Why we don’t offer FUE procedure?

Why we don’t offer FUE procedure?

Because we don’t think it’s your best interest!

Don’t listen to what people tell you! Take sometime, do your study seriously, ask questions, use your own intelligent and make your own decision.

Differences between FUT and FUE:

The only different between FUT and FUE is donor harvesting.

FUT uses blade and FUE uses punch. The recipient site transplant are completely the same.

Different tool used produced different result!

Comparison	FUE	FUT
Is it the latest technique?	no, it is the oldest punch graft but change the size of punch
Tool	punch	blade
Donor harvesting	blind	under direct microscopy vision
Wound treatment	leave open	closed
Scar	thousand of small punch scars	one linear scar
Scar distribution (in same length)	5 to 6 times wider	one line only
Total Scar Size	10 times bigger
Scar long term effect	permanent	permanent
For keloid patient	disaster-hard to treat thousand keloids	easier- only one scar to treat
Quality of graft	defect graft (no tissue around follicle)	intact graft (come with tissue around follicle)
Growth rate of transplantation	61.40%	86%	Read Dr.Beehner's study
Impact to 2nd surgery	huge-scar tissues change the hair direction	minimum- can use different donor area
Length of hair need to cover up the scar	1 cm	2 cm
Hairstyle options such as marine cut	no	yes
Price	Double

Why most surgeons prefer FUE?

  

FUE: need only one technician

FUT: need 3-4 technicians

Some surgeons do everything by themselves without hiring any assistance to save on business costs. It is for their own best interest, not yours.

In addition to the overhead expense, the surgery fee is double for the FUE technique. The incentive using FUE for physicians are simply irresistible. Especially for new physician who’s just starting his practice with only 3 to 5 surgeries a month. It’s difficult to start a business when you need to hire 3 to 4 technicians to assist.

ISHRS Warning

Learn from one hair transplant surgeon’s own experience.

Dr. M Beehner’s Study about FUE and FUT

Below is  Dr. M Beehner’s  (3560 hairs/ follicles) study which was presented at the ISHRS annual meeting on Sep 2015.

Please see the two photos. The only difference is the FUT grafts have tissue around its follicles and the FUE grafts have no tissue. 

FUE is a blind procedure, the deeper the cutting, the more chance of dissection of the follicles. The standard method is to blindly punch through the skin then use a strong forcep to pull them out. This is the reason why there are no tissues are around the follicle level and the follicle is left exposed with no protection.

The impact to survival rate is 10-14 months after surgery- 

FUT 86% survival rate (765/890) vs FUE 61.4% survival rate ( 547/890).

The difference is 24.6 %.

We all know donor hair is limited, our worst nightmare is that we might run out of it someday .
Remaining concerns are, what’s the impact to the transplanted hair quality and the life of it? So far no one has done this study.    

Paired Graft vs. Intact Graft

From July 2009 Dr. Michael Beehner’s report ~

One intact 2- hair graft: contain two single hairs follicular unit. This can also be cut into two 1-hair follicular units (paired graft). *paired graft=combine two grafts and insert into one slit.

One intact 3-hair graft: contain one single hair follicular unit and one two-hair follicular unit. This can also be cut into one 1-hair and one 2-hair follicular unit (paired graft).

BFU=Bi-Follicular Unit

Conclusion from Dr. Michael Beehner:

Intact follicular unit’s growth rate is better than paired grafts (93% vs. 70%)
3-hair follicular unit has higher growth rate than 2-hair follicular units. (99% vs. 83% on intact 2-hair graft, 49% on paired graft 1 hair+1 hair

Comments:
Intact follicular units and 3-hair follicular units are our modified follicular units (bi-follicular unit). Paired grafts are single follicular units. This is why our modified follicular unit (bi-follicular unit) has higher growth rate.
Another reason why we opposed to the paired graft is that the goal of hair transplant is to minimize the empty spaces among the grafts. When transplant same size of donor area and hair, paired grafts will increase the empty space.

The photo below shows the scalp skin. If you paired the blue circled hair into adjacent hair, the empty area will increase almost four times.

From another point of view, the intention of hair transplant is to use lesser amount of hair to cover a bigger area. But when you pair grafts, it covers less area. That’s against the purpose of hair transplantation.

Look at the picture above and imaging that if you paired all the hairs, the empty space becomes huge and unnatural. If you want to keep same space then we have to remove 50% of empty skin. Transplant area will be reducing to 50% smaller area.

Super dense packing (92 grafts/cm2), does it benefit the patients?

Here is the abstract of another presentation that I did at the 2009 ISHRS annual meeting.

Super dense packing (92 grafts/cm2), does it benefit the patients?

I. Introduction
For past several years, mega-session with dense packing is the main trend in hair transplant surgery. The graft number and density get more and higher every year.
Does it really benefit the patient in general?

II. Technique
To precisely calculate the growth rate of the transplanted hair, we transplanted hair onto eyebrow instead of the scalp. We transplanted 544 grafts in an area of 6 cm2. The density is 92 grafts/ cm2.

Prior to this case, we usually deliver a density of 40 to 50 grafts/ cm2 on eyebrow transplantation.

We compare the result of the growth rate to find out if super dense packing benefits the patients.

III. Discussion
Six months after the 92 grafts/ cm2 eyebrow transplant surgery, we counted 455 hairs. The growth rate is 82%.

We have done about 300 eyebrow cases for the past 15 years and the average growth rate is about 96%.

With the super dense packing technique, we have sacrificed 14% of hair.

To grow 455 grafts with 40 to 50 grafts/ cm2 density, we only need to implant 474 grafts. The last 70 grafts (544-474) were wasted.

In order to achieve 92 grafts/ cm2 density, we have to cut the graft much smaller and instead of making 19G coronal slit, we have to make 20G needle coronal slit.

When we transplant hair onto the scalp, we had the same result. http://hairtransplantion.blogspot.com/2009/08/chubby-vs-skinny-graft.html

In the process of preparing the smaller graft, the technician must trim off all the tissue next to the grafts. Bare graft obviously has lower growth rate.


IV. Conclusion
So far no one knows what the best density for best growth rate is, maybe we never will.

I’m sure that depends on age, health, nutrition, etc. everyone has different limitation. Without knowing the body’s limitation, only looking for higher density is not the patient’s best interest.

Chubby vs. Skinny Graft

The more denser-packing, the more skinny grafts.

Here are the study results that I can find about chubby vs. skinny grafts.






Conclusion:

All studies show that compared to the chubby grafts, the growth rate of the skinny graft is decreased 15% to 33%.