There has been some mention of how the blade from a scalpel absolutely must destroy many many grafts during extraction. CIT mentioned that it is virtually impossible to NOT destroy some hairs when using a DOUBLE blade scalpel. I agree, that’s why better clinics use a single blade scalpel. Here’s the trick though; If one were to remove a strip with a “linear” incision as CIT suggests then of course hair will be destroyed, multi-blade scalpel or single. The key is to NOT cut a straight line but navigate between the follicular bundles and make adjustments on the fly.
Here are a few example photos of a strip done right…
As you can see, the follicles at the edge of the tissue are perfectly fine and hardly a trasectional waste land. As with any procedure however, results will vary from clinic to clinic.
As far as donor density goes, a proper strip taken from a patient with laxity suitable for the intended size procedure will experience no decrease in density especially none that is perceptible to the human eye. I say suitable for the intended size session because a good clinic will close with minimal tension and there are ways to decrease the tension during the procedure. You get to the higher threshhold of what is possible with strip, then yeah, the decrease in density will occur but even then it is pretty hard to see. My donor area is a bit thinner after 8000 grafts with Dr. Wong and my two nasty mini-grafts sessions with Dr. Norris but the decrease is slight and I’ve had more work done than most here. The great thing is that skin has an amazing ability to expand and even regrow under tension. This is why you don’t read about megasession patients complaining that their donor area has thinned.
With FUE there is an immediate decrease in density because the tissue that the FU used to reside in is still intact and left behind. Less hair, same amount of tissue. The ability to actually see this depends however on the original donor density and of course how localized or spread out the extraction area is. You pull 1000 grafts over the entirety of a patients true donor zone and nothing will seem out of place, to the patient or to those around them. You take those same 1000 grafts out of a single area then people will be asking why you have a hole in your hair. It’s pretty simple, really, and only means that a clinic, strip or FUE, needs to exercise some basic common sense when performing a procedure.
“With FUE there is an immediate decrease in density because the tissue that the FU used to reside in is still intact and left behind. Less hair, same amount of tissue.”
I see what you are saying and you have put it out there in a very elegant and straightforward manner. However, the above statement is not 100% correct. For example, when a surgeon uses a .75 mm diameter punch, the tissue, along with the embedded FU are extracted and not left behind still intact. For a 3000 graft FUE procedure using a .75 mm punch, approximately 13.25 square centimeters of tissue are removed in the process. A 1.0 mm punch yields about 24 square centimeters of tissue (about a 9-inch by 1 centimeter strip)
You are very welcome. The basic mathematics of one’s donor area can vary based on race. Caucasians usually have a higher hair density and Asians typically have a lower hair density. Each patient is not created equal and no two donors are the same
The majority of patients who have a finer thickness of hair usually have more hairs per follicular unit. Patients who have larger follicular units typically have thicker hairs. The trade off is significant in some cases because the hair follicles may even be wavier.
Our clinic uses small customized devices after careful examination of any given patient’s donor area. You will see from the photo below, the follicle angulations, instrumentation, and magnification account for low transaction.
Peripheral transaction is insignificant as you may notice that follicular units are naturally distributed on the donor area. To ensure that this doesn’t occur, Dr. Cole routinely changes devices during the procedure as follicle may splay in different directions. To compensate for the characteristics, Dr.Cole uses his judgment to determine what instrument will accomplish the best result on the donor area as well as recipient area.
Below is a microscope photo taken of an above average donor that measures a donor density of 250 hairs per square centimeter and 90 follicular units per square centimeter. Please remember that the follicular units naturally grow at a density that allows tolerance for these extremely small geometric instruments to harvest between them. There is no pattern at which the FU are harvested other than being harvested at a low density for preservation of the area. I will have you know that “diffuse decrease in density” is another way of saying that our clinic uses an actual device on the donor area as to not over-harvest any one particular area. I would be enlightened to see the data that shows any peripheral transaction from a given clinic. With the small instruments we use at our clinic, peripheral transaction is non-existent. Every graft is examined before the next process occurs. Once I do find an isolated incident where a surrounding FU was compromised then I will post the recorded data.
In the end, the donor area or donor density will always decrease by any harvesting method. The questions of a lifetime will be which patients will have the unbearable side-effects. What patients will have the luxury of wearing their desired hair style, and what donor resource will be available after the laxity of the donor is non-existent. Each patient must decide if the risks outweigh the benefits.
» “With FUE there is an immediate decrease in density because the tissue
» that the FU used to reside in is still intact and left behind. Less hair,
» same amount of tissue.”
»
» I see what you are saying and you have put it out there in a very elegant
» and straightforward manner. However, the above statement is not 100%
» correct. For example, when a surgeon uses a .75 mm diameter punch, the
» tissue, along with the embedded FU are extracted and not left behind still
» intact. For a 3000 graft FUE procedure using a .75 mm punch, approximately
» 13.25 square centimeters of tissue are removed in the process. A 1.0
» mm punch yields about 24 square centimeters of tissue (about a 9-inch by 1
» centimeter strip)
Jtelecom,
You are absolutely correct (and thank you for the comments). However, what I meant to say, and should have with more detail, was that while the tissue surrounding the FU is indeed removed, the area encompassing said tissue still remains. For argument’s sake, take a 1cm by 10cm grid and fill it with 1000 FUs. With strip, the grid is simply removed in it’s entirety. If you remove the same 1000 FUs in the same grid with FUE ( remember, this is for argument only) you are indeed removing the supporting tissue along with the FU but the grid itself still remains, ergo the density is immeditately reduced. Make sense?
Yes, it makes sense. It should also be noted (or reiterated, as the case may be) that when a strip is taken, The “sides” of the incision are pulled together and closed with sutures/staples. This pulling of the sides of the incision to bring together the gap left by the harvested strip also has an immediate impact on local density. This decrease in density would tend to be more apparent in those patients with poor scalp laxity. As always, thank you for the thoughtful reply.
» Joe:
»
» Yes, it makes sense. It should also be noted (or reiterated, as the case
» may be) that when a strip is taken, The “sides” of the incision are pulled
» together and closed with sutures/staples. This pulling of the sides of the
» incision to bring together the gap left by the harvested strip also has an
» immediate impact on local density. This decrease in density would tend to
» be more apparent in those patients with poor scalp laxity. As always, thank
» you for the thoughtful reply.
I believe that Jotronic,CIT, and jtelecom have all summed this topic up very well. Thannks.
» Joe:
»
» Yes, it makes sense. It should also be noted (or reiterated, as the case
» may be) that when a strip is taken, The “sides” of the incision are pulled
» together and closed with sutures/staples. This pulling of the sides of the
» incision to bring together the gap left by the harvested strip also has an
» immediate impact on local density. This decrease in density would tend to
» be more apparent in those patients with poor scalp laxity. As always, thank
» you for the thoughtful reply.
I totally agree with what you and Jotronic said. Most people are born with reasonably good scalp laxity. The decrease in density after 1 strip is so miniscule that it will be barely perceptible to the human eye, and I am speaking from my own experience.
» » Joe:
» »
» » Yes, it makes sense. It should also be noted (or reiterated, as the
» case
» » may be) that when a strip is taken, The “sides” of the incision are
» pulled
» » together and closed with sutures/staples. This pulling of the sides of
» the
» » incision to bring together the gap left by the harvested strip also has
» an
» » immediate impact on local density. This decrease in density would tend
» to
» » be more apparent in those patients with poor scalp laxity. As always,
» thank
» » you for the thoughtful reply.
»
» I totally agree with what you and Jotronic said. Most people are born with
» reasonably good scalp laxity. The decrease in density after 1 strip is so
» miniscule that it will be barely perceptible to the human eye, and I am
» speaking from my own experience.
Again, I am clearly stating that the density in the surrounding few centimeters where the strip was taken is less dense than the rest of the donor area that isn’t affected by the strip procedure. The blade also transects hairs, period. Each patient must face the decision to live the benefits and disadvantages. Can there be a common consensus on the subject?
Yes both procedures can cause transections and neither are 100% fool proof.
Density is affected by both procedures.
Proper research and no bashing of the other procedure with the worst pictures you can find.
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