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How FUE over harvesting effects the donor.

sl

sl

BHR Clinic Patient Advisor
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1
#1
A sometimes overlooked fact is that the surface area of the scalp remains the same with FUE BUT the amount of hair on that surface is reduced and lowers the density.

Because FUE doesn €™t cause a linear scar it doesn €™t mean no damage can occur. Even when using small punches 0.75 or 0.8mm the pattern the follicular units are taken is very important, if taken all in a small area it will reduce the density compared to the surrounding areas, it will cause more obvious hair less areas and potential scarring, also possibly cause the surrounding hair that is left to be traumatised and miniaturise.

It is important to try to make use of the entire safe zone when selecting FUE grafts and not isolate an area and remove. FUE can be used with great effect to fill scar lines from Strips and because the number of grafts needed can be small it is still important to try and spread the extraction. A downside for some with FUE is having the shave the donor, so it €™s common for people to ask for partial shaving, grow their hair a little longer and just have a band of hair or patches shaved that can be hidden under hair while it grows back. While this is possible the surface area should still be relative to the density so when a few hundred are removed the density loss is very minimal.

The problem with partial shaving is when the number of grafts needed is bigger, and then it is important to use the entire safe zone and not just remove from a small area. This can create an imbalance in the distribution of the hair on the scalp resulting in effecting the healing laxity of the skin and cause over harvesting in isolated areas, results in the donor potentially being too thin for further extraction even from a relatively small number being removed.


It €™s also easier to harvest only from the back of the scalp, around the occipital area, around the sides the angle and direction of the hair changes so more time is needed when extracting, more changes in body position to ensure no grafts are transacted when being punched, generally it is harder. As the back generally has a higher density anyway and is easier to extract from it €™s not uncommon to see even with 2000 plus grafts only the back being used and the sides left. This will cause obvious scarring in the back, over harvesting and make even a Strip procedure difficult because of the density loss.

Here are a couple of examples of uneducated extraction patterns, over harvesting in a small area and the effects it has. If the pattern had been spread more for the number of grafts removed and performed well it could have been possible to shave with no obvious signs of extraction, but as it is in these examples it is obvious.

















 
Bigmac

Bigmac

Administrator
Staff member
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#2
Very informative post Stephen,thanks for sharing this insight with us.

Cheers bm.
 
Bigmac

Bigmac

Administrator
Staff member
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#3
Nice close up pictures.

You can clearly see where the grafts were taken too close to each other resulting in the white dot scars joining together and becoming more visible.
 
H

hairtech

member
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#4
hey stephenl and philb,

I remember when Dr.B was learning about FUE way back when and was asking me where to find Zeiss loupes. How times have changed.

 
sl

sl

BHR Clinic Patient Advisor
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1
#5
Hi BM,

Hopefully this shows that FUE can and does scar and how cosmetically can make obvious changed to the appearance your head and how important it is to have an educated extraction pattern as well as understanding about skin type healing and characteristics to achieve the best results. No one can honestly promise no visible scarring BUT there are many ways to reduce the appearance to almost undetectable, even at close inspection, and certainly not leave a buck shot appearance. Not just the punch type used but technique of punch/extraction and understanding the need for an educated extraction pattern.
 
Prohairclinic

Prohairclinic

Prohairclinic FUE and SMP
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1
#7
I tend to agree, with hairtech.
Probably the punch was too large and damaged neighbouring follicles during the extraction?
 
sl

sl

BHR Clinic Patient Advisor
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1
#8
Punch size large or small is in some respects irrelevant, probably 0.9 to 1mm in size though used here. What apart from this shows is the poorly thought out extraction pattern, even with a smaller punch size it would have been obvious, less but obvious. That is what makes FUE harder to perform, the smaller the donor area or the larger the extraction numbers the pattern of extraction must be spread as far apart as possible, and if not possible then maybe the person is not a FUE candidate.
 
H

hairtech

member
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#9
I respectfully disagree with you stephenl in terms of the punch size used in an example above. Punch size is not exactly irrelevant.

Based on my experience and in my opinion, working for and with several clinics, I have yet to see this type of "white dotting" on any patient where upon a 0.8, 0.9, or a 1.0mm was used. And I have been involved in FUE since 2003. If this patient in fact had a procedure using a 0.9 or 1.0mm punch then this is a very very rare case. Now I have seen white dotting and/or the "shotgun" look when a clinic breaches the 1.0mm threshold.

I DO agree totally with you in the matter of which the extraction pattern was performed. Poor poor skills. Extractions next to each other. Some extractions are so close to each other that it looks like one extraction. '''ss''
 
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sl

sl

BHR Clinic Patient Advisor
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1
#11
Hi Hairtech, I said "in some respects irrelevant" because even with a smaller tool size this extraction pattern would still look a mess and have caused problems to the donor and future harvesting. A smaller punch would have less obvious signs but the point being the pattern of extraction has caused problems with the donor in terms of over harvesting areas, over lapping extractions etc.

Surprised you have not seen before, I guess we live and learn. Of course punch size is very important in the FUE equation, before I started my FUE journey it was one very important aspect in my research. Dr. B has been a proponent of this for years, but the residule scarring is not soley down to punch size but also the personal technique the Doc uses when punching, and the type of punch used and understanding different skin characteristics for example.
 
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H

hairtech

member
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#12
Well again stephenl... i don't know how to say this without being me... hairtech...

I understand your posts... I see that you are trying to educate the public on what should be a successful FUE... extraction pattern, etc, etc...

However my only "beef" if u will in the example above... is that I catagorically state the FUE example above is not an extraction with a 0.9, 0r a 1.0mm punch.

Why do I harp on this?

Well if I were a person looking around for an example of on FUE extraction post op... and not completely educated... in terms of FUE transplants... then the example above would scare me. period.

So I guess I'd rather be more real about a typical 0.8, 0.9, 1.0mm general extraction via FUE. This is an abnormal example... and whoever did this... did not care what they were doing. sad.
 
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sl

sl

BHR Clinic Patient Advisor
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1
#13
Not sure if it's been grapsed but what we were trying to discuss and example was the harvesting pattern, most of the extractions have been made directly adjacent to each other, side by side, next to, so the scarring overlaps creating larger scarred areas made by multiple extractions, besides the very odd single extraction that was made in an area all others combine so to determine the punch diameter is not possible simply from the picture.

That said I'm a little surprised you of all people dismiss flatly this is possible, I've read many of your posts from the past and I do not think you can adjoin .8,.9 and 1mm together as the same, there is a significant difference between a 0.8 and 1mm. "Real" is what is fact, what you see, as I said earlier this was not as such about punch size anyway but the extraction pattern, but if you wish I can post more pictures of "more real" donors.

The point of this post was not to get into a debate about punch size, we have written so much about that, it was to show that FUE can create visible damage and impair the quality of the donor if not performed well (regardless of punch size) and that people need to know this, rhetorically I assume you would be in agreement, that knowledge and research is important. I would suggest someone researching has a right to know what can happen and see examples of good donor management and poor donor management so they can judge for themselves what to expect and what is exceptional, expected and good, bad or indifferent.

So, not to "scare" people, FUE is a great technique, please do not misunderstand this post, it is not anti FUE, that would be crazy as I've had over 7000 myself! It is just about trying to educate that there must be correct protocols in place, and the protocols cover a multitude of technical aspects. No different to strip really, it can be performed well and poorly, it doesn't make the technique bad, just the way in which it is administered.
 
Dr. A s Clinic

Dr. A s Clinic

Valued member
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#14
I agree with stephen. While punch size is relevant when larger punches are used, a poorly planned or thought extraction pattern can lead to visible effects on the donor. Both have a role to play. To say that a small size punch is the end of the matter is false. And I am not talking of white dot scarring. I am talking of absence of hair from certain patches where the hair have been extracted too close together.
 
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Prohairclinic

Prohairclinic

Prohairclinic FUE and SMP
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1
#15
Extraction pattern is important, no question about it.

However there are punches and there are punches.

By this I mean the following:
Inner diameter can be equal, but still the outer diameter can vary strongly. This is when punch size really start to come into play.

Here a picture of a titanium tipped 0.8 inner diamenter punch. As you can see the wall of the punch will make that the outer diameter is just over 1 mm. In other words the punch wall is 0.2 mm.

 

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Prohairclinic

Prohairclinic

Prohairclinic FUE and SMP
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1
#16
Here is another example of a punch made of of surgical steel.
In this example the inner punch diameter is 1 mm, yet the outer diameter is almost 1.7 mm ! The material wall makes 0.7 mm in this type of punch.


This might explain why some patients have more white dot scarring that others (appart from the extraction pattern).

At our clinic we use titanium tipped punches only with a maximum inner diameter of 0.8 mm. Over the years we have found that punches between 0.7-0.8 mm allow us to extract most graft types on most patients intact. This allows us to score around the grafts without damaging neighbouring follicles. Combined with an 'intelligent' extraction pattern it has given us the best possible means of optimising the donor and grafts harvesting.
 

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J

JJ09

Member
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#17
Stephenl

I agree that if grafts are extracted too close together it will obviously leave patches of €œno hair € regardless of tool size. Will this also leave visible scar tissue? From the pictures it's hard to tell if there is scarring or just an absence of hair.


On another matter €¦is there a different approach when extracting facial grafts? If it €™s possible to extract facial hair with no visible scarring €¦then I imagine any concern over €œwhite dot € scalp scarring is negligible if performed correctly of course.

Bverotti

Does Prohairclinic perform facial/BH transplants €¦if so, how long have they been doing this?
 
H

hairtech

member
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#18
Finally V... After several years of posting you make sense. Punch size and pattern of FUE extraction... all comes into play. It all matters.
 
Prohairclinic

Prohairclinic

Prohairclinic FUE and SMP
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#19
Hi JJ,
No, at current we do not offer any bht or facial hair transplants. We like to concentrate on head hair FUE only.

BV
 
sl

sl

BHR Clinic Patient Advisor
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1
#20
Hi JJ09,

On the top picture it there is visible scarring to the skin, it has caused slight ridging on the skin surface in areas, the bottom picture is less obvious as it is close up but yes it did also leave white dot scarring around the donor, from a distance it was more obvious, but less actual "damage" compared to the top picture but there.

When I had my first beard hair the doc took around 200 or so, normally he would do no more than about 500 and spread the extraction to minimise leaving a really patchy look in the beard. He starts from under the chin area and a little down the sides and then prefers to let the skin heal and check for visible scarring before going back and taking much more.

I've had 1000 grafts from the beard now and honestly cannot see any scars, obviously the beard is a little thinner than it used to be in areas but even this is not obvious unless you know, the pattern of extraction is spread so I have not got "empty" areas. You can also ask topcat, scarred5 and zionaxel who post here if they have scarring from their beard extractions, I think they will say no signs. Much is down to the extraction technique and knowing skin/hair culture, especially on the beard. The angle of extractions are all over the place making it harder, but very possible to remove with no obvious signs if you have a good understanding.