Enhancement of Follicular Unit Extraction

James A. Harris, MD.
University of Colorado, Greenwood Village, CO, USA.

SUMMARY of Dr. Harris’ Abstract from his presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia

The SAFE System for FUE provided a novel methodology and new hair transplant instrumentation to increase graft production rates, decrease follicle transection rate, and expand patient candidacy for surgical hair restoration. However, the mechanism of the interaction of the blunt dissecting punch and the dermis produced follicular unit graft burial (approximately 7.2% of attempted extractions) that slowed the extraction process during the hair transplantation and resulted in inflammatory cysts requiring surgical excision in .02% of attempted graft extractions.

The purpose of this study was to assess the efficacy of a new dissecting tip that could potentially decrease the graft burial rate and increase the graft production rate in the hair restoration. In the study, three patients received a total of 422 grafts. The protocol utilized limited sharp dissection of the epidermis (using a 1-mm punch to a depth of approximately 1.3 mm) followed by the insertion of the specially modified dull dissecting tip to its full depth of 5 mm. The follicular units were then grasped with fine forceps and removed.

The grafts represented a possible total of 1207 follicles, with 48 follicles transected. This is a follicle transection rate of 4%. In this series of 422 extracted grafts, there were 4 buried grafts with three retrieved representing a graft burial rate of .9% and a non-retrieval rate of 0.2% of total graft extractions. This is an approximately 8-fold improvement when compared to the 7.2% burial rate and 1.4% non-retrieval rates of the previously described dull dissecting punch. Subjectively, the modified tip allows for a more rapid and smoother insertion process that enhances the dissection phase of the extraction.

The improvements to the dull dissecting tip have decreased the graft burial rate, increased the graft extraction rate by decreasing the need to search for buried grafts, and allowed for a more ergonomic extraction process while producing a nominal transection rate. This will lead to time and cost savings for the physician performing hair transplantation using follicular unit extraction and allow broader acceptance by physicians and increase the availability of this procedure for patients.

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