Hair restoration surgery with hair transplant has undergone incredible advances over the last ten years. This has been most pronounced with Follicular Unit Extraction (FUE) where single follicle grafts are taken from the donor site one at a time, typically using punches that are less than one millimeter in diameter. The hairs are then individually placed.
A new emerging concept with FUE relates to the long-term management of the donor site. The donor site is to the hair restoration surgeon as paint is to an artist. If an artist is working on a large canvas with a small amount of paint supply, in order to create a beautiful painting, then the paint must be used effectively. A hair restoration surgeon frequently encounters this dilemma – a patient presents for consultation with a large area of balding and with a minimal donor supply, requesting maximal results. Just like the artist the surgeon must effectively manage the donor site to get optimal results. Prior to this concept, it was difficult if not impossible to provide sufficient density to these types of patients.
This new concept was presented and discussed at the European Hair Restoration Workshop in Brussels, Belgium which I was fortunate to attend. The concept first works by staging the total hair restoration over a number of procedures separated by at least five months to allow for total recovery of the donor area between cases. Second, at the time of each case, Smaller units are extracted with a goal of 2.0 to 2.2 hairs per graft are extracted as not deplete the donor site. Prior to this concept, larger grouping of hair follicles were extracted to that more hair and create as much density as possible in one case. This effectively depletes the donor reserve for subsequent cases. Third, at the time of subsequent hair transplant surgeries the donor site can be reevaluated and managed again as to not deplete potential donor grafts. Over one’s lifetime, by using these concepts there are more potential grafts and improved long-term results. As a result, even individuals with advanced Alopecia can receive incredible results.
Most patients have approximately 6000 to 8000 hair follicles that can be extracted over one’s lifetime. If donor extraction of hair follicles is done without implementing these new concepts, too much hair can be extracted at one time or in an incorrect manor to where the number of potential available hair follicle for future transplant drops. Patients with more advanced hair loss may require maximal coverage over time with possible need of 6000 to 8000 grafts.
The new concept works by extracting only portions of the hair follicle groupings which are typically closely grouped into two to six hairs. The old concept was to take the entire unit so that more hairs could be moved. Unfortunately, by removing the entire unit, there was actual depletion of the number of available hair follicles that could be taken at a later time for more coverage through repeat hair transplantation.
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