White spots vs large punch size in FUE

[inako123]

Hi

Has it been proved that white spots in the extraction area are the result of using large punch sizes? According to a well known & experienced doctor in atlanta, irrespective of the punch size used the FUE procedure always results in white spots. And many other established FUE doctors doesn't agree to this. According to them white spots won't occur if the punch size is <=1mm. is this true?

i appreciate if people who had undergone FUE procedure could chime in and share there experiences on this.

thanks
inako

 

[mattj]

The white spots are scar tissue containing less pigmentation than the surrounding skin. Smaller punches will, of course, result in smaller wounds and less scar tissue. The degree to which these scars are visible will depend a great deal on the individual's skin and healing characteristics. Some patients are fortunate and the extraction sites are very hard to notice.

 

[recedingboy]

hi what size punch does Dr. Rahal mostly use, and what is the transection rate of his FUE procedures?

Any special FUE tools used?

 

[Galileo]

mattj wrote:

The white spots are scar tissue containing less pigmentation than the surrounding skin. Smaller punches will, of course, result in smaller wounds and less scar tissue. The degree to which these scars are visible will depend a great deal on the individual's skin and healing characteristics. Some patients are fortunate and the extraction sites are very hard to notice.

The question is - WHY?

Hypopigmentation (loss of skin color), especially in human, is more a function of the removal of INTACT follicular units, rather than a function of €œindividual patient healing characteristics €.
Try to perform traditional FUE on a mouse, and you will neither see any hypopigmentation nor any loss of the removed hair after a given healing period. With FUE, unfortunately the patient doesn €™t have typical mouse (survival) characteristics €“ and that €™s the problem. Meaning, the neighboring hair follicle (cells) in human, simply doesn €™t support (at least not sufficient) tissue regeneration that much, if at all, like in mice.
But if you perform indirect injury during FUE extractions in human, the following happens normally:

€¦ independent of €œindividual patient healing characteristics €. That is humanly normal.

The smaller the extraction needle is, the more there is the chance not just for repair/regeneration of the epidermis, for the whole hair follicle also - as studied and explained e.g. by Dr. Elaine Fuchs (pic above) or Dr. George Cotsarelis etc.

 

[topccat29]

You are right I have seen his work and his work always results in white spots. I have spoken to several of his patients and they were not too happy about it. They felt like they were misled. Personally I believe it was due to the punch size.

 

[hairtech]

After many years gone by... working for different FUE Clinics... I can honestly report that the average punch size has become a steady state between 0.8mm to 1.0mm...

It makes sense that an FUE extraction site whether it be a scar, hypopigmentation or both is still directly dependent upon the size of the punch.

The last two clinics I have worked for since 2007 both have used between a 0.8mm-1.0mm and have rarely seen the extraction white holes.

 

[Prohairclinic]

As a representative of an FUE clinic I would like to agree with Hairtech. It is indeed a fact that white dots depend largerly on the size of the punch. Then of course there is a technical debate over the inner and out diameter, the wall thicknes, sharpness, manual/motorized ...

The second issue is the amount that is harvested. If you harvest just 1000 grafts over the full donor area it will not show. After removing several thousands of grafts the missing hairs will create a non uniform pattern and can be noticed when shaving to short hair length.

 

[topccat29]

I think it €™s important to really go over the details when deciding on whom you want operating on your head and face. It is really important to understand what kind of person you are dealing and to also have a good understanding of character traits. Much can be gathered up by just some of the postings we see on the forums but in person interactions are always better.

For instance if you have a clinic that is focusing their time on developing a drill so that they can work faster and get more patients into the chair does this benefit the patient or clinic? Now if that drill was being developed to give the patient a more aesthetically pleasing result than it €™s not an issue but that hardly seems to be the case. If a clinic is focused on opening more clinics in Korea and China does that benefit the patient probably not.

I can understand focusing on the next million dollar idea and wanting to fill your pockets full of cash but maybe that time would be better spent focusing on better results and patient care. So in some cases white dotting should not be a surprise.

 

[topccat29]

I rarely come on to the forums to bash specific clinics. I tend to speak in general terms about things as I see them. But I would like to make a point here.

If this is the same clinic in Atlanta, than what you have posted does not surprise me. I have spoken to several of the patients from this clinic and they have white dot scarring. Some described their donor areas as looking like a shot gun blast. Even knowing this I still considered going there for a test to see it for myself just as I have done with other clinics.

I scheduled a video consult about 7 years ago as it seemed the best way to get started. I didn €™t own a webcam at the time as I had no need for one. So I went out and purchased one specifically for this purpose. I set it up and made an appointment. It was to be on a weekday at noon. There I sat patiently in front of my computer for about 40 minutes. I was starting to feel like a complete jackass realizing no one was coming online. So I just got up and started doing something around the house. Of course this was very discouraging and disappointing. Other repair patients might know how it feels, gut wrenching that your case could be so easily forgotten. Maybe for the clinic it was not a big deal but for me it happened to be quite a big deal. One hour later the clinic phoned, they completely forgot about the appointment. Okay I thought that €™s fine I will agree to reschedule. They made that next appointment after being about 15 minutes late and it wasn €™t even the doctor it was someone completely different. Once again I was very disappointed but went through with the process. He rattled off some numbers and listened to what he had to say but I was hardly impressed.

I thought maybe an in person consultation might be better so I made an appointment as the doctor would be in the Chicago area. That appointment was made and cancelled by the clinic a total of 3 times. At that point there were so many bells, sirens and whistles going off in my head that I told my wife I would not use that clinic even for a test if it was the last clinic on earth. This is not even mentioning the experiences with the front office which was completely clueless. The left hand didn €™t know what the right hand was doing.

Then to top it off I still get the occasional cold and impersonal form letter asking me when I would like to schedule my surgery. This is what happens when patient care comes secondary to filling your pockets full of cash with ideas for drills and clinics in Asia and one of the reasons you see white dot scarring.


I have also noticed a recent uptick in their postings. It €™s interesting to watch how customer service and patient care seem to take priority when there is a downturn in the economy. For the truly great clinics it was always a priority.

 

[hairtech]

good post topcat