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Follicular Unit Transplant - Surgery of the Skin - Dr. BernsteinSurgery of the Skin: Procedural Dermatology; published in 2005 by Elsevier-Mosby and Edited by Robinson, Hanke, Sengelmann and Siegel; is monumental work that covers the entire spectrum of dermatologic surgical procedures. In the editor’s words, the goal of this 872 page textbook is:

“To capture the art and practice of dermatologic surgery at the beginning of this century.”

It is to be used as the core surgical textbook for dermatologic training programs. The book is divided into four parts: Part I – Basic Surgical Concepts, Part II – Essential Surgical Skills, III – Aesthetic Surgical Procedures, and IV – Special Procedures.

The text covers a wide range of subjects on aesthetic surgery, including liposuction, chemical peels, Botox, soft tissue augmentation, laser hair removal, laser skin resurfacing, leg vein treatment, blepharoplasty, face lifts and, of course, hair transplantation.

Dr. Bernstein was honored to write the section on hair transplantation that covers the historical aspects of the field, patient evaluation and surgical planning, operating room set-up, surgical techniques and how to maximize the cosmetic outcome of the hair transplant.

The focus of Dr. Bernstein’s chapter is on Follicular Unit Transplantation, the technique that has changed the face of surgical hair restoration over the past decade. The chapter discusses strip harvesting, follicular unit extraction, the use of anesthetics, ways to optimize density and ensure the naturalness of the procedure, as well as a host of other important topics. The textbook may be purchased at Amazon.com.

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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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Procedures in Cosmetic Dermatology: Hair Transplantation - Elsevier Saunders“Hair Transplantation” is one in a series of medical textbooks published by Elsevier Saunders. The textbook — part of a series entitled Procedures in Cosmetic Dermatology — is written by Robert S Haber and Dowling B. Stough and edited by Jeffrey S. Dover. “Hair Transplantation” offers a step-by-step, practical guide to performing cutaneous surgical procedures.

The book’s editors selected Robert M. Bernstein as a major contributor, writing in two chapters. As pioneer of the advanced surgical hair restoration procedure known as Follicular Unit Transplantation (FUT), and as Associate Clinical Professor of Dermatology at Columbia University, Dr. Bernstein was uniquely qualified to provide medical professionals with insight and training on the state-of-the-art in hair transplant surgery.

Dr. Bernstein is lead author of the chapter entitled “Follicular Unit Transplantation” and co-author of “Follicular Unit Extraction”. The text details how to best achieve natural results, donor area diagnosis, aesthetic principles, tumescent technique, and more.

The purpose of this volume in the Dover series is to cover the tenets of hair transplant surgery by considering the philosophy, basic science, and techniques in a practical clinical text.

Succinctly written and lavishly illustrated, “Hair Transplantation” presents current, to-the-point guidance with a focus on procedural how-to’s and offers step-by-step advice on proper techniques, pitfalls, and tricks of the trade.

“Hair Transplantation” is shipped with a comprehensive DVD, containing video clips of techniques and procedures, as well as the hints and tips for surgical hair restoration. It features a wealth of color illustrations and photographs that depict cases as they appear in a hair restoration practice.

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Q: If someone doesn’t have enough donor hair, do you ever perform an FUE hair transplant using donor hair from outside the permanent hair zone? — M.V., Nashville, TN

A: No. If hair was taken from outside the permanent zone as the surrounding hair continued to bald, the scars from FUE, although small, would become visible.

In addition, the transplanted hair would not be permanent, and over time would eventually fall out.

Read more about FUE hair transplant procedures

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