FUE Hair Transplant Follicle Extraction donor site harvesting using FUE technique and the concept of zone of least resistance for donor extraction without transection.

Improvements in extraction of Follicles
Written by Dr Reddy

Hair transplant has come on leaps and bounds since its early days. FUE is becoming more and more mainstream form of hair transplants. FUE stands for Folicular Unit Extraction.

The recent ISHRS Convention (that stands for International Society of Hair Restoration Surgeons convention) it was agreed that the acceptance of FUE is a lot better in the industry now and gradually the amount of surgeons performing FUE has increased worldwide also there is a bit more predictability with the outcomes in the results.

When I started performing FUE's , one of the things I learnt that not every client is suitable for FUE. There were days where the process was a cake walk and there were days where we were literally struggling the whole day. On revisiting these clients and revisiting the results and notes, one thing became conspicuous that not every client is suitable for FUE transplant and the process of filtration was introduced in the consultation process. What I noticed during the consultation process was that on average no more that 15-20 % of clients were suitable for an FUE transplant. Bearing in mind my colleagues will probably agree with this figure I gather that probably might be the industry norm in the coming years until something changes in technique and technology.

What I also understood was there were few new unexplored concepts with regards to FUE. Now lets start by visiting the donor area. The grafts in the donor area are arranged as follicular units ,in groups of 1,2,3,4,5 and up to 8 units per hair per unit. When a surgeon starts off with a journey of FUE the initial concern is to get a graft ,immaterial of the quality of the graft. I realised that with the use of few manoeuvres ,the quality of the grafts can be improved . By using 1mm punch and the manoeuvres developed by me, we were able to extract grafts containing up to 8 hair. These manoeuvres can also be applied to placement and these were the origins of the 3rd generation of FUE. When I discussed my findings with other senior colleagues in the industry they did acknowledge that the concepts were great but that would mean that the whole process would take a lot longer meaning more surgical time.

Once the client selection process has been improved the question mark the man versus supply arises here. The key thing is to counsel the patient, to give them the facts. Let's start by visiting the donor area . Following are a few concepts about the third generation FUE

Good extraction is the most critical element in defining the outcomes of FUE hair restoration:

1. zone of least resistance.
2. spacing between the donor grafts.
3. depth of extraction and the extraction force.
4. Use of acell to assist or enhance donor healing.

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