Follicular unit extraction allows the surgeon to remove individual follicular units


Follicular unit extraction

Follicular unit extraction (FUE) allows the surgeon to remove individual follicular units without making a linear donor incision and without removing a strip of donor scalp. This technique has evolved into a minimally invasive technique, just like the evolution of surgeries in the brain, heart, joints, prostate, and intestinal areas where classical incisions have been abandoned for most surgeries.

Individual follicular units are extracted directly from the donor area with a punch of less than 1 mm in size. In contrast to the old punch method in which the punch cut out many follicular units in one swipe in order to remove the grafts, in FUE only a single follicular unit of between one and four hairs is removed directly from the patient’s scalp.

In the one-step technique, the doctor uses a sharp punch to surround the targeted graft and then pushes it into the scalp to a depth of approximately 5 mm. The edge is grasped with forceps, and the entire graft is pulled out from the scalp.

In the two-step process, the skin is cut to a depth of less than 1 mm and then the doctor uses a dull punch to dissect the graft from the deep structures below the skin. The freed graft is grasped with forceps and pulled from the scalp. The advantage of the two-step over the one-step technique is that the extraction process minimizes (but doesn’t entirely eliminate) injury to the follicles in some patients. FUE has the following advantages:

There’s no linear scar in the donor area. Of course a scar always results from every skin incision, but since scars are very small and scattered in a larger area, they often aren’t detectable even when the hair is relatively short.

There are no sutures or staples to be removed. The small donor wounds are left to close on their own with no sutures or bandages, and they heal within a few days.

There’s minimal discomfort in the donor area after the grafts are removed.

Exercise and athletic activities can be resumed within a week after the procedure is performed.

Following are some of the disadvantages of FUE:

Not everyone is a good candidate for this procedure. Not all doctors agree, but we always test our patients first by taking several biopsies using different FUE instruments and viewing the grafts under a microscope to see whether we can harvest the follicular units without significantly damaging the hair follicles. If we see a significant amount of damaged follicles, we don’t recommend this procedure for a patient.

It’s more expensive than strip harvesting. FUE is very tedious, and every graft should be individually extracted by the surgeon as opposed to the strip method, in which skin is removed first and grafts are harvested under a microscope, generally by a skilled team of dissectors.

For the same number of grafts, FUE takes more time, sometimes over twice the time, when compared to a strip procedure.

FUE produces small puncture scars. That means that if you shave your head, you may see small, whitish dots. There’s no linear scar and the stretched scars of a more traditional strip harvest is virtually eliminated. It is very difficult to detect the FUE scars.

A large area of the scalp needs to be shaved or clipped very short when a large session of over 600 grafts is performed.

Many patients object to this requirement because of the radical change in their hair styling. In small FUE procedures (under 600 grafts), the areas shaved are generally small, and your doctor will try to shave the areas so that they can be camouflaged by existing hair as much as possible until the hair regrows.

We advise patients undergoing small FUE to keep their hair long enough to cover small shaved strips of scalp. In larger FUE procedures, the shaved areas may be too large to be camouflaged after the surgery. This contrasts dramatically to a strip that can almost always be covered by existing hair immediately after the strip harvesting procedure.

FUE can produce damage that ranges from cutting of the hair follicles to destruction of vital elements of the graft in the hands of inexperienced surgeons. The percentage of such damage should be under 10 percent, but that’s still a significant amount considering that in traditional strip harvesting surgery, the follicular units taken from the strip under the microscope are mostly perfect.

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Note: This article was sent to us by: Lionel Venera at 06192010

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