Follicular Unit Extraction (FUE) Treatment

INTRODUCTION

Dr Orentreich first introduced hair transplant in 1950’s “punch hair transplant” then in 1990’s new era of mini and micro grafting was introduced that FUT (Follicular Unit Transplantation) by strip method. Now in recent past less than a decade a new technique FUE (Follicular Unit Extraction) is introduced by Bernstein and Rassman and is becoming an alternate and with this dream of “no visible scaring” in the donor area looking like a possibility.

OVERVIEW

Principle: FUE is dependent on principle that erector muscle of follicular unit is the tightest zone. It is separated from surrounding dermis and then extraction of the inferior segment can be done easily.
Indication:
Patent Related:
Who specifically requests and enough graft can be harvest.
Who want to wear V short hair (can afford to have linear scar)
Those require small sessions (limited hair loss or scarring from any previous procedure)
Who want to resume full activity immediately
Who have inordinate fear of pain and scars
Donor Site Related:
Inadequate skin laxity for strip excision
Previously strip is already taken and now it’s not possible to take another strip
Tendency to have bad scars
When body or beard serves as donor

Contraindication:
Patient Related:
Unrealistic patient expectation
Not willing for long sessions
Not willing to cut hair short
Has large bald areas needing > 2500 grafts
Donor Site Related:
Inadequate donor supply
Scarring as it makes procedure problematic
Fox grade 4-5 ( graded 1-5 according to ease and completeness of external graft)
Surgeon’s Related:
Inexperience (as it has a long learning curve)
He doesn’t not have proper instruments

PROCEDURE:

Prerequisites:
Surgeon Related:
Experienced and trained surgeon
Proper understanding of angle of hair
Hand moments should be stable and proper
Should have trained staff with him
Instruments Related:
Sharp/Blunt punches
Punch size 0.6 to 1.0mm
Excellent lightening
Magnifying devices (2.5-5 times)
Patient Related:
Fox test positive (surgeon takes out few grafts and then calculate how many units are extracted completely Bernstein and Rassman classified in 5 grades Fox positive is 1-3)
Types of Procedure for Extraction of Graft:
Two step Procedure (Sharp Punch)
Three step Procedure (Harris Concept – sharp and blunt punch)
STEPS:
Oral antibiotic + painkiller +/- sedative given
Patient positioned prone and donor area trimmed
L/A infiltrated (1% Xylocaine)in donor area
Area prepped
FUE is done under magnification
Graft is preserved in saline
When extraction is over FUT is done on recipient site.

ADVANTAGES:

Patient Perspective:
Procedure is less traumatic
Minimal scars/invisible
Minimal recovering time
Can use body hair
Can keep short hair
No need to visit surgeon for stitch removal
Surgeon’s Perspective:
Less manpower needed
Minimal graft perspective
Less equipment needed
More client satisfaction
No stress of post p wound related
No need for early visit for stitch removal

SIDE EFFECTS:

Pin point scars
Mouth eaten or pseudophillitic appearance in donor region
Donor area has increase risk of hair fall
Necrosis of donor region
Temporary or long term numbers of scalp
Infection
Cyst formation/ Buried graft