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Topic Title: question for Dr. Cole
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Created On: 04/13/2004 06:42 AM
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 04/13/2004 06:42 AM
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falco
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Dr. Cole, here in Italy there are a few surgeons that continue to advise against the FUE, because, according to them, this is completely identical to the hair transplant procedure performed with "plug" grafts about 20-15 years ago. Could you give me a clear answer about it? I'll post it on the italian forum. Thanks.
 04/13/2004 01:14 PM
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b-mann
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I am not Dr Cole or any other Dr but, I know a little something about the procedures.

Back in the day, Dr's like Dr Orentriech in NYC were doing non strip procedures by using a 3-5 mm biopsy punch (some say even larger than that) to punch out the grafts in the back of the head and replant them into the bald scalp up front. This is what led to pluggy grafts, a corn row appearance and horrific donor scarring from removing pencil eraser size grafts from the back of the head. Furthermore, the donor area had to "fill in" the holes by themselves leaving shiny scar tissue in place of hair bearing scalp tissue and took a great length of time to heal with weeks of oozing and bleeding wounds.

Todays FUE is indeed a refinement of the old technique, however it is a great deal more advanced than it once was. A Dr uses a 1mm punch (or smaller) to punch out a single follicular unit (FU) containing 1, 2 3, or 4 hair groupings, depending on how many actual hairs are growing from the one cluster and where the Dr plans on planting the grafts. (hairline, crown etc.) The donor scarring is barely visible, the healing time is in days and not weeks, the results of the transplant appear much more natual and realistic because the groupings are much smaller and not the size of pencil erasers. Many if not all of the Dr's further trim down the FU's for hairline work or leave them as is for areas like scar repair or for adding density behind the hairline.

While the 2 procedures are similar in their approach to extraction, there are many major differences in how they grafts survive, how the donor area heals and how the final results appear after tranplanting them back into the scalp. FUE is a major advancement of an outdated technique and should not be confused with what was done 20 years ago in any way.
 04/13/2004 03:45 PM
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Dr. Cole
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I think that B-man did a nice job.

FUE is still poorly understood by most hair restoration physicians. It also is frightenning to most of them. FUE will increase their personal work load and reduce their potential graft count. No one likes to work harder and especially if they can't make as much money. Thus, they will do their best to stay in the dark and keep their patients in the dark.

I will be in Turino, Italy the first week of June (June 3 to June 6). During this time, i will present several papers on FUE to the Italian Society of Hair Resotoration. I will also hold a seminar for any Italian that is interested in learning about FUE and attempt to see individuals on a personal basis should they request this.

FUE involves making an incision around an individual follicular unit, an individual follicular group, or a part of a follicular group. The old punch grafting technique involved making an incision around a multiple follicular units or multiple follicular groups. The old way was a larger incision. The new way is a much smaller incison. The old way left a large white scar in the donor area. The new way leaves a faint scar that is not perceptable to the naked eye or is barely visible to the naked eye. Only a trained eye would notice the missing follicular unit from FUE. Any one could note the destruction from the old punch graft method. This is similar to the destructive nature of a strip harvest. You simply can't miss the damage is the head is shaved.

The new method leaves a donor area that can be cut very close or even shaved without leaving a visible or noticable evidence that you had surgery. The old method left obvious evidence that you had surgery. The old method is easy. The new method is very hard and requires extremly good hands, as well as, appropriate instruments. The old incision was between 2mm and 5.00 mm in size. The grafts contained between 6 and 20 follicular units. The new method removes only one follicular unit. The old method left you looking pluggy up top. the new method leaves you looking natural in the recipeint area.

The typcial punch graft method in the past averaged 13 to 15 follicular units and 25 to 40 hairs. You can imagine that a graft with this many follicular units and hairs will leave a huge void in the donor area and an obvious pluggy appearance in the recipeint area. In short, there is nothing comparable to the old punch graft method with the new method of FUE or FIT.

This leads me to a new subject. How many grafts can you get from FUE. The answer is, "how many follicular units do you have in your donor area". Thus, you can obtain more grafts from FUE than you can from strip and the number is much higher than you can from a strip. The problem from a strip harvest is that you leave a visible scar. I have been vague on how many grafts we can obtain from FUE simply because i have been trying to leave no visible evidence that we removed hair from the donor region. You can over harvest though. Only once you reach a critical level will it be apparent that you removed grafts from the donor area with FUE. The key today is to remove follicular units in such a way that you do not leave an obvious geometric pattern that indicates that you removed grafts from the donor area. This number will vary from one individual to another but most likely will parrallel the number you can take from an average individual via strip. even if the number is less, why not do the fue method until you cannot take anymore without leaving an obvious geometric pattern. at that point you can elect to have a more obvious donor region with a strip scar or a potentially less obvious donor area by removing only with FUE. to me the answer is obvious. FUE is superior in all cases. It simply is up to the individual whether they want a strip scar in their donor region.

www.forhair.com
 04/14/2004 06:02 AM
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falco
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 04/14/2004 06:03 AM
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falco
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Thank you very much B-mann
and Dr. Cole, all is very clear
 04/14/2004 05:23 PM
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HairWeGo
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Hey Dr Cole, I was curious if you put grafts in a strip scar after its healed, will it look ok if say you cut your hair down to a #2 blade? Will it be visible??
 04/15/2004 03:48 PM
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backnats
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Good question Hairwego. I want to know if he has filled scars that thin & if so, how close the area can be buzzed.

Dr. Cole, if you have pics of fully grafted donor scars, please post them.

TKDkid is getting work done by Dr. Jones, he buzzes his head and is filling up the scar. Would be nice to see his pics/updates.
 12/16/2004 04:25 AM
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backnats
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Bump.
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