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Greetings,

Today I want to discuss the scarring that is created in FUE versus FUT. In FUE procedures a small tool measuring between .8-1.0mm is used to harvest each individual follicle. In FUT a linear strip is resected and the strip is dissected into individual follicles. In FUE because we cannot extract every follicle in any one area (or we would create bald patches in the donor zone) we must extract every third or fourth follicle. Because of this, if we are trying to obtain over 1200-1500 follicles for transplantation in an FUE procedure, we must extract these follicles over the entire donor zone, which can measure up to 30cm x 10-12cm. If we were doing a 1500 graft FUE case using the 1mm extraction tool and we wanted to measure the amount of scarring produced in the donor zone by the harvest, this would create approximately 1500 x 1mm = 1500mm= 150cm of pinpoint scarring over the entire donor region. By comparison, to harvest 1500 grafts via FUT and using a density of 80 follicles per cm2 this would require a strip of about 19cm x 1cm to be resected and after normal healing this should result in a linear scar that measures 1-3mm (lets say 2mm x 20 = 40mm or 4cm of linear scar). By looking at these numbers it is clear to see that there is significantly more scarring produced in FUE procedures versus FUT procedures. The main difference is that the FUE scars are pinpoint and spread over a much larger area, while the FUT scars are linear and over a much smaller area. Also, because FUE must be harvested over a much larger area, the number of donor follicles any individual will be able to donate over a lifetime will be significantly less with FUE versus FUT. There is a still a place for FUE in Hair Transplantation, specifically with people who insist on wearing their hair at a #1 or #2 buzz cut, when the linear scar may show through even under the best of circumstances. These are the people who I generally recommend FUE to. It is imperative  that every patient understand all the details related to both harvesting techniques prior to deciding which is best for them in the short term and the long term.

All the best,

Marc Dauer, MD

Greetings,

Today I want to discuss FUE otherwise known as follicular unit extraction. All Hair Transplant surgeons are not created equal and certainly all surgeons performing FUE are not created equal. There are many different devices on the market used to harvest FUE grafts ranging from the Artas Robot, to the Neograft, to motorized hand held punches to manual punches. After doing extensive research into all the different devices I opted to use the SAFE system which is a dull tip motorized punch to harvest my FUE grafts. Because FUE involves harvesting a follicle (with a typical diameter small than 1mm, and the base of the follicle below the skin which you cannot see when harvesting) it requires a tremendous amount of skill on behalf of the person performing the harvest. In my practice I harvest every follicle personally. I will post a photo of my FUE grafts that I harvested yesterday. What you can see in the photo is that each and every graft in completely intact with the entire follicle and a small amount of tissue surrounding the follicle as well. This is crucial to the graft survival and a key reason why so many patient’s do not get the results they hope for with FUE. Not all FUE surgeons are created equal and it is very important to do your proper research before deciding to have FUE with a specific surgeon. In experienced hands FUE can be an amazing procedure.

All the best,

Marc Dauer, MD

Greetings,

Today I will discuss a very interesting case I just performed. This patient presented with a skin graft in his mustache region from a previous accident that required extensive Plastic Surgery. He was left with a large scar  and no ability to cover the scar as it would only grow a scant amount of hair. The patient prefers to wear a goatee but it is very unnatural with only one side growing hair. In this case I performed follicular unit extraction otherwise know as FUE by harvesting the hairs from his beard on the neck individually with a .8mm punch. I harvested the neck hairs as these will most closely resemble the beard hairs we are meant to recreate. After I harvested all the beard hairs via FUE we placed the grafts individually to recreate a mustache.The angles and orientation of the grafts placed in the mustache were made to mimic the angles of the hairs on the unaffected part of the mustache. Typically there is a slightly lower growth rate of grafts transplanted into scar tissue, but these patients usually have excellent cosmetic results. Below you can see the pre operative photo and the post operative photo and the immediate difference that is seen with the transplanted grafts present over the scar.

All the best,

Marc Dauer, M.D.

Greetings,

I just returned from the International Society Of Hair Restoration Surgery annual meeting in Anchorage Alaska. It was an amazing meeting as usual, but this year there were many less attendees which made it even more intimate than ever before. I had the opportunity to meet and re-connect with many of my friends and colleagues and discuss the latest advancements in the field and compare and contrast what others are doing and what seems to be improving the process and results. I definitely took home many new ideas that I plan to implement into my practice ranging from a new low level laser light device I will be offering, to a new storage medium for my hair grafts.

Other things I plan to look into for the future will be Platelet Rich Plasma therapy. I also purchased the new Hair Check system which measures hair mass and I plan on using this on new patients to measure their hair mass prior to initiating treatment and also after treatment has been implemented. This is an amazing new tool which measures hair mass which is an excellent indicator of the amount of hair in any given region on the scalp. I will attach a few photos from the meeting and my day trip excursion to the glaciers.

All the best,
Marc Dauer, MD

Greetings all,

Today I would like to discuss the issue of donor strip scars and how to approach them when they are too wide, or noticeable, or the patient just wishes to cut their hair very short. In the world of Hair Restoration today there are many physicians trying to push the envelope of grafts in a single session. Physicians trying to perform 4000, 5000, or even 6000 grafts in a single session. Using the strip method, the only way to achieve these numbers is by taking a donor strip that is very wide. This puts undue tension on the skin closure and can then result in very wide donor scars. Sometimes though, even under the best of circumstances and a proper closure, a wider than expected donor scar can also occur. I have been seeing more and more of these patients from other physicians recently.

After much experience I am finding that when you attempt to excise these scars, often times they will just come back again. The best approach to this situation is to harvest grafts via FUE ( Follicular Unit Extraction) and then transplant the grafts into the scarred areas that are devoid of hair or have very little hair in them. Typically the grafts grow nicely through the scar tissue and provide hair coverage of the scar which acts to conceal the scar thus making it more feasible to cut the hair short.

I have included photos below of a patient who had multiple strip scars from a procedure performed by another physician. The ‘before’ photos show the donor area shaved and the donor scars. The ‘after’ photo shows the FUE punctate sites (these heal in about a week) and the hair immediately transplanted into the donor scars. A difference in the donor scars with hair transplanted into them is immediately visible and when the hair grows in this should provide nice coverage to the donor scars and allow the patient to cut their hair much shorter than was possible before.

Greetings all,

For the past few months I have been using a new machine for my FUE procedures called the “New F.U.E. S.A.F.E System”. For those of you who are not familiar, FUE stands for “Follicular Unit Extraction”. It is the process where donor follicles are taken out one by one, instead of removing them via the “Strip Method”, where a strip of donor scalp is removed and dissected under the microscope into individual follicles. There are a number of advantages and disadvantages to FUE vs. Strip Harvesting but I will not get into this discussion here. FUE is typically described in marketing and promotional advertisements as a “scarless” procedure. This is not actually true. What is true is that FUE causes many “micro scars” in the areas where the follicles are removed. In most cases these micro scars heal well and only leave a small dot of hypo-pigmentation in each spot where a follicle is removed. This is usually cosmetically insignificant as the area where the donor hair is removed is usually covered by the remaining hair in that region. The other issue with FUE is that in the past there has been a high rate of transection with the removal of the follicles. This means that in the process of removing the follicle, the structural integrity of the follicle is compromised, thus giving the follicle a much lower percentage chance of growth. The goal is a system where there is a low rate of transection and where the follicle is exposed to the lowest amount of trauma possible. There are many new automated and manual systems available now for FUE and I did extensive research into all of them and decided that the SAFE system was the way to go. The thing I really like about this system is that the punch that is used to extract the donor follicle has a blunt tip as opposed to a sharp tip that most of the other systems use. What this means is that since the tip is not sharp there is a much lower incidence of transection. Since donor follicles are very finite in each individual (the average person has about 8000 donor follicles), a lower transection rate of even 10-20% can result in hundreds or possibly even thousands of saved follicles. In addition, because the tip is not sharp, I believe it causes less trauma to the underlying vasculature, which can protect the scalp for future procedures. Also, because this system is motorized, like a small drill, it allows you to “score” the follicles much quicker, thus allowing more follicles to be harvested in a session. With this system, you still have to manually extract the follicles, manually trim the follicles, and manually implant the follicles, but the automation in the drill definitely speeds up the process. FUE is good for some patients and has it’s advantages and disadvantages. We are now able to transplant up to 1200 follicles in a day with the new FUE system, as opposed to significantly lower numbers before this system. In addition, FUE allows us to harvest chest hair, back hair, and beard hair for donor follicles. What is most important, is that every patient throughly understands all the advantages and disadvantages of both harvesting techniques before deciding which route to take in their own hair restoration journey.

Marc Dauer, M.D.