skin laxity changes. Dependent on the donor area in most cases up to 3000 grafts can be removed whilst maintaining an educated extraction pattern and high yield.


In the future we believe this will become clearer, and with greater openness regarding tools, techniques and protocols the patient will hopefully be able to recognise FUE as a valid and credible technique with consistency in results and also recognise that it does not hold all the answers to a hair transplant, more so that it can sit next to Strip with both valid techniques both with pros and cons.
 
Bigmac

Bigmac

Administrator
Staff member
Likes
6
#2
Great post Phil,some good points addressed such as the doctors feel/sense between fingers and the skin through the instrument.

I`ve heard this mentioned many times by doctors.

When you mention the extraction pattern,how is this worked out?

Also it would be great to see pictures of donor areas shaved down one year after a mega session to see what it looks like.



Thanks bm.

 
D

drmwamba

Valued member
Likes
0
#3
I will let philip post a picture of donor area after FUE megasession.

For us ,it is now a routine to do FIt/FUE megasessions and I am happy they rose some aspects doctors and patients have to understand when requesting or performing such procedure.

Mechanisation of this procedure may bring a lot but we need to be carefull about what we can loose by trying to gain time.

For me this is a lifetime decision and in italian ,there is a proverb that say:"qui va piano,va sano and also va lontano "

piano =slow

sano=wise or health

lontano= longer.

Hair transplant is a lifelong or lifetime decision ,just be carefull and move accordingly...
 
Nervousnelly

Nervousnelly

The Coolest Member
Likes
0
#4
Thanks for another very informative post. You certainly add a lot of great knowledge and insight to this forum. I hope that newbies are reading these threads and gaining a lot of research. From everything that you have demostrated I am in agreement of your clinics approach and ethics surrounding HT's. You guys are great and do world class work. I don't hesitate a second to recommend potential patients to you. Keep up the good work.

NN
 
Last edited:
P

Philb

Member
Likes
0
#5
drmwamba wrote:
I will let philip post a picture of donor area after FUE megasession.

For us ,it is now a routine to do FIt/FUE megasessions and I am happy they rose some aspects doctors and patients have to understand when requesting or performing such procedure.

Mechanisation of this procedure may bring a lot but we need to be carefull about what we can loose by trying to gain time.

For me this is a lifetime decision and in italian ,there is a proverb that say:"qui va piano,va sano   and also va lontano "

piano =slow

sano=wise or health

lontano= longer.

Hair transplant is a lifelong or lifetime decision ,just be carefull and move accordingly...

Hi Patrick,

I hope you are well, warm regards.

I couldn't agree more "Hair transplant is a lifelong or lifetime decision be careful"

As for pictures of mega sessions, that is my point, what is a mega session, it really depends on suitability of the person in the first place. We're not putting a label on it just saying we do not feel it is prudent to go above a certain number in one session, maybe someone else believes the limit is even lower than us.

Pictures I will see what I can find, I can show general over harvesting pictures regardless of the size of the procedure. (By the way, FIT/FUE not the same, you FIT guys have been telling us that for ages now)
 
P

Philb

Member
Likes
0
#6
Bigmac wrote:
Great post Phil,some good points addressed such as the doctors feel/sense between fingers and the skin through the instrument.

I`ve heard this mentioned many times by doctors.

When you mention the extraction pattern,how is this worked out?

Also it would be great to see pictures of donor areas shaved down one year afger a mega session to see what it looks like.

Thanks bm.
NN,

Thanks for your comments, they are genuinely appreciated, and if we can get across to people the effects and reality then hopefully it will improve their knowledge and that within the industry that the potential patients need to know and be given.

BM.

The extraction pattern has so many variants to take into consideration, take a virgin scalp to make it easier. Assume you measure out the basic safe zone, then look at their hairs per FU average, then any miniatuisation (really important).

One aspect of FUE is "no scarring" or to put it another way, "small hair less areas", to achieve this look there is going to be a max. % that can be taken dependent on the density and general number of hairs per FU in a cm2. You cannot take adjacent FU because the "hole" becomes larger, so the pattern of extraction must be random and this will reduce the numbers that can be removed.

Also from the extraction point it is hard for the brain to move in a random motion, it wants to create even patterns, and this can result in obvious patterns of thinning in the donor making it impossible to keep the hair short without seeing an artificial thinning. We all have the odd scar on our head and if we shave no ones pays any attention, that is because it is random or isolated, but when the pattern looks regular it shouts artificial, regardless if the person knows what they are looking at.

This is another aspect that reduce the extraction pattern, something we call "educated extraction pattern", ironically it has to be very random but well thought out to ensure it doesn't look educated or uniform.
 
N

NW5a

Valued member
Likes
0
#7
Very interesting Post !

Can u share these pics of overharvesting donors for us ?

Thx