I have decided to split this into three sections, as below; hopefully it will help show different aspects of FUE extraction and donor management
This post will seek to discuss some Extraction Pattern issues and present our own findings. It will be ongoing rather than a “one off” post and look at the issue in stages as presented below.
Allowing for an educated and well planned extraction pattern will not compromise the donor as much and give greater options for more grafts using FUE in the future. The pattern of extraction is random to the point it is has to be calculated to not leave obvious areas of no hair or any uniform signs of pre-meditated extraction, “factory extraction” with an obvious pattern seen when short/shaved.
We have so many hairs in the donor area so…
Why are there not more large FUE sessions
Why do many people feel the results are not the same as that which Strip yields,
What are the implications to the donor area?
FUE may not leave a linear scar like FUT but if not performed correctly with an educated extraction pattern scarring can become obvious and areas of the donor can become compromised making future FUE or FUT a problem.
Spread the extraction pattern over the largest area possible, try not to limit the surface area whenever possible. It is known that different areas of the donor are easier to extract from than others and also, for example, the “better/bigger” follicular units (FU) groups are also in an area easier to harvest from. The occipital or back of the scalp is richer normally in density and in the number of hairs per FU, making it easier to extract and a richer zone to take from.
The amount that can be removed from the donor is always up for debate, Dr. Bisanga feels around 25-30% per cm2 on a good donor density and little to no miniaturisation is about the limit without causing potential problems in the future.
Why do we not see bigger FUE sessions like FUT?
Dr. Bisanga limits his FUE sessions to 3000 grafts over two consecutive days; he has learnt over time to harvest more puts added strain on the scalp during the crucial first days post op healing with the potential to increase visible scarring in the donor and reduce yield in the recipient due to so many multiple open wounds reducing the capacity for the scalp to heal to its best ability.
The more extracted at one time means the closer each punch has to be to the other, this makes it harder to not leave visible “hair less” areas as the extraction pattern becomes more confined. Each extraction has to allow for FU’s to surround that point, you cannot punch two points adjacent to each other, so the more removed makes this pattern harder and harder to adhere to.
Possibly another reason is time; to manually punch each FU and ensure transection is kept to a minimum, considered by Dr. Bisanga to be below 5%, takes time. Physical and mental pressures play a part when working in so close proximity to the scalp and under magnified conditions as the doctor is dealing with scales less than a mm at times. There is also the strain on the patient having to be in the same position for lengthy periods of time and remaining still becomes harder mentally and physically. The time aspect though is connected to the rate of extraction, be the doctor only able to extract 500 or 1500 per day, realistically an FUE procedure should not last more than 2 consecutive days for the wellbeing of the patient.