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Follicular Unit Extraction or Direct Follicular Unit Microextraction
With the relatively new technique of follicular unit extraction, surgeons experienced in the technique are able to obtain thousands of grafts without a donor site incision. It can be argued that the single most important incision made in hair restoration using the traditional strip procedure is the donor site incision. As a fellowship trained, board-certified facial plastic surgeon, Dr. Epstein is obsessed with achieving the smallest scar in this area, so as to allow the patient the ability to keep the hair cut short- as short as a #2 or even a #1 razor. In recognition of the quote by Sir Gillies, one of the world's most famous plastic surgeons, "Plastic surgeon, by your incision you will be judged", Dr. Epstein has conducted scientific clinical studies to assess the optimal technique of donor site incision and closure.
Parallel with this research, a relatively new technique was developed, initially by a doctor in Australia , that faced this challenge with a fresh approach- avoiding an incision altogether. Rather, in a pain-staking fashion, individual follicles from the back and sides of the head, could be extracted using a tiny circular-shaped punch- leaving minimal to no detectable scar in the donor site. Thus, follicular unit extraction was born.
Over the past 2 years, Dr. Epstein has painstakingly developed his own version of this technique, which he calls direct follicular unit microextraction (FUM) or extraction (FUE). Using the very smallest ultra-sharp punches 0.8 mm in size, FUM permits the harvesting of hundreds to as many as 3000 follicular unit grafts in one or two procedures performed over one or two days- all without the need for an incision in the back of the head. Each follicle, after being extracted, is still carefully dissected free from the surrounding non-hair bearing skin under microscopic visualization, then can be implanted into tiny incisions in the donor site.
What were once perceived as limitations to FUE have, with more and more experience as well as new instrumentation, proven to be in fact not issues at all. Any patient who wants to leave open the option of shaving the head, including African American patients with curly hair, are actually outstanding candidates for FUE. This is especially indicated for young patients who desire some increased coverage, but want to know that, as they get older and may chose to cut their hair short, even buzz it, they will be able to do so. The rate of growth of these FUE grafts, while not quite as high usually as the 90% to 95% rate as strip harvested grafts, now approach a 90% rate under experienced hands such as those of Dr. Epstein.
The main limitation of the procedure is the time required to peform. Working with an experienced team of assistants, as many as 1800 grafts can typically be harvested and then planted over a single 8 to 9 hour long procedure. Often times, patients will return the very next day to have a second similarly-sized procedure, to allow for the greatest amount of coverage in this two-day span. Because of the greater amount of time and effort, the cost per graft is higher with FUE than with strip grafting.
In spite of the higher cost and smaller number of grafts per procedure, patients regularly undergo FUE by Dr. Epstein and the other Foundation doctors, who now perform 2 to 4 of these procedures weekly. Donor site healing is quicker and sutureless, and healing of the transplants is as rapid as that with follicular unit grafting. Finally, because the FUE or follicular unit grafting procedure is being peformed by Dr. Epstein or another Foundation doctor, patients are assured of having the most aesthetic results- the most important element to hair transplantation.
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FUE (no linear donor site incision) procedure, showing the donor area that has been shaved down to harvest 1800 grafts, at 1 day after the procedure.
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Before and 7 months after 1700 FUE grafts. This is an ideal patient for FUE- likes to keep his hair short, even shave it at times.
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Before and just 4 1/2 months after 1600 FUE graft procedure. Note absence of donor site scarring.
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Before and one day after 450 FUE grafts for a revision procedure to soften a prior transplanted hairline. Note that this patient did not have his entire head shaved for the FUE procedure, so is able to conceal the donor area.
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next procedure >> If you have further questions about follicular unit extraction, or other hair transplant issues, please don't hesitate to contact our office. |
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