The Expanding Needle Concept (in body hair transplants)

[Dr. A s Clinic]

3 lecture presentations and 1 poster presentation was given by Dr. Arvind Poswal at International Society of Hair Transplant Surgery (ISHRS) 2012 conference, Bahamas. They were widely applauded by hair transplant doctors from around the world.

I am putting them here one by one as people - doctors and patients alike - often ask us how we do FUSE hair transplants and how are they different from traditional fue.


This is my favorite - The expanding needle concept to extract intact healthy grafts from anywhere in the body.
I have converted the ppt to a video format. Just click at the link below to view

http://vimeo.com/52214081

 

[Bigmac]

Thanks for posting this V, the doctors i spoke to said it was a great technique.

 

[hairtech]

The expanding needle could go far... Dr. A... if you would from it now... just show a video.

 

[bullitnut]

Thanks for posting V

 

[Dr. A s Clinic]

hairtech wrote:

The expanding needle could go far... Dr. A... if you would from it now... just show a video.

You are still the same as before Hairtech. Type or speak before you see!!! Thats you as I see it.

Check the link above before shooting comments.

 

[ejj]

very good video , im wondering why there is no blood when the graft is extracted ? do you inject anything to restrict bloodflow while you extract ?

Does this method cause more trauma to the graft as it appears to be cut out all be it with a small needle , but cut out none the less , whereas a small punch scores the graft in one hit , and then is carefully pulled out ,wondering which method really is less invasive

regards

ejj

 

[janna]

Nice technique. I think it'll be useful for body hair, or when follicle units are not tight but are splayed. Also for punch out sessions because it's difficult to judge the direction of the follicles.

Dr. Shapiro did find the presentation interesting at the conference. Thanks for posting it here.

 

[hairtech]

I saw the video V. Thank you. This was a similar technique we (Cole/Mwamba/Bisangsa)used on scalp FUE when the extractions were difficult back in early FUE. We would use an 18 to 20 gauge needle to dissect around a follicle. I now understand the what you mean by the term "expanding"... expanding by dissection.;

@ejj The reason there is no blood during these extractions is because they aren't hitting any vessels. The same thing happens we we use the safe system which uses a blunt punch here at SMG. The blunt punch "pushes" structures (small blood vessels) out of the way instead of cutting them.

Lastly, I agree with Janna here too... splaying could be an issue.

 

[Dr Arvind]

ejj wrote:

very good video , im wondering why there is no blood when the graft is extracted ? do you inject anything to restrict bloodflow while you extract ?

Does this method cause more trauma to the graft as it appears to be cut out all be it with a small needle , but cut out none the less , whereas a small punch scores the graft in one hit , and then is carefully pulled out ,wondering which method really is less invasive

regards

ejj

Dear ejj,
We do not inject anything special. Usually there is no/minimal bleeding because we are actually cutting under direct magnified vision (not blind cutting).

For the same reason, its also less invasive.

Moreover the grafts are not "skeletonized". If you notice the graft has fat around it = better survival.

Regards,
Dr. A

 

[ejj]

many thanks for the replies hairtech and Dr A , anything that is less traumatic with a high yeild has got to be good for the patient
we have come a long way from the 4 mm punch grafts of the nineties !

regards

ejj

 

[Bigmac]

Good informative post.

 

[topccat29]

Mechanically speaking that is a very hard way to crack a nut. If most clinics do not have the patience or skill to use a hand punch what makes anyone think they would adopt something that would take even longer.

Most clinics in fact are doing the exact opposite and adopting drills and robots willing to do more damage as it is better for their bottom line plain and simple.

Always good to think outside of the box but not very practical.

 

[hairtech]

Topcat,

I understand your passion to keep this industry in check. Heck you and I have agreed mostly over the years and have stood up to many problems in this industry... In this instance I agree and disagree with you. Case in point... We (SMG) adopted the safe system (a blunt rotary device).

This only occurred after careful evaluation and consideration of several devices on the market for FUE automation today. Believe me... we looked at them all... They sent us machines, hand held devices, representatives and salesmen/saleswoman...etc.

I agree here (my opinion).

1. Every FUE clinic should have a mastery of knowing how to remove follicles from any given scalp or body by use of a manual punch.

2. There are no short cuts for any FUE clinic until the clinic can grasp the statement above.

3. At some point there can be options that works for an experienced clinic when the said clinic has mastered a manual FUE.

I disagree with you here (my opinion).

1. We have (SMG) after a careful evaluation and a time tested review... adopted a rotary device that in fact helped an overall decrease in transection rates, decreased the "skinny" grafts and overall increased the survival rate of our FUE transplants. Part of this was due to technical staff implanting changes.

2. I do think that the expanding needle concept posted here is a procedure that all clinics should master before they move on to better or more technologically advanced ways of removing follicles safely. However this technique is not the only technique that works to date.

So in summary... and in my opinion and experience my last statement here is this.

If a clinic continues to have a good reputation for producing good results and taking care of the patient first... such as Ron/Paul Shapiro,MD , Patrick Mwamba,MD, or Chris Bisanga,MD... then their techniques work... whatever method they use.

 

[topccat29]

We can disagree I don €™t have a problem with that, just my opinion. I have heard that you can feel when the extraction is being done just right and so I can completely relate to that as I am very mechanical by nature. With some tools most especially hand tools I can also feel when it €™s just right as the tool becomes only an extension of the hand and this is often lost when using power tools. I would also add that my extensive experience in machining and mechanical repair of very heavy manufacturing equipment has also made me very sensitive to the slightest change in the sound of equipment that is so loud hearing protection is needed. But even so that slightest change in sound tells you something and although I don €™t know this to be fact as I have never performed a procedure, I could imagine the sound of the epidermis just breaking and that sound being unique when it €™s being done just right and coupled with the feel it makes complete sense to me that a hand punch would be a superior way of performing the technique.

I would also add that comments from several patients that I have spoken to seem to have a similar refrain. The fu*king prick used the Black & Decker on my head and destroyed my donor. Their words not mine and not something to be taken lightly.

 

[hairtech]

I agree with you. The sound and the feel and the experience is extremely important. There is a sound and a visual cue that we look for in every attempt of a follicle extraction... It is exactly as you are describing for the larger machinery you talk about. If anyone would disagree with either of us... knowing what we both know in this industry then they are naive.

You are at the extreme as a veteran HT recipient and cares... and I am at the extreme as an HT experienced technical staff that cares.

 

[topccat29]

Good to hear about the sound aspect as it was only a guess on my part but I can imagine a subtel snapping type of sound, thanks for the information.

 

[Dr. A s Clinic]

[flash=425,344]http://www.youtube.com/v/aH5fhIGESxM&hl=en&fs=1[/flash]

 

[musclehair]

Interesting and hopefully this will mean an improvement in the almost impossible art of BHT.
Few questions:
1. Is this really practical when trying to extract hundred or thousands of grafts?. It seems much more complex and difficult technique than the others with manual punch.
2. Is this technique applicable to face or Beard hair transplant as well?. I am asking this because Beard hairs have a much thicker and longer root than Body hairs and scalp hairs and this would probably mean the need of deeper incisions with this needle. Correct me if I am wrong, I am just a person who was "in the chair" twice.

Many thanks for the video and for your great work.

 

[Dr Arvind]

Bigmac,
I am searching for a post I made in 2006 about mechanized rotary punch. Can someone help me locate it?