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    FUE developed primarily as an effort to address scarring in the donor area that occasionally became a problem with strip surgery. The evolution is interesting and goes as follows: Strip surgery by its nature produces a linear scar in the donor area. Usually this scar is fine and easily hidden by the remaining donor hair, as long as it is longer than 1 cm. However occasionally the scar can be wider and harder to hide. When graft sessions started to become larger about 10 years ago the size (width) of the donor strip also became larger in order obtain the increased number of grafts. The larger sessions were a breakthrough and improved results in the recipient area. The field was so excited about the improved results they were slow to notice that there was an increased incidence of wider scars now appearing in the donor area. In retrospect this makes sense, as wider strips will in some patients cause increased wound tension, which is the primary cause of larger scars. In response to this problem a few physicians began the development of an alternative method of harvesting grafts…hence the birth of FUE. By extracting individual grafts with a small micro punch a linear scar was avoided. The first physician to promote this technique was Dr. Woods from Australia. Unfortunately early versions of this technique had their own problems. Extracting each graft was difficult and a high transaction rate and damage to the grafts occurred. In addition the process was slow, expensive, and much less grafts could be done at a time then with strip harvesting. A final problem was the realization that the potential for visible scarring also occurred with FUE…just a different form of scarring. With FUE scarring consisted of multiple small white dots in the donor area at the sites of each extraction. This was not a linear scar but could be noticed as a spotty or moth-eaten look in the donor area if the hair was cut very short. For this reason FUE did not find acceptance in the main stream early on. Another factor that added to the slow acceptance of FUE was the fact that major improvements had occurred in traditional strip harvesting at the same time. Improvements included; more accurate ways to predict scalp laxity; exercises to improve scalp laxity; better suturing and stapling techniques, and finally the development of the “trichophytic” closure. With these improvements, most strip surgeries were now leaving a very minimal scar and in the majority of case the hair could be worn as short as 1cm without the linear scar being visible.

    However the story does not end there. A handful of physicians still believed that FUE could be a powerful tool if the problems could be worked out. They improved the instrumentation and technique dramatically over the last 5 years. Among the advancements were the use of smaller punches that decreased the incidence of the “spotty scarring”; limited depth scoring that reduced transaction, motorized punches that made it easier to score the skin; a better understanding of the amount of extractions that can occur per area before scarring occurs; blunt dissection techniques, and many others.

    The result of these improvements have made it possible to perform FUE much more consistently with minimal damage to the grafts, more grafts per procedure, and less of the spotty scarring occurring in the donor area. In essence we now have two very useful and powerful tools for removing grafts from the donor area. We have both strip harvesting and FUE. Both work quite well and both have their advantages and disadvantages. Some situations are perfect for the use of FUE while other are better suited for FUT. At SMG we feel it is good to be skilled in both techniques and be able to use the tool that is most appropriate for a patients situation.


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“Thank you very much for your attention. I am very happy with the results of the surgery. After 3 months only I already have full hair coverage in all the affected areas and don’t need to use the hair clips like I used to do for many years. Please give my beast regards to Dr. Shapiro and the team...”Read More

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