There has been much discussion in the hair transplant community over FUE- (Follicular Unit Extraction) which is a type of hair transplant procedure whereby individual follicular units from the the donor area are removed using a punch, rather than the more traditional donor strip harvesting (FUS).
Proponents of this technique point to the fact that no linear scar is produced in the donor area which allows the patient to wear their hair short at the back. FUE takes much longer than traditional FUS, consequently it is more expensive.
I read with interest a recent paper that was published in the Journal “Dermatologic Surgery” by Dr. M. Onda from Tokyo, Japan. His aim was to develop a device which would speed up FUE harvesting and his results were fascinating; I summarize them here.
The harvesting time using the FUE powered-device was 6.o minutes per 100 grafts compared to 14.2 minutes per 100 grafts with manual FUE.
The follicle transection rate (i.e. the hairs that were damaged by cutting through their roots with the punch) varied from 3.0% to 8.6% with the powered device and 9.7% to 25.9% with manual FUE.
What does this mean for the hair transplant patient?
As is the case with many medical procedures, there are trade-offs between advantages and disadvantages of various techniques. Many consumers mistakenly believe that FUE is “scar-less surgery.” However this is not the case, as the holes created by the FUE punch heal by scar-formation which leaves hundreds or thousands of circular”dots” in the donor scalp. These white dots may be visible, especially if the patient has dark hair and white skin and the hair is trimmed very short. The linear scar resulting from FUS is usually 1-2 mm wide & will never be noticeable unless the hair in the donor area is trimmed very short.
With traditional strip harvesting the hair is dissected under binocular stereoscopic microscopes so there should be no transection of hair follicles. This results in a better yield of intact follicular units for transplantation.
Using the data from this paper, a session of 3,000 follicular unit grafts could take up to 7 hours to harvest. Re-implanting the grafts would add another 4 to 6 hours to this procedure. For this reason, many clinics which offer FUE will perform a large procedure over several days which causes more patient inconvenience.
Similarly with a transection rate of 9.7% to 25.9% there is a potential for up to 777 grafts to be damaged during a 3,000 graft procedure. For the balding patient, donor hair is an extremely precious, non-replaceable resource and every effort should be made to preserve these follicles so that they can be used for transplantation. To risk their destruction simply to avoid a scar (which will likely never be visible) would appear to be illogical.
Ref: Novel Technique of Follicular Unit Extraction Hair Transplantation with a Powered Punching Device by Masamitsu Onda, M.D., Ph.D et al, Dermatologic Surgery (1683-1688) 2008
