Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
Hair Transplant 360: Follicular Unit Extraction (FUE) (Volume 4)
Samuel M Lam, Kenneth L Williams Jr
I: FUE BASICS 360
1:
History of FUE: A Retrospective
ORIGINS
FUE: THE INCEPTION
ADVANCING FUE THROUGH MECHANIZATION
THE DRIVING FORCE
DISCLOSURE
2:
FUE Terminology
INTRODUCTION
BASIC CONCEPTS
Follicular group, follicular family, follicular cluster, or follicular bundle (Fig. 2.1)
Subfollicular group graft
Connective-Tissue Sheath (CTS) (Fig. 2.2)
Outer Root Sheath (ORS)
Inner Root Sheath (IRS)
Dermal Papilla (DP)
TECHNICAL VARIATIONS
Splay (Fig. 2.3)
Anchor system of the follicular units
Tethering
ALTERNATIVE VARIATIONS
Capping or topping (Figs. 2.4 and 2.5)
Pluck
Broken or fractured follicle(s) (Fig. 2.6)
Paring or desheathing (Fig. 2.7)
Splitting (Figs. 2.8 and 2.9)
Partial follicular family harvesting (Fig. 2.9)
Individual group harvesting
Transection (Figs. 2.10 and 2.11)
External dissection
Graft cleaning
Trimming
FUE TECHNIQUES
Follicular unit extraction
Follicular Isolation Technique (FIT)
Cole Isolation Technique (CIT)
Harris Surgically Advanced Follicular Extraction (SAFE) technique
Body hair transplant
Beard hair transplant
Woods technique
FOX test
FUE DEVICES
Powered Cole Isolation Device (PCID) (Fig. 2.13)
Harris SAFE System (Fig. 2.14)
NeoGraft (Fig. 2.15)
True device
Alphagraft
Devroye device
Feller device
ARTAS system (Fig. 2.16)
FUE DYNAMICS AND APPROACHES
Rotating extraction
Oscillating extraction
Rotating and oscillating extraction
Step methods
One-step method
Two-step method
Three-step method
Sequential method
Coring method
Open method
Sharp dissection
Blunt dissection
Pulling
Scoring
Depth control
Limited-depth extraction
Full-depth extraction
Follicle distortion
Axial force
Tangential force
Donor tension or traction
Bulls eye
Aid to extraction
Delay in extraction
Follicle depth
Time out of body
FUE PUNCHES
Handle (Fig. 2.17)
Cannula punch
Titanium Nitride (TiN)-coated punch (Fig. 2.18)
Serrated punch or wave punch (Fig. 2.19)
Serrounded punch (Fig. 2.20)
CLASSIFICATION OF PUNCH BY DIAMETER
External diameter of the punch
Internal diameter of the punch
Cutting-edge diameter of the punch
CLASSIFICATION OF PUNCH BY THE CUTTING EDGE
Outside-diameter punch (or inside-bevel punch)
Middle-diameter punch (or middle-bevel punch)
Inside-diameter punch (or outside-bevel punch)
CLASSIFICATION OF PUNCH BY THE DIAMETER OF THE CUTTING EDGE (FIG. 2.21)
Small punch
Medium punch
Large punch
CLASSIFICATION OF PUNCH BY THE SHARPNESS OF THE CUTTING EDGE (FIG. 2.22)
Sharp punch
Blunt punch
DONOR AREA
Safe donor area
Donor-area template
Donor-area regions
Major donor regions
Minor donor regions
Additional donor regions
Donor-area hypopigmentation
FUE GRAFTS AND RATIOS
Intact graft (Fig. 2.23)
Partially transected graft (Fig. 2.24)
Completely transected graft (Fig. 2.25)
Buried graft
Empty graft
Missing graft
Total number of punch insertions (or punch attempts)
Total number of grafts available for transplant
Total number of grafts unavailable for hair transplant
Total number of grafts extracted
Missing grafts rate
Graft Transection Rate (GTR)
Completely Transected Graft Rate (Total Transection Rate—TTR)
Follicle Transection Rate (FTR or TR)
Calculated Follicles per Graft Expected (CFGE)
Calculated Follicles per Graft Achieved (CFGA)
Pared Follicle Rate (PFR)
Donor area calculated density (hairs per follicular group)
3:
Skin Properties and Anatomy
INTRODUCTION
THE IMPORTANCE OF SKIN
BASIC SKIN ANATOMY
Epidermis
Dermis
Subcutaneous Layer (Hypodermis)
BASIC ANATOMY OF THE HAIR FOLLICLE
THE FOLLICULAR UNIT
THE RELATIONSHIP BETWEEN FUE AND SKIN STRUCTURE
BERNSTEIN AND RASSMAN'S FUE RESEARCH
CONCLUDING REMARKS
4:
The Physics of Follicular Unit Extraction
BACKGROUND
INTRODUCTION TO THE FUNDAMENTAL PRINCIPLES OF FUE
THE OUTGROWTH ANGLE MODEL6
Geometry, Medical Physics, and Exit Hair Angle
RESULTS
TISSUE TURGOR AND REDUCING WOUND SIZE
THE HARVEST PROCESS MODEL
Summary
THE MECHANICS OF FUE
THOUGHTS AND PEARLS
DISCLOSURE
5:
Punch Characteristics
INTRODUCTION
THE FUE PUNCH OR DEVICE DOES NOT MAKE A HAIR SURGEON
HISTORY OF CIRCULAR SHARP PUNCHES USED IN HAIR TRANSPLANTATION
METALLURGY OF PUNCHES
Conventional Steelmaking Versus Crucible Particle Metallurgy Processing
Punch Design: Cutting Edges, Bevel Positions, and Styles
CUTTING EDGE AND BEVELS
Punch Serration
Sharp versus Blunt Punch
THOUGHTS AND PEARLS
6:
Scalp Anesthesia and Hemostasis for FUE
INTRODUCTION
PAIN
Preoperative Sedation
LOCAL ANESTHESIA
Basic Lidocaine Solutions
NEEDLE AND SYRINGE CHOICE
Essential Equipment
KEY PRINCIPLES FOR INITIAL AND INTRAOPERATIVE ANESTHESIA AND HEMOSTASIS
Relevant Anatomical Considerations
Ring Block and Tumescent Field Infiltration Procedure
Supraorbital Blocks
Hemostasis in the Scalp
EPINEPHRINE IN THE SCALP
STAGING INJECTIONS
Pearls
CLINICAL PEARLS—TROUBLESHOOTING ANESTHESIA AND HEMOSTASIS
SUMMARY
7:
Ergonomics in FUE Donor Harvesting
INTRODUCTION
HISTORY
SURGEON'S INVOLVEMENT
WORK ENVIRONMENT
Surgeon and Patient Positioning
Work Distance and Choice of Instruments
PATHOPHYSIOLOGY OF MSDS IN FUE DONOR HARVESTING
Patient musculoskeletal and body position
THOUGHTS AND PEARLS
FUTURE OF ERGONOMICS IN HAIR-RESTORATION SURGERY
8:
FUE Donor Evaluation and Surgical Planning
INTRODUCTION
PATIENT GOALS AND EXPECTATIONS
MINIMIZING DONOR SCARRING IN FUE
EVALUATING THE DONOR AREA
CALCULATING THE NUMBER OF FOLLICLES THAT CAN SAFELY BE EXTRACTED
DOES THE SDA DIFFER DEPENDING UPON EXTRACTION TECHNIQUE?
COMBINING FUE AND LINEAR EXTRACTION FU TRANSPLANT
PARTIAL FUE
9:
Strip versus FUE Considerations
10:
Improving Graft Survival: Extraction Techniques and Transection Management
INTRODUCTION
ANATOMY OF THE FOLLICLE
PYRAMIDAL STRUCTURE
FUE TERMINOLOGY
THE FU TISSUE ATTACHMENTS
THE MAJOR EXTRACTION TECHNIQUES
Mechanized or Motorized FUE
POTENTIAL CONSEQUENCES OF POOR DISSECTION TECHNIQUE
CHOOSING THE IDEAL PUNCH SIZE
THE USE OF TUMESCENCE IN DONOR HARVESTING
LIMITATION OF PUNCH PENETRATION
SUPERFICIAL SCAR AND THE DISTORTION OF NEIGHBORING GRAFTS
WHY IS IT IMPORTANT TO AVOID TRANSECTION?
EXTRACTION OF GRAFTS
HOLDING SOLUTION AND BIOENHANCED SOLUTIONS
IMPLANTATION OF GRAFTS
CLINICAL PEARLS
CONCLUSION
11:
Improving Graft Survival: Graft Placement and the Use of Implanters
FUE-GRAFT CHARACTERISTICS
HAIR DIRECTION
GRAFT PLACEMENT USING FORCEPS
GRAFT PLACEMENT USING SHIAO IMPLANTERS
LOADING THE IMPLANTERS
PROBLEMS ENCOUNTERED IN GRAFT PLACEMENT
Popping
Bleeding
CONCLUSION
12:
Surgical Flow and Set-up for FUE Transplant Cases
BACKGROUND
SURGICAL FLOW
Patient Preparation
Platelet-Rich Plasma Treatment
Sedation and Anesthesia
Recipient-Site Creation: Timing and Considerations
Donor Harvesting: Follicular Unit Punching and Extraction
Graft Placement
Wound Dressing and Postoperative Care
SURGICAL ASSISTANT TASKS AND SKILL REQUIREMENTS
SIZE OF THE SURGICAL TEAM
SURGICAL TIMING
SURGICAL SUITE/OPERATING-ROOM SET-UP
THOUGHTS AND PEARLS
13:
Starting an FUE Practice
INTRODUCTION
MY JOURNEY AND MY STORY
NOT A “SEE ONE, DO ONE, AND TEACH ONE” PROCEDURE
Hair-Restoration Workshops
PHYSICIAN TRAINING AND BACKGROUND
OUTDATED HAIR-RESTORATION KNOWLEDGE
PRACTICE AND PHYSICIAN DRIFT INTO FUE
ESTABLISHED HAIR-RESTORATION PRACTICE ENTRY INTO FUE
Hair Restoration Diverse Clinical Experience and Background
A New Trend: Dedicated FUE Practices
Hair-Restoration Surgery Core Curriculum
Fellowship Training in Hair-Restoration Surgery
Ethical Considerations Involving Nonphysician Operators
Defining Physician Duties and Responsibilities
Obtaining FUE Punches, Supplies, and Devices
Final Thoughts and Pearls
CONCLUSION
II: FUE METHODS 360
14:
Manual FUE
INTRODUCTION
CHALLENGES OF ADOPTING FUE INTO YOUR PRACTICE
First Acquire Manual FUE Skill Sets
PATIENT SELECTION CRITERIA
PREDICTIVE POINTS
QUALITY OF THE DONOR AREA
Hair Diameter
Color
Shape
Hairs per FU
Follicular Density
Follicular-Unit Family
SURGICAL STRATEGY
SURGICAL RECOVERY TIME OF THE DONOR AREA
THE RELATIONSHIP BETWEEN PUNCH DIAMETER AND HAIR THICKNESS
BENEFITS OF PARTIAL TRANSECTION
CONCLUSION
15:
Motorized FUE with Blunt Punch
THE INTRODUCTION OF SURGICALLY ADVANCED FOLLICULAR EXTRACTION SYSTEM AND POWERED SYSTEM
COMPONENTS OF THE POWERED SAFE UNIT
PREPARATION FOR SAFE-POWERED FUE
SAFE SYSTEM-POWERED FUE: THE PROCEDURE
Preparing the Donor Area
Using Tumescence and Pulse Oximetry
Anatomy of the SAFE System
Choosing the Appropriate Punch Size
Setting Punch Rotation Speed
CLINICAL PEARLS
Applying Skin Traction
Dissecting Follicular Unit Grafts
Techniques for SAFE-Powered FUE
Engaging the Punch
Pearls for Engaging the Punch
Power Dissecting
The Fate of Transected Grafts
Going with the Flow: The “Zen” of FUE
SAFE-Powered FUE Hexagon Punch Technology
Depth Control
FINAL THOUGHTS
16:
Motorized FUE with Sharp Punch
FOLLICULAR UNIT EXTRACTION—A DISCUSSION OF SHARP PUNCHES
HISTORY OF FOLLICULAR UNIT EXTRACTION
MY EXPERIENCE WITH SHARP AND BLUNT PUNCH DEVICES
CURLY HAIR CONSIDERATIONS
THE “MODERATELY SHARP-PUNCH” TECHNIQUE
PEARLS AND SUMMARY
OVERVIEW
DETERMINING FUE CANDIDACY
BIOMECHANICAL AND VISCOELASTIC PROPERTIES OF SKIN RELATIONSHIP TO SUCCESSFUL DONOR HARVESTING
DONOR- AND RECIPIENT-SITE ANESTHESIA
PREOPERATIVE SEDATION
PREOPERATIVE PREPARATION
STARTING MY FUE CASES
PLATELET-RICH PLASMA
PRP: Contraindications
MATRISTEM MICROMATRIX
POSITION OF THE PATIENT
DIRTY, STERILE ENVIRONMENT OF FUE
DONOR-SITE ANESTHESIA, MANUAL PUNCH TECHNIQUE, SELECTING PUNCH SIZE
ESTABLISHING DEPTH OF PENETRATION
EXTRACTING THE SCORED GRAFT
FUE SAFE DONOR AREA
AVOIDING POOR OUTCOMES: DONOR-HARVESTING MANAGEMENT
PUNCH SIZE AND DONOR APPEARANCE
Hypopigmentation
Clinical Pearls
GRAFT PRESERVATION, BIOENHANCED STORAGE SOLUTIONS, AND LIPOSOMAL ATP
Linear Donor Scar Repair with Sharp-Punch Grafting Technique
CONCLUSION AND PEARLS
17:
Suction-Assisted FUE
INTRODUCTION
EQUIPMENT
Suction Loop
The Motorized Punch System
The Punch
Graft Collection
THE INSTRUMENT PANEL
Cleaning
Dependability
How I Do It—The Procedure
Graft Harvesting
Graft Placement
Clinical Pearls — My Experience
Benefits of SAE
Dangers of SAE
18:
Automated FUE
HISTORY
HARDWARE OVERVIEW
Punches
Skin Tensioner
The User-Interface System
AUTOMATION AND THE DISSECTION PROCESS
ARTAS Reading of the Active Grid
Graft Selection
Graft Dissection
SURGERY WORK FLOW
PERFORMANCE
CLINICAL RESULTS
THE FUTURE OF THE ARTAS SYSTEM
CONCLUSION
DISCLOSURE
III: FUE SPECIALIZED TOPICS 360
19:
FUE Complications and Difficult Situations
BACKGROUND
AESTHETIC COMPLICATIONS
Acute Effluvium of the Donor Area
Donor-Site Depletion
Hypopigmentation—White Dots in the Donor Area
Suboptimal Results due to Higher Transection Rate and/or Graft Fragility
Harvesting Outside of SDA
Low Graft Yield Due to Capping, Buried Grafts, or Missing Grafts
TECHNICAL/SURGICAL DIFFICULTIES
Patient Candidacy
Limited Graft Numbers per a Single Session
Difficult Harvesting in Subsequent Procedures
CONCLUSION
20:
FUE in Patients of African Descent: Pearls and Pitfalls
INTRODUCTION
THE HISTORY OF THE AFRICAN-AMERICAN HAIR-CARE INDUSTRY
CHARACTERISTICS OF AFRICAN-AMERICAN HAIR
BEFORE THE TRANSPLANT: FACTORS TO CONSIDER
Sickle-Cell Anemia
Hypertension, Diabetes, and Obesity
Skin Conditions and Scalp-Disease Processes
Keloids
Central Centrifugal Cicatricial Alopecia
Traction Alopecia
Frontal Fibrosing Alopecia
Lichen Planopilaris
Dissecting Cellulitis Decalvans
Androgenetic Alopecia
HAIR TRANSPLANTS IN AFRICAN-AMERICAN PATIENTS: STRIP OR FUE
THE CHOICE OF INSTRUMENT
TESTING PROCEDURE
Tumescence
Trimming of the Donor Hair
Planning the Donor Area
Determining Hairline Design
Deciding Number of Grafts per Session
Sharp versus Blunt Punch and Choosing Punch Size
THE FUE HARVESTING PROCESS
Determining Punch Angle
POSTSURGERY FOLLOW-UP
POSTOPERATIVE FUE COMPLICATIONS IN AFRICAN-AMERICANS
Keloid Formation
Graft-Growth Failure
Hyperpigmentation and Hypopigmentation
Folliculitis
Depletion of Donor Density
Slow-Growth Patterns
SMP and FUE: A Promising Pair for African-American Patients
SMP and FUE in My Practice
African-American Hair Loss in the Media
CONCLUSIONS
21:
Regenerative Medicine Techniques
BACKGROUND
TERMINOLOGY
REGENERATIVE MEDICINE IN HAIR-RESTORATION SURGERY
WOUND HEALING
WOUND REPAIR VERSUS REGENERATION
MSMM IN HAIR RESTORATION
PRP IN HAIR RESTORATION
Preoperative Considerations
Operative Considerations
Postoperative Considerations
THOUGHTS AND PEARLS
22:
Combined Strip and FUE Technique
BACKGROUND
PREOPERATIVE CONSIDERATIONS
OPERATIVE CONSIDERATIONS (Video 15)
Demarcation and Donor-Area Preparation
Anesthesia
Strip Removal and Follicular-Unit Implants
Demarcation of the Untouched Strip and FUE Harvesting
The Combined Technique with Minimal Shaving
Combining FUE and Strip in Secondary Surgery
POSTOPERATIVE CONSIDERATIONS AND MANAGEMENT OF COMPLICATIONS
THOUGHTS AND PEARLS
ACKNOWLEDGMENT
23:
FUE from the Beard and Body
BACKGROUND
PATIENT SELECTION
TECHNIQUE
POSTOPERATIVE CARE
THOUGHTS AND PEARLS (Video 16)
COMPLICATIONS
24:
Avoiding Disastrous Outcomes in FUE Practice
BACKGROUND
Ethical Challenges in FUE and Hair Restoration
Recipe for Disaster-Marketing FUE
“Top Ten List”
CASE STUDIES (Video 17)
CONSIDERATIONS IN PATIENT SELECTION FOR FUE
Case Study 1
History
Examination
Discussion
Case Study 2
History
Examination
Discussion
DONOR AREA MANAGEMENT AND HYPOPIGMENTATION
Case Study 3
History
Examination
Discussion
Case Study 4
History
Examination
Discussion
AVOIDING DONOR OVERHARVESTING
Case Study 5
History
Examination
Discussion
Case Study 6
History
Examination
Discussion
CONCLUSION
25:
Piloscopy
BACKGROUND
PILOSCOPE
SURGICAL APPROACH
PROOF OF PRINCIPAL METHOD
PREOPERATIVE CONSIDERATIONS
SURGICAL PROCEDURE
POSTOPERATIVE CONSIDERATIONS
THOUGHTS AND PEARLS
INDEX
TOC
Index
×
Chapter Notes
Save
Clear