From Follicular Unit Extraction (FUE), a new approach.

Designed by Woods and Campbell, is a technique of direct sampling follicular units from the donor areas and replanting in areas receiving direct.

Historical notions

The follicular unit is thus the basic structure used in this new approach in which one of the pioneers include Bernstein and Rassman. Before the advent of technology, most of those who practiced surgery 's hair transplant technique avail themselves of the strip followed by dissection technique developed by stereomicroscopy Limmer in 1988, which were obtained by follicular units. Obviously the outcome was a linear scar strips in nuchal-occipital region, which in some patients is a condition of discouragement initial psychological and actual discomfort later.

As a result a growing number of patients have expressed doubts and hesitations to perform a procedure which might be caused unsightly scarring.

Rassman in 1990 he became interested in extracting follicular units from a 'donor area using small punch. The first results were not encouraging because tainted by 'high index transdissezione follicular problem that was immediately the object of surgeons, by Richard Shiell to Masubi Inaba.

To overcome these drawbacks of trans-dissection were subsequently developed procedures for extraction of follicular units by means of punch like that penetrate deep into the hair follicle and later remove it with pliers (technical Inaba). With the contribution of Inaba has therefore come to define a 'whole process of hair transplantation surgery can from the strip.

After the execution of the first operations by adopting this method in patients of different nationalities were shown some variability in the extraction process. Histological examination was performed to highlight the causes of variability in patients and was introduced on "FOX TEST", an 'important recommendation surgical patients to determine candidates for the technique.

The test showed that about 60% of patients were candidate for the technique, yet also good candidates for the technique have shown significant possibility of follicular trandissezione, demonstrating that the success of the procedure is linked to 'experience and capabilities' operator plus the requirements of the patient.

Technical aspects

In recent years we have developed different techniques of extraction of follicular units with the intent to improve the quality of the seed and increase the percentage of engraftment trying to overcome or reduce the problem of follicular trans-dissection.

The technique "in two days" uses a "first phase" in which a punch of 1 mm is introduced over the follicular unit and aligned with the approximate angle that the hair shaft shape with the skin surface. The punch is made to make a rotational movement through the skin to isolate follicular units in the epidermis and upper dermis. So the technique is successful, the angle of incidence of the punch must not vary much relative to the direction of the hair shaft to avoid shearing the hair follicular units. Since the hair follicles in each follicular unit extending into the deep dermis and subcutaneous in the adipe, it is also important to limit the depth to the upper dermis, the latter sometimes difficult to maneuver.

In the "second phase" extraction, using toothed forceps to apply gentle traction to the top of the follicular units, to extract the follicular unit that is free of connections to the deep dermis. During this phase the process is characterized by a marked variability from patient to patient, so the technique has undergone some improvements with the addition of dissection, where the simple extraction becomes difficult.

If the follicular unit is removed with a gentle pull to separate the deep follicular unit from the surrounding tissue can use a fine needle which passes through the dissection, while the traction is guaranteed by using sensitive calipers.