Wine and Hair Transplant

The top news around the world today. ONE GLASS OF WINE A DAY INCREASES
RISK OF BREAST CANCER. It shocked so many people, because not too long ago, they said to drink one glass of wine a day to protect your heart and was published on all medias, That encouraged many people to drink wine every night.
This kind of controversial report it is not the first to happen, and it happens very often. It is
like vitamins, they always have controversial reports.
It happened in hair transplant field too. To try to transplant more and more grafts in certain area, the grafts should be cut smaller and smaller, without doing any study about its impact to the quality of regrowth and hair quality. Especially a lot of FUE grafts and not even a intact graft
( like bare graft)
We all know donor hair is limited if it were wasted, we never be able to undo it.

Intruder

After microscopy dissection was introduced, the chance for hair transaction during the surgery was mainly during donor harvesting.
To reduce it, the instrument changed from a multiple blade knife to a single knife. Instead of cutting blindly, the Haber Spreader and Tykocinski intruder were invented.
So far the intruder seems the safest and has minimum transecting rate( less then 1%).
The method is to score the outline about 2mm in depth, then make multiple insertions of the intruder into the incision line going to a depth slightly below the hair bulbs. Then, using two skin hooks to separate the incision gently. This way there is almost no transection and you don’t have to worry about damaging nerves and vessels.
Tykocinski intruder is easy to use and a great break through for donor harvesting.

Compare Different FUE Methods

There are so many name and methods for FUE. I would like to organize them
in this form to make easy comparison.

	punch	motorized	unique point
2 step	sharp	no
3 step	sharp+dull	no
Safe system	dull	yes	*1
Roto core	sharp	yes	*2
Neo graft	sharp	yes	*3
Artas robotic	sharp+ dull	yes	*4

*1,Safe system
The initial rotation speed is only enough to allow the dull punch to penetrate
the skin and slow down the speed when pass deeper to separate the follicular
units from surrounding tissue. This will reduce transection rate of follicles.

*2, Roto core
Automatic rotation when downward pressure is placed. It has debris disposal
window to fasten disposal process and potential harm to the Punch tip.

*3, Neo graft
The device is used to extract follicular units and implant them in the recipient area
via a suction system. It seems a great idea, but has two major problems.
At first, suction has tendency to produce bare grafts. 2nd the contineous flows of air will dry up the delicate follicular units.

*4, Artas robotic
After initial calibration, the robot will work 100% automatic.
The quality of the grafts is excellent and transection rate is about 5-8%.
I would like to say it is the best way to have FUE procedure, if the price is
right.

No Linear Scar, New Approaches!

You don’t like to have a linear scar at the back of your head.

FUE is not the only option anymore.

We have new approaches:

1, FUT+FUE approach
We can use FUT method to transplant as many grafts as needed (at the 50% of FUE cost ). With the Tricophytics Closure technique, it will ensure a fine scar. After 6 months if you don’t like the fine scar we can transplant 100 to 200 FUE grafts onto the scar to make the scar invisible.

2, FUT+FUT approach
First step as above but instead of using FUE graft to cover up the scar, we can cut only 2-3 cm strips to use as grafts.

3, FUT+TATOO
This approach is much easier.First step as above but use tatoo to make scar invisible.

Advantages of these approaches compare to total FUE (no linear scar from all approaches)-

1, Much better result. Grafts quality is much better to cut under microscope direct vision then blind FUE extraction.
2, No extensive shave at donor site during the surgery.
3, Leave only 100-200 small punch scars compare to thousand scars left from total FUE procedure.4, Save thousand and thousand surgery fee.

Disadvantage-You may need second minor surgery. But anyway, FUE procedure always needs more than one procedure too.

Sharp Punch and Dull Punch

Hair alignment is different in and out of the scalp.

Using FUE procedure to punch the grafts is a blind procedure.

There is no way to see through the skin. Therefore, two types of punch (sharp and dull punch) are used to reduce the transection rate.

	Deep Level	Advantage	Disadvantage
Sharp Punch	shallow, only cut through skin	less transection	bare graft caping
Dull Punch	deep to whole follicle	punch out whole follicle	more transection

* Sharp punch only punch through skin, need to use two forceps to pull out the grafts.Because the tissue around the follicles didn’t separate, a lot of time follicle come out without any surroundings tissue,that we call bare grafts. Sometimes during pulling, only skin pull out,follicle still stay in the scalp, that we call capping.*Dull punch method,use blunt dissection to isolate the follicular units from the surrounding tissue.Require more experience and skill to perform, even the speed of punch is very important.

FUE and Me

In my 18 year hair transplant career, I have been seeing numerous old 4mm Punch grafts.

It was rare to see any grafts without transection. There are times I even see the graft without any hair.

Initially I believed using the new FUE 1mm punch would yield a much higher transection rate, but after I visited Dr.James Harris at Denver last year, I completely changed my mind.

Seven hair transplant physicians attended the workshop. Dr.Harris taught us how to align the angle, where the scalp entry point is, how to tighten the scalp and how to control the punch speed. He watched us perform the procedure and corrected our mistakes one by one. He was such a good teacher, he could tell us how the grafts would turn out before we did it, by observe our alignment. By the end of the workshop, everyone had reduced the transection rate dramatically.

Now I changed my attitude toward FUE. I recognized it as a completely different method now, even though it is still a blind procedure but the transection rate might be reduced dramatically via adequate training and practice.

Limitations of hair transplants.

Hair transplantation is a surgery that relocates hair from the donor site to the front or vertex of the head. Hair transplantation itself cannot increase the number if hairs, it can only relocate the existing hair.
The more bald the head becomes, the larger the area is that needs coverage and less donor hair is available.With hair transplant surgery, we have to use less hair to cover a bigger area. To deliver 100 % density is impossible. How we use the hair is very important. The hair style, shape of the pattern of hair loss, color contrast and hair quality plays a role in what we should emphasize. Transplanting equal density throughout the head is never a good idea.

Hair Style and Hair Transplantation

After 2 surgeries, parted from the side.

After 2 surgeries parted in the middle.

Before surgery.
Your hair style is extremely important after hair transplantation. We have to deliver 50-60% density to develop balance and a natural result. To make 50-60% density look like 100%, we recommend a part on the side or combing the hair straight back. Parting the hair down the center is not recommended!

Short donor hair

Even with short hair, we can cover the donor site, but it is still visible to the naked eye. This is 3 days post op. We prefer the donor hair to be at least 3/4 inch in length. The donor site availability is limited when the hair is too short, because we prefer the hair to be long enough to cover the suture site.