Follicular unit extraction

Last updated

Follicular unit extraction (FUE; also follicular unit excision or follicular transfer, FT) Performed under local anaesthetic, FUE procedure involves the harvesting of individual hair follicles from the donor site at the back of the head using a tiny 0.8 - 1mm punch which creates an incision around the top of the follicle and extracts them directly from the scalp. The FUE method allows the surgeon to complete the procedure without leaving any linear scarring. It is one of two primary methods of obtaining hair follicles, naturally occurring groups of one to four hairs, for hair transplantation. [1] The other method is called strip harvesting. [1] In 2018, Mejia published the updated guidelines adopted by the International Society of Hair Restoration Surgery. [2] This name change came about to accurately describe the procedure  which involves  surgically cutting or incising a full thickness hair follicle skin graft with a circular scalpel, punch or motorized drill and subsequently carefully extracting it from the scalp to be placed in  the donor balding scalp.  Due to the new developments of incision punches and devices and a variety of different extraction techniques, it was necessary to more accurately define the procedure. Additionally, many places were incorrectly marketing the extraction procedure as a simple plucking of hairs and deceiving the public.

Contents

The follicular units obtained by either method are the basic building blocks of follicular unit transplantation (FUT).

Follicular unit extraction was first described in 1988 by Masumi Inaba in Japan, who introduced the use of a 1 mm needle for extracting follicular units. [3] [4]

Follicular unit excision takes considerable time and expense to learn and to develop skills to a high standard. [5] The first part of the procedure involves making an incision with a circular cutting punch around the hair follicle through the epidermis into the subcutaneous tissue in order to release the follicle from the underlying tissue. The hair follicle grouping or follicular unit is a full thickness skin graft containing epidermis, dermis and fat. The graft is then subsequently extracted utilizing suction, or forceps or specialized aid to extraction instruments (ATOE) and carefully preserved until it is time to reimplant into the donor scalp or recipient area. Each follicular unit is excised one at a time being very careful not to cut the underlying hair matrix cells and injure or fracture the graft with transection.  [6] Additional care must also be taken when extracting the grafts with forceps to insure the hair follicles are not crushed or manipulated too aggressively which could also affect the growth. [7]  Hence FUE requires careful attention to detail and time. Consequently, many physicians are not able to excise as many grafts in one day compared to traditional FUT due to the time involved.

The survival of follicular units upon cutting around the hair follicle and then extracting from the scalp is one of the key variables of successful hair transplantation. If follicular units are transected in the incision process, there is a greater likelihood that they will not survive the transplant, and the hair transplant will fail. While FUT procedures using strip-harvesting of follicular units typically guarantees a large number of non-transected follicular units, FUE procedures can, and often do, transect grafts, rendering them useless in a transplant. [8]

FUE harvesting is a surgical technique of grafts and may cause "pit" scarring, [9] small, round, and typically white scars in the patient's donor area where the grafts have been removed. [10] However, thanks to changes in punches in recent years, graft transection rates have decreased significantly. Patients' skin type, hair structure and FU depth are the parameters used when determining puncheshttps://onlinelibrary.wiley.com/doi/abs/10.1111/dth.15340. There are many different types of punch; star-shaped ones, trumpet-shaped ones, sharp ones and blunt ones. Punches can be used manually or motorized. In addition, thanks to oscillating machines, the FUE method can be performed without shaving the hairs. Follicular unit excision generally has a quicker patient recovery time and significantly lower post-operative discomfort than follicular unit transplantation (FUT). [11] Additionally the risk of long term nerve damage, leading to chronic numbness and/or pain in the donor area, is significantly reduced with FUE vs the strip (FUT) procedure. Additionally, FUE provides an alternative to FUT when the scalp is too tight for a strip excision and enables a hair transplant surgeon to harvest finer hair from the nape of the neck to be used at the hairline or for eyebrows. [9] [12]

However, with FUE, the follicles are harvested from a much greater area of the donor zone compared to FUT, estimated to be eight times greater than that of traditional strip excision so requires patients to have hairs trimmed in a much larger donor area. [13] [14] Follicles excised from borderline areas of the donor region may not be truly "permanent," so that over time, the transplanted hair may be lost. [15] Due to the scarring and distortion of the donor scalp from FUE it makes subsequent sessions more difficult, and grafts are more fragile and subject to trauma during placing, since they often lack the protective dermis and fat of microscopically dissected grafts. [16]

See also

Related Research Articles

<span class="mw-page-title-main">Rhinoplasty</span> Surgical procedure to enhance or reconstruct a human nose

Rhinoplasty, commonly called nose job, medically called nasal reconstruction, is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery can also treat birth defects, breathing problems, and failed primary rhinoplasties. Rhinoplasty may remove a bump, narrow nostril width, change the angle between the nose and the mouth, or address injuries, birth defects, or other problems that affect breathing, such as a deviated nasal septum or a sinus condition. Surgery only on the septum is called a septoplasty.

<span class="mw-page-title-main">Hair follicle</span> Organ found in mammalian skin

The hair follicle is an organ found in mammalian skin. It resides in the dermal layer of the skin and is made up of 20 different cell types, each with distinct functions. The hair follicle regulates hair growth via a complex interaction between hormones, neuropeptides, and immune cells. This complex interaction induces the hair follicle to produce different types of hair as seen on different parts of the body. For example, terminal hairs grow on the scalp and lanugo hairs are seen covering the bodies of fetuses in the uterus and in some newborn babies. The process of hair growth occurs in distinct sequential stages: anagen is the active growth phase, catagen is the regression of the hair follicle phase, telogen is the resting stage, exogen is the active shedding of hair phase and kenogen is the phase between the empty hair follicle and the growth of new hair.

<span class="mw-page-title-main">Scalp</span> Anatomical area bordered by the face at the front, and by the neck at the sides and back

The scalp is the area of the head where head hair grows. It is made up of skin, layers of connective and fibrous tissues, and the membrane of the skull. Anatomically, the scalp is part of the epicranium, a collection of structures covering the cranium. The scalp is bordered by the face at the front, and by the neck at the sides and back. The scientific study of hair and scalp is called trichology.

<span class="mw-page-title-main">Skin grafting</span> Surgical transplantation of skin

Skin grafting, a type of graft surgery, involves the transplantation of skin without a defined circulation. The transplanted tissue is called a skin graft.

<span class="mw-page-title-main">Sebaceous cyst</span> Types of cyst

A sebaceous cyst is a term commonly used to refer to either:

<span class="mw-page-title-main">Corneal transplantation</span> Surgical procedure of repairing corneal tissue to treat corneal blindness

Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue. When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. Keratoplasty simply means surgery to the cornea. The graft is taken from a recently deceased individual with no known diseases or other factors that may affect the chance of survival of the donated tissue or the health of the recipient.

The management of hair loss, includes prevention and treatment of alopecia, baldness, and hair thinning, and regrowth of hair.

<span class="mw-page-title-main">Hair transplantation</span> Surgical operation to relocate hair follicles

Hair transplantation is a surgical technique that removes hair follicles from one part of the body, called the 'donor site', to a bald or balding part of the body known as the 'recipient site'. The technique is primarily used to treat male pattern baldness. In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding are transplanted to the bald scalp.

Follicular unit transplantation (FUT) is a hair restoration technique, also known as the strip procedure, where a patient's hair is transplanted in naturally occurring groups of 1 to 4 hairs, called follicular units. Follicular units also contain sebaceous (oil) glands, nerves, a small muscle, and occasional fine vellus hairs. In follicular unit transplantation, these small units allow the surgeon to safely transplant thousands of grafts in a single session, which maximizes the cosmetic impact of the procedure.

Eyebrow restoration is a surgical procedure to reposition the eyebrow. With advancing age, a common occurrence is descent of the eyebrow, or brow ptosis. A similar condition is eyelid ptosis. Eyebrow repositioning is a commonly performed procedure in cosmetic surgery. The brow is repositioned, optimally, for the wishes of the patient as well as to correct the descent.

<span class="mw-page-title-main">Trichilemmal cyst</span> Common cyst that forms from a hair follicle

A trichilemmal cyst is a common cyst that forms from a hair follicle, most often on the scalp, and is smooth, mobile, and filled with keratin, a protein component found in hair, nails, skin, and horns. Trichilemmal cysts are clinically and histologically distinct from trichilemmal horns, hard tissue that is much rarer and not limited to the scalp. Rarely, these cysts may grow more extensively and form rapidly multiplying trichilemmal tumors, also called proliferating trichilemmal cysts, which are benign, but may grow aggressively at the cyst site. Very rarely, trichilemmal cysts can become cancerous.

Madarosis is a condition that results in the loss of eyelashes, and sometimes eyebrows. The term "madarosis" is derived from the ancient Greek "madaros", meaning "bald". It originally was a disease of only losing eyelashes but it currently is the loss of both eyelashes and eyebrows. Eyebrows and eyelashes are both important in the prevention of bacteria and other foreign objects from entering the eye. A majority of patients with madarosis have leprosy, and it was reported that 76% of patients with varying types of leprosy had madarosis.

Eyelash implants are a form of cosmetic surgery involving transplanting additional eyelashes around the eye. The process typically involves removing a section of hair from the patient, typically from the back of the head, and grafting the hair to the eyelids, replacing the existing eyelashes. The procedure typically involves 60 to 70 hairs per eye, and after removal and a thorough cleaning of the oil on the hair, they are reattached to patient by delicately sewing the lashes back on. Maintenance of the eyelashes is needed thereafter, as the hair continues to grow at the same rate as on other parts of the body.

Multiple follicular unit grafts is a hair transplant technique that has been developed to complement and enhance current micro grafting and follicular unit procedures by increasing density without sacrificing naturalness. A follicular unit (FU) is a naturally occurring bundle of hairs. This bundle contains anywhere from 1 to 4 hairs. A "multiple follicular unit" is a graft that contains more than one follicular unit. When combined these follicular units can total 5 to 8 hairs creating more significant results. These grafts are not to be mistaken with old style hair plugs harvested with a punch biopsy instrument, but instead are modern day slit grafts harvested from a thin donor strip in the back of the head and separated under magnification.

Rashid M. Rashid is an American dermatologist, known for his work on hair loss and transplantation.

Hairline lowering is a surgical technique that allows an individual to have their frontal hairline advanced certain distances depending on variables such as pre-operative hairline height, scalp laxity, and patient preference. It can be used to address a congenitally high hairline or sometimes a hairline that has recessed from hair loss. It is performed mostly on women.

Hair multiplication, or hair cloning, is a proposed technique to counter hair loss. The technology is in its early stages, but multiple groups have demonstrated pieces of the technology at a small scale, with a few in commercial development.

Scalp reduction is a surgical procedure in which the hairless region of the scalp of a bald person is reduced. This procedure can reduce the area of the scalp in which hair transplantation is needed or even eliminate the need for hair transplantation.

Fat transfer, also known as fat graft, lipomodelling, or fat injections, is a surgical process in which a person's own fat is transferred from one area of the body to another area. The major aim of this procedure is to improve or augment the area that has irregularities and grooves. Carried out under either general anesthesia or local anesthesia, the technique involves 3 main stages: fat harvesting, fat processing and fat injection.

<span class="mw-page-title-main">Dermatologic surgical procedure</span> Skin surgery

Dermatologic surgical procedures are treatments aimed at managing a wide range of medically necessary and cosmetic conditions, with a long history dating back to ancient times.

References

  1. 1 2 Avram, Marc R.; Rogers, Nicole E. (2009). Hair Transplantation. Cambridge University Press. p. 23. ISBN   978-0-521-87967-5.
  2. ↑ Mejia, Ricardo (2018). "Redefining the "E" in FUE: Excision = Incision + Extraction". International Society of Hair Restoration Surgery. 28 (1): 1.1–6. doi: 10.33589/28.1.0001 . ISSN   2641-6719. S2CID   219235705.
  3. ↑ Papel, Ira D. (2009). Facial Plastic and Reconstructive Surgery. Thieme. p. 419. ISBN   978-1-58890-515-4.
  4. ↑ Pathomvanich, Damkerng; Imagawa, Kenichiro (2010). Hair Restoration Surgery in Asians. Springer. p. 133. ISBN   978-4-431-99658-3.
  5. ↑ William R. Rassman; Robert Bernstein (2008). Hair Loss and Replacement For Dummies. For Dummies. p. 201. ISBN   978-0-470-08787-9.
  6. ↑ Kwack, Mi Hee; Kim, Moon Kyu; You, Seung Hyun; Kim, NaRae; Park, Jae Hyun (2021). "Comparative Graft Survival Study of Follicular Unit Excision Grafts With or Without Minor Injury". Dermatologic Surgery. 47 (5): e191–e194. doi:10.1097/DSS.0000000000002878. ISSN   1076-0512. PMID   33165067. S2CID   226287584.
  7. ↑ Park, Jae Hyun; You, Seung Hyun (2017). "Various Types of Minor Trauma to Hair Follicles During Follicular Unit Extraction for Hair Transplantation". Plastic and Reconstructive Surgery - Global Open. 5 (3): e1260. doi:10.1097/GOX.0000000000001260. ISSN   2169-7574. PMC   5404445 . PMID   28458974.
  8. ↑ Rusciani – Robins; Luigi Rusciani; Perry Robins (2008). Textbook of dermatologic surgery. PICCIN. p. 815. ISBN   978-88-299-1898-0.
  9. 1 2 Haber, Robert S.; Stough, Dowling Bluford (2006). Hair Transplantation. Elsevier Health Sciences. p. 133. ISBN   978-1-4160-3104-8 . Retrieved 5 June 2011.
  10. ↑ Trüeb, Ralph M.; Tobin, Desmond J. (2010). Aging Hair. Springer. p. 215. ISBN   978-3-642-02635-5.
  11. ↑ M, Bicknell, Lindsay; Natalie, Kash; Chitra, Kavouspour; M, Rashid, Rashid (1 January 2014). "Follicular unit extraction hair transplant harvest: a review of current recommendations and future considerations". Dermatology Online Journal. 20 (3). doi: 10.5070/D3203021754 . PMID   24656268.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ↑ Thomas, J. Regan (September 2009). Advanced Therapy in Facial Plastic and Reconstructive Surgery. PMPH-USA. p. 531. ISBN   978-1-60795-011-0.
  13. ↑ "Follicular Unit Extraction (FUE)". Carlos K. Wesley, M.D., A.B.H.R.S. Archived from the original on 14 March 2012. Retrieved 9 December 2011.
  14. ↑ Truswell, William (2008). Surgical Facial Rejuvenation: A Roadmap to Safe and Reliable Outcomes. Thieme. p. 162. ISBN   978-1-58890-491-1.
  15. ↑ "Follicular Unit Extraction (FUE)". Carlos K. Wesley, M.D., A.B.H.R.S. Archived from the original on 14 March 2012. Retrieved 9 December 2011.
  16. ↑ Armani, Antonio Alvi (1999). How to Beat Hair Loss: The Complete Guide to Surgical, Medical, and Alternative Treatments for Hair Loss. Redom Books. p. 95. ISBN   978-0-9683898-1-2.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.