2 different Spicule theories in FUE... Hairtech

[hairtech]

The graft on the right has a spicule because of the transection. The spicule is actually the hair fragment or just part of the hair shaft without the follicle. One of the clinics I worked at did not allow for spicules to be transplanted so they were trimmed off. In the case at hand on the right… this would now become a 1 haired graft.

Now to further explain something about spicules… depending on the actual transection point… there are some beliefs that the transection will actually grow a hair without a follicle. But this theory is not concrete and is solely dependant upon where the transection occurs. The closer to the follicle, the increase in the likely hood that a second hair will grow. This is where Dr. Gho derived his theory of “hair multiplication”. However, after a period of time, he was unable to figure out how to make the “perfect transection” to grow 2 hairs from one.

Now on the flip side. There is another theory that spicules if left can cause an inflammation process… like an in-grown hair. Why? Because it just sits there and does not grow. Thus a foreign body reaction can occur. And with inflammation, there could be an issue of a possibility of retarding or killing the healthy follicle next to the spicule.

I hope some of the doctors post their theories or discussions.

[hairtech]

Someone asked about FUE being different at different clinics. This was my response: And this discussion takes into account using my experience, reading here about different clinics and speaking with colleagues. The disscussion is primarily for newbies wondering what the heck FUE is:

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1. FUE is an old technology that was re-vamped. The old punch grafts of the 80’s and 90’s used cylinders to extract grafts. The re-vamped form decreased the cylinder size that was as large as 1.7mm down to a standard size that is 0.75mm-1.0mm. Some clinics go larger than 1.0mm however, we all know what clinics can and do adhere to the 0.75mm and produce good results.

With the exception of blunt punches, slot punches, and crown tipped punches, this basically takes care of tools. In summary there are differences in FUE techniques based on tool sizes, and different tips.

2. Some clinics like to dissect their grafts and possibly this is partly based on tool size(larger grafts), or it may be that a clinic needs to derive more 1’s and 2’s.

3. The manner in which a graft is extracted: One way is to use a fully sharp punch. This is a one step method that takes great practice and only the highly specialized clinics are able to used the smaller 0.75mm punch. Larger cylinder bored punches allows for technical error, ie, a physician will still be able to get a decent graft with a larger punch and not transect so much… when it comes to the graft itself, however peripheral transections are common with this approach. Only in the last year have I seen higher growth rates from a few highly specialized 0.75mm punch clinics.

The second way is a blunt punch technique, AKA the “Safe” technique coined by Dr. Harris. This technique is different from straight sharp punching in that a score of the epidermis is followed by a blunt punch into the dermal and deeper layers. The theory here is blunt dissection protects the follicle as well as decreases cutting into capillaries and/or other vessels. What that does is decreases vascular damage and can be seen visually by a decrease in blood during the procedure. In other words… a virtual bloodless procedure in most cases. And to further add to this… healing of the donor area is rapid.

4. A difference in the FUE techniques from my experience and/or reading is where upon I noticed some clinics plant/place the grafts into the recipient areas at different times. Some put the grafts in at the same time at the end of the case… in which they store the grafts in a holding solution, extract them all at once then place them all at once. Another method was extracting and placing at the same time. Still another was to extract half of the case, place those grafts, and then do another round of extractions and then placing.

5. And another technical difference is who does the extractions themselves. A physician may do all of the extractions. A physician and a highly specialized technician may do the extractions. It is ot un-heard of for a highly specialized technician to do all of the extractions…

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[johnp]

Hey hairtech, very good information. What about the cost? Does it mean that we will be over paying if there is a spicule being transplanted and the patient is not aware of that?

[hairtech]

A very very good point JohnP. I don’t know if anyone has ever been charged extra for grafts where spicules are/were used… I am going to say no. Well, I am going to say, “I hope not.” But judging from this industries reputation, I cannot honestly say for sure. I can say the clinics I worked at I never saw that type of dis-honesty. But thing is… a graft is a graft… whether it is a 1,2,3, or 4 haired graft…

Now having said this… What if there was a high transection rate in case/s which resulted in higher than normal spicules used… and in those case/s there was/are issues of growth? One can speculate many things!

[helpmeout]

» A very very good point JohnP. I don’t know if anyone has ever been charged
» extra for grafts where spicules are/were used… I am going to say no.
» Well, I am going to say, “I hope not.” But judging from this industries
» reputation, I cannot honestly say for sure. I can say the clinics I
» worked at I never saw that type of dis-honesty. But thing is… a graft is
» a graft… whether it is a 1,2,3, or 4 haired graft…
»
» Now having said this… What if there was a high transection rate in
» case/s which resulted in higher than normal spicules used… and in those
» case/s there was/are issues of growth? One can speculate many things!

Am I missing something? Why does that matter? Doctors charge by the graft anyway. Shouldn’t it be the same price whether it is 1,2,3 haired graft?

[hairtech]

Your exactly correct… A graft is a graft.

A two haired graft is 1 graft.
A two haired graft with 1 transection is 1 graft.
A 5 haired graft is 1 graft.

In all cases above, the patient is charged as 1 graft.
If a clinic has poor growth rates per number of FUE grafts, one can speculate in one of many theories… as there must be a high transection rate for this clinic. This can mean that there was a large number of spicules which meant zero growth per spicule, or that the spicules caused an inflammation that resulted in retarded growth of surrounding follicles. No one knows for sure and this is one of many theories in poor growth FUE.

[arun]

» Your exactly correct… A graft is a graft.
»
»
» A two haired graft is 1 graft.
» A two haired graft with 1 transection is 1 graft.
» A 5 haired graft is 1 graft.
»
» In all cases above, the patient is charged as 1 graft.
» If a clinic has poor growth rates per number of FUE grafts, one can
» speculate in one of many theories… as there must be a high transection
» rate for this clinic. This can mean that there was a large number of
» spicules which meant zero growth per spicule, or that the spicules caused
» an inflammation that resulted in retarded growth of surrounding follicles.
» No one knows for sure and this is one of many theories in poor growth FUE.

So a spicule should not be used. Right?

[fastforward]

So how can I tell whether they transplanted a spicule during the surgery or not?

[hairtech]

Hhmmm Well, I would have to say for you guys to be vigilant and ask! They way I would ask would be, "Sir, I do not want any hair fragments from transections, can you please make sure every graft is checked under the microscope?

At the last clinic I worked at, every single FUE graft was inspected, counted, and was all spicules removed. What this provides is an accurate hair count as well as an assurance of viable grafts. Now having said this, the inspection of all grafts slows a procedure down, but hey, your paying your hard earned money… and I know that t least in this clinic there was a noticeable higher growth rate per graft. In other words when a patient came in for a thousand grafts, it was at least a 95% return in growth or more. I see this percentage in Bisanga and GHI also.

[Franklin]

Haitech. I agree that careful examination of the grafts are very important under magnification. Also being able to if one wishes to watch the implantation of the grafts on a t.v monitor under high powered magnification was very reassuring.

[hairtech]

You bring up an important point Franklin. The handling of the grafts are by far one of the most important factors that can make or break an FUE case. You see, the typical FUE graft is devoid of extraneous adipose tissue (fat) like a strip graft. Even the thinly dissected grafts of a strip excision has some protection of fat around the follicles. The FUE graft is more vulnerable to crushing by the forcepts. A hasty technician or an un-aware technician can easily crush the bulbs of a follicles and render the graft useless.

Now what Franklin is speaking of is how Dr. Woods performs his placing. He and/or his sister performs the placing under a video camera so the patient can watch the grafts go in.

[carrot]

» 3. The manner in which a graft is extracted: One way is to use a fully
» sharp punch. This is a one step method that takes great practice and only
» the highly specialized clinics are able to used the smaller 0.75mm punch.
» Larger cylinder bored punches allows for technical error, ie, a physician
» will still be able to get a decent graft with a larger punch and not
» transect so much… when it comes to the graft itself, however peripheral
» transections are common with this approach. Only in the last year have I
» seen higher growth rates from a few highly specialized 0.75mm punch
» clinics.
»
» The second way is a blunt punch technique, AKA the “Safe” technique coined
» by Dr. Harris. This technique is different from straight sharp punching in
» that a score of the epidermis is followed by a blunt punch into the dermal
» and deeper layers. The theory here is blunt dissection protects the
» follicle as well as decreases cutting into capillaries and/or other
» vessels. What that does is decreases vascular damage and can be seen
» visually by a decrease in blood during the procedure. In other words… a
» virtual bloodless procedure in most cases. And to further add to this…
» healing of the donor area is rapid.

Thanks for the very informative post hairtech_ . Do you have more info on the 2nd technique - "blunt punch technique, AKA the “Safe” technique coined by Dr. Harris"
I tried to google it but couldnt find much info. Im trying to understand how it actually is a ‘safer’ technique.

[hairtech]

No problem. I like discussing this technique. It is my favorite among the FUE clinics. Give me a little time. I have to Christmas shop for the fam. brb.

[hairtech]

The blunt technique… a full discussion I wrote a while back.

[Iron_Man]

» You bring up an important point Franklin. The handling of the grafts are by
» far one of the most important factors that can make or break an FUE case.
» You see, the typical FUE graft is devoid of extraneous adipose tissue (fat)
» like a strip graft. Even the thinly dissected grafts of a strip excision
» has some protection of fat around the follicles. The FUE graft is more
» vulnerable to crushing by the forcepts. A hasty technician or an un-aware
» technician can easily crush the bulbs of a follicles and render the graft
» useless.

Before I make a comment about your “Spicule theories in FUE” (your OLD thread start post above), I have some questions based on some observations …

According to your signature, right now you work as a (hair-)technician at the
Shapiro Medical Group – right? Right.

Here is a documented report by a HT patient (he is the admin of another hair loss board and I know that YOU know him) and he reported the following in 2008/2009 – just some essential snippets…

“I went back to Shapiro medical group on the 16th October 2008 and had Fue grafts placed in my scars. The surgery was performed by Dr Paul Shapiro.”
i got 123 grafts total but I got almost as many 3’s as 2’s. Here’s the breakdown:

1 hairs - 19

2 hairs - 49

3 hairs - 43

4 hairs - 12

Total hairs: 294

He posted the following photo (among some others) – extraction area after Dr. Paul Shapiro’s FUE:

Within such a large extraction area just 12 (valuable) 4-hair grafts?
For a normal caucasian around his 40s - it might be true …

In addition, a zoomed-in photo of the donor area, posted by the patient …

Do you think it makes sense to produce lots of other scars (even they are small and wide spread) to repair another scar?

Which punch size is Dr. Shapiro using for FUE extractions?
1.2 or 1.5 inner-diameter punches? Do you know whether Dr. Shapiro works as a gardener in his free time? I mean, you could actually plant flowers into these FUE wounds …

And now the absolute HIGHLIGHT (among some other observations) from this patient report:

In addition, the patient posted the photos below and he (not I) labled them as follows:

So what? Untrimmed vs. trimmed grafts?

Does it mean that you, as a hair-technician, must “trim” or “render” all the exctracted FUE grafts under a microscope so that they rather fit into the prior created small slits in the recipient area??

The following photos is a photo YOU took during your work in Dr. Cole’s clinic – right?

You commented them recently …
http://www.hairsite.com/hair-loss/forum_entry-id-89794-page-1-category-2-order-last_answer.html

Are these FUE grafts trimmed or untrimmed FUE grafts?
You trimmed Cole’s FUE grafts (cough …I mean CIT grafts) under the microscope as well?

Anyway, how do you know, and even under a microscope, HOW MUCH tissue and WHAT KIND of tissue you can remove/discard from FUE grafts on your chopping board?

How do you know WHERE EXACTLY you have to cut?
Which tissue belongs to the “intact” follicle structure and which tissue belongs to dermis tissue?

Is it easy to cut cylindrical-shaped bodies (as shown on YOUR photo above) on a chopping board with a razor blade?

Don’t you think that this “useless tissue” you remove (and finally discard into the toilet) from FUE grafts actually belong to the donor/extraction area?

Why do you have to remove the “useless tissue” around FUE grafts at all ?

[hairtech_4]

Man I haven’t seen this thread in a while. lol

WE here at Shapiro Medical DO NOT trim any FUE graft unless we are making single haired grafts beyond what the natural amount of 1’s that are being extracted.

As of the time I left John Cole’s office his office DID NOT trim FUE grafts unless the the same issue came up of needing more 1’s for a hairline creation.

We do not want to trim anything from FUE grafts because survivability in part is dependent upon tissue protection.

Our punch sizes are from 0.8-1.0mm in size.

The usage is as follows:

Rarely is the 1.0mm punch used.

[Stevie.Dee]

Sorry but rarely? if ou take a look at this patient, you dont need any seeing help to see the actuall big holes and obvious shot gun wounds.

First its overl bloody

Second you extracted regeneration cell portfolio and throw them away

Your theor about transected hairs is not entirely correct. If you transect a follicle, that the important tisue is stuck with the extracted hair and also remains to certain parts in the donor are, your follicle will completely regenerate with a 97% chance.

The 3% is for people who gonna scratch their head all the time during the healing process because its itching

[hairtech_4]

»
» Your theor about transected hairs is not entirely correct. If you transect
» a follicle, that the important tisue is stuck with the extracted hair and
» also remains to certain parts in the donor are, your follicle will
» completely regenerate with a 97% chance.
»
» The 3% is for people who gonna scratch their head all the time during the
» healing process because its itching.

Yes if it is transected more than likely it will grow back in the donor. The extracted transected hair in my opinion is useless. But opinions vary.

[Iron_Man]

» WE here at Shapiro Medical DO NOT trim any FUE graft unless we are making
» single haired grafts beyond what the natural amount of 1’s that are being
» extracted.

That’s clearly not what the patient explicitly reported.

He posted several photos (as some shown in my prior post above) where he explicitly tried to highlight how his extracted FUE grafts (FOLLICULAR UNITS) look untrimmed and trimmed thereafter!

[hairtech_4]

» » WE here at Shapiro Medical DO NOT trim any FUE graft unless we are
» making
» » single haired grafts beyond what the natural amount of 1’s that are
» being
» » extracted.
»
» That’s clearly not what the patient explicitly reported.
»
» He posted several photos (as some shown in my prior post above) where he
» explicitly tried to highlight how his extracted FUE grafts (FOLLICULAR
» UNITS) look untrimmed and trimmed thereafter!

What are you taking about? This doesn’t make sense. How would a patient get pictures of his own grafts unless he asked for them. And I have never had a patient ask to take pictures of their own grafts. They could if they wanted too but this hasn’t really happened. So whoever is supposedly posting pictures from our clinic of their own grafts and especially saying that we trimmed them is bologna.

We don’t trim FUE grafts. Period. And I don’t go around lieing about anything on these forums and especially when it comes to FUE.