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Dr. Bertram Medical Hair Transplant
眉 髮 醫 學 移 植 中 心 ( 香 港 ) |
( 852 ) 3421-1138
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FUE - Our Technique
Our Technique Step-by-Step
Our FUE technique has been refined after visiting Dr Lorenzo (Spain) in 2009, and attending Dr John Coles' FUE Live Surgery Workshop in 2010. We have found the solution that overcomes the many problems of FUE: high transection, low yield of usable graft, low density implant, and unsatisfactory result. The future of FUE is encouraging.
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Manuel vs. Automatic FUE
We insist that our FUE is performed manually. Athough automatic FUE extractors have gained a lot of attention lately, we have not yet found the perfect machine. So far none of these machines have demonstrated a more superior final result. We prefer not to try new things on our patients unless we are certain of the pros and cons.
Test Extraction
Not everyone is good candidate for FUE. Dr Rassman pioneer in FUE recommends test extraction (FOX Test) to select good candidates. We do not do it as not practical to make holes on people's head during a consultation.
Preparation - Donor hair
• Less than 500 grafts - keep at least 1.5 inch of hair. One or two "windows" can be trimmed for harvesting.
• 600 grafts or more - donor hair MUST all be shaved for easy extraction.
Number of days for surgery
We are only offering one day FUE session. Reasons are :
- It is very tiring for the patient lying face down for 4-5 hours
- Local anesthesia has to be injected again, causing more pain and discomfort
- Too much injection on the same area will disrupt the blood and nutrient supply to hair follicles
- The grafts transplanted on day 1 may be damaged on the second day
- May affect the final result if grafts extracted on the second day is less than expected
Number of Grafts Expected
The number of grafts extracted within a day ranges from 800 to 1,000 grafts. If you need over 1,000 grafts, we strongly recommend the Strip technique for a more reliable outcome.
Positioning
Patient lies prone with head turns from time to time. This position has to be kept for 5 -6 hours for 1,000 grafts.
Local Anesthesia
Similar to strip harvesting. Read more »
Sharp Scoring
Round punch of appropriate size is selected, 0.7-0.8mm for Caucasian and 1mm for Chinese. The angle of the punch is directed to align with the hair. The handle is rotated to-and-fro to advance the punch. Scoring should stop when tissue resistance is felt (usually 1/3 the follicle length). Passing beyond this point may transect the roots (Fig 2). The finger tips sensation is important and can never be replaced by automatic device.
Extraction
The follicle is then grasped and pulled out with forceps.
Hours of Extraction
Any extracted follicles should be re-implanted as soon as possible. We allow 5-7 hours on extraction, and another 3 hours to inserted into the recipient site. So the whole procedure may last 8-10 hours.
Wound care
The wound is usually left open. Dressing is only needed in perfuse oozing. Pain is uncommon but expect some numbness and itchiness.
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How We Minimize FUE Donor Scar
Although no linear scar in FUE, hundreds to thousands white dots can still be visible on wearing skinhead. We have 3 methods in minimizing FUE donor scar :
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Technique 1 - Use a Smaller Punch
| Punch diameter (mm) |
0.7 |
0.8 |
1.0 |
1.2 |
| Area per 1,000 holes (sq.cm) |
3.85 |
5.03 |
7.85 |
11.31 |
It is obvious that using a 0.7mm punch will reduce scar by 300% when compared to a 1.2mm punch ( size of a $5 coin ). However this is not always practical as the latter can only be used for very fine Caucasian hair. We often use a 1.0mm punch In Chinese to reduce transection and retain more stem cell tissue.
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Large holes left by a 1.2mm punch |
We do not punch larger than 1.0mm |
Technique 2 - Spread the Extraction
Extract over a large area can reduce tissue trauma and promote healing. However a much larger donor area will be involved and future session will be more difficult.
Technique 3 - Minimize Transection
Less transection means less empty holes. We do not believe in automatic device and insist that all extraction must be done manually. The surgeon's finger-tip sensation is most crucial. By feeling the tissue resistance the depth and angle of the punch can be adjusted accordingly. Also there can be no rush in FUE.
Extract over a large area can reduce tissue trauma and promote healing. However a much larger donor area will be involved and future session will be more difficult.
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Who Should Consider FUE
FUE serves as an alternative other than strip in donor harvesting. FUE is uaully recxommended for the following groups of patients :
- Turned off by a linear donor scar
- Unable to tolerate any discomfort after surgery
- Prefers wearing very short hair after surgery
- Only requires a few hundred grafts
- When strip is no longer feasible
What Patients Groups Are Suitable for FUE
Not all patients are suitable for FUE. For good result they must fulfill the followings :
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Good donor density
Once hair density falls below 50%, early baldness becomes apparent. FUE should therefore extract no more than 50% of hair per donor area. Higher density yields more hair.
Light skin color
Scar from FUE is less obvious in lighter skin people.
Less skin-hair color contrast
FUE provides less graft per session. Low density transplant gives good result when the skin-hair color contrast is less.
Easy extraction
Follicles small in size and with a shorter roots are easier to extract (below left). Thick and tough skin increases transection (below right).
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Comparing FUE in Caucasian and Chinese
Summary
Caucasian is most suitable for FUE due to their special hair and scalp characters. That is why FUE centers flourish in Europe. The same may not apply to Chinese.
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