Follicular Unit Extraction Brings Minimally Invasive Surgery Technique to Hair Transplantation

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NEW YORK (October 16, 2003)– Hair transplantation is a two-part surgical procedure. First, the hair that is to be transplanted is surgically removed from the donor area on the scalp-most often, at the back of the head or nape of the neck where baldness seldom occurs. Then, after the surgically removed hair follicles are examined and "prepped" they are surgically transplanted into recipient bald or balding areas on the patient's scalp (See Follicular Unit Transplantation and Extraction). Both surgical procedures-removal of hair follicles and subsequent transplantation-create small surgical wounds. Removal of donor hair by "strip harvesting" creates a wound that has the potential to scar when it heals. Over the past decade or more, progress in the techniques of hair transplantation has tended to further reduce surgical invasiveness and the size of surgical wounds. Hair transplantation has moved steadily from grafting of "plugs" containing 20 or more hairs to the use of donor-hair units containing 1 to 3 or 4 hairs.


The technique of follicular unit extraction (FUE) has shown the potential to harvest donor hair with minimal invasiveness and much reduced potential for scarring at the site of donor hair removal, according to physician hair restoration specialist William R. Rassman, MD, Los Angeles, CA. Dr. Rassman discussed new developments in FUE at the 11th Annual Meeting of the International Society of Hair Restoration Surgery (ISHRS). The ISHRS is meeting October 15-19 at the Marriott Marquis Hotel, New York City.


Follicular unit extraction is a method for removing single hair follicles from a donor site, using very small punch excisions. The most common current method for removing donor hair on the scalp is to surgically remove a strip of follicle-bearing skin and underlying tissue; the follicles to be transplanted are dissected out of the follicle-bearing strip. Although donor wound scarring is an infrequent complication of strip harvesting, the potential for scarring concerns some patients. FUE, said Dr. Rassman, offers an alternative for selected patients who have a medical history of scarring or who are concerned about the possibility of scarring.


FUE, Dr. Rassman said, is a technique that might be classified as minimally invasive surgery. The term "minimally invasive surgery" is reserved for procedures that can be performed with minimal surgical intrusiveness. The definition includes those procedures that are carried out through an endoscope rather than through an open incision-for example, surgical removal of the gall bladder through an endoscope.


Follicular unit extraction is performed using instruments especially designed or adapted for the procedure: a tiny 1 millimeter punch that makes an incision around the follicle to be removed, small forceps to remove the follicle, and a specially-designed needle that frees the fibrous base of the follicle from underlying tissue when necessary.


The number of follicles removed by FUE in any individual patient is determined by the physician hair restoration specialist, based upon the patient's medical history, the patient's scalp and hair characteristics, and the wishes of the patient regarding the appearance that the patient hopes to achieve from hair transplantation.


Not every patient is a candidate for FUE, Dr. Rassman said. About 90% of patients qualify for the procedure on the basis of the ease with which follicles can be extracted. However, there is a limit to the number of follicles that should be extracted in a single session, he said. FUE, he said, is best limited to:


  • those who need a small number of hair follicles transplanted over the long term,
  • those who must shave their heads for professional reasons such as modeling,
  • those who have a medical history of poor healing or scarring,
  • those who could benefit from hair transplants into scarred areas of the scalp, and
  • those who could benefit from hair transplants into hair-bearing areas other than the scalp-eyebrows, eyelashes or beard.

Patients who are not good candidates for FUE, Dr. Rassman said, include:

  • those who require a large scalp area to be transplanted,
  • those who have hair or scalp characteristics that preclude them from having FUE, and
  • those who have unrealistic expectations regarding what can be accomplished by hair transplantation.

FUE is a technically demanding procedure that requires special training, Dr. Rassman said. The procedure should not be performed by anyone who lacks the proper training, he warned. Included in proper training is assessment of the patient to determine suitability for FUE. This may include a biopsy of the donor area to determine hair and follicle characteristics and the ease with which follicles can be extracted.


The ISHRS is the world's largest not-for-profit professional organization in the field of hair restoration surgery, with 512 physician members in 45 countries. The organization was founded in 1992 to promote the advancement of the specialty of hair restoration surgery through education, information-sharing, and observance of ethical standards.



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