Follicular unit extraction (FUE) is a method of acceptance for individual follicular unit grafts to achieve hair transplant surgery. Since follicles are removed from the back of the scalp using tiny punches that result in the minimum scarring, they are quickly accepted among the patients. However, proper care must be taken when doing FUE. FUE should not be mixed with the older graphite extraction methods to relieve hair skin plugs. Lack of due diligence and such extraction can lead to a reduction in the graphs in the sub-dermal layer of scalp. Each of the following areas can contribute to the sensitivity of the scalp donor area, the use of bald pockets and attempting to “core” the overall thickness graphs. The following cases show some traps to avoid and FUE and the adverse consequences if they occur.
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Follicular unit extraction (FUE) is a method of acceptance in hair restoration surgery for the treatment of male pattern / alopecia baldness. In FUE, individual follicular unit grafts are removed using small punches. The punches (of diameter 1 mm or less) are used to score the follicular unit to the middermis level. A sweet pull is applied to the cut and is therefore scored. The extraction grafts are then trimmed and placed in the recipients slits created in the bald or balcony scalp.
As the extraction sites / holes are very small (1 mm or less), no rope is required.
Three patients in the 25-30 year age group approached us for hair transplant repair surgery. Each of these normative, nondiabolic men had hair transplant surgery at a number of other clinics, probably at FUE technique. The common complaints were heterogeneous, non-prolonged painless attachments in the scalp donor area. Patients arrived 6 months to 2 years after their previous “FUE” hair transplant.
All routine investigations were within normal limits. A major examination of the scalp donor area showed that there was an unattractive zero atmosphere with no signs of inflammation or sunshine.
Under aseptic precautions and after the local anesthetic administration, a strip was removed from the donor’s area of the scalp. During strip leakage, a multi-layer was observed in the sub-thermal layer of the scalp, and. Gross examination of the cysts showed that hair was long, intact hair bulbs as well as skin tissue, which suggests that follicular units had full thickness and graft.
These cysts were excreted individually and launched for histopathology examination. The donor strip cleaning material of all cheese material, hair, etc.
HPE report: Gross – multiple yellow fatty showed that light soft brown tissue bits together measuring 1.8 × 1.3 × 0.5 cm.
Impression: Chronic folliculitis with scattered eosinophils and stromal fibrosis. No granulomas and atypia were noted.
The reason why there may be cystic masses is to form violently than grafts of the overall thickness scope to mitigate beneath the surrounding dermis which was then left in situ. The surrounding scalp tissue which is cured by a secondary resolution, thus, burying the entire thickness cuttings in the subdermal layer.
FUE should not be mixed with the older graph excretory methods. In the older methods, a 3-4 mm punch was used to cut scalp tissue on which hair was cut, down to the subdermal tissue. Afterwards the hair additive was removed like a spawn biopsy.
However, FUE uses much smaller diameter punches (1 mm or less). The handful will not be used in a “crown” way and is intended to be used to score the single follicular unit to the middermis level only. In this way, the follicular graphic unit is still attached to the reticular dermis.
The cases presented in this report highlight the difficulties / disadvantages if these FUE declarations are not followed.
Here are some of the factors that may be contributing to the formation of subdermal courtyard in the above cases:
Lack of due diligence on some of the extraction that failed to find and remove all punched graft.
Over tumescence of the tissue scalp donor: As a result of excessive use of the healing fluid the subdermal layer is being removed. When the subdermal layer expands to the thickness of the entire dermis, it is easy for the “cored” paste and detached skid beneath the surrounding dermis.
Use bald punches leading to a relaxation of the subdermis along the surrounding tissues. The use of bald punches requires more force to be placed in a vertical direction for a cut. This reduces the tactile sensitivity of the extract and contributes to cutting to deeper layers of the dermis. The punches used for scoring around the follicular unit must be very sharp.
Deep avoidance should be avoided through the full depth of the resin dermis. The handful must be used to score around the follicular unit paste until reticular dermic. Since the reticular dermis is closer than the papillary dermis, the extraction feels increased when he / she reaches that layer. Scoring should not be carried over that point. The attachment to the reticular dermal will ensure that the paste does not “sink” and remain standing until removed.
FUE is a screening extraction technique and, while very invasive and minus smaller, needs to be mastered and done carefully. FUE should not be considered as an alternative to old-grid methods. Through intense dissection, use only sharp punches, and avoiding over tumescence, will help inadvertently avoid the follicular units beneath the dermis.
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