When FUE goes wrong!

Abstract

Follicular unit extraction (FUE) is an accepted method of extracting individual follicular unit grafts for hair transplant surgery. Since follicles are harvested from the back of the scalp using tiny punches resulting in minimal scarring, it has gained rapid acceptance among the patients. However, due care needs to be exercised while performing FUE. FUE should not be confused with the older plug graft extraction methods of coring out hair-bearing skin plugs. Lack of due diligence while performing such extractions can lead to subluxation of the grafts into the subdermal layer of scalp. Overtumescence of the scalp donor area, use of blunt punches and trying to “core” out the full thickness grafts can all contribute to this. The following cases illustrate some pitfalls to be avoided while performing FUE and the adverse consequences if they occur.

Follicular Unit Extraction Hair Transplantation with Micromotor: Eight Years Experience

“…Use of the finer diameter punch is not meaningful because the transection rate increases. Previous studies report that the use of sharp-pointed punches decreases the ratio of inclusion cyst formation compared to the use of bluntended punches [28,29]. Inclusion cysts are caused by buried follicles.…”

“…A major drawback of the FUT technique is the linear scar occurring in the donor area [27]. Besides the scar on the incision line, regional suture problems such as suture dehiscence, keloid and hypertrophic scar formation, and neuralgia can occur with this technique [28,29]. On the other hand, since there is no suture in the FUE method, patients do not experience these incision site problems and scar formation.…”

Acute post-operative edema. A major morbidity after hair transplant.

“…We had furunculosis in 1.92% patients in Group A, while it was a complication in 1.02% patients in the study by Wesley et al 13 We report the incidence of Keloid formation in Group A to be 1.92% and 2.22% in Group B, while this incidence was 1.02% in the data of Poswal. 14…”

Photoacoustic Imaging as a Tool for Assessing Hair Follicular Organization

“…Factors such as graft size, angle, and grafting density have a significant effect on follicular unit survival rates [ 9 , 10 ]. Beyond implant survival, these metrics also have implications for potential complications such as the development of subdermal cysts or telogen effluvium (“shock loss”) [ 11 , 12 ]. Finally, variations in graft density and angle can have major impacts on cosmetic satisfaction.…”