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"The current relatively-invasive surgical approaches are also accompanied by a 4.7% complication rate, which include: enlarged scars, necrosis (dead tissue) in the donor area, hematomas, prolonged nerve hypersensitivity, and infection."
... because I have the following problem with tissue removal beneath the skin:
Surgical anatomy
"The five layers of the scalp, from superficial to deep, can be easily memorized by using the mnemonic SCALP. The Skin of the scalp is the thickest of the human body [increases in thickness from the frontal to the occipital region], measuring up to 8 mm in thickness and contains approximately 100.000 hairs.
Hair lines make scalp reconstruction difficult because the hair lines have to be respected to get a satisfying aesthetic result.[3] The subCutis is a layer of fat, enclosed in compartments formed by rigid fibrous septa. Their inelasticy prevents bleeding vessels to collapse and retract under the skin to achieve haemostasis. All large blood vessels and nerves of the scalp are located in this layer.[4] The next layer [below the subCutis] is the galea Aponeurotica, which separates the underlying bone and the overlying layers. The large blood vessels and nerves of the scalp don’t pierce this layer.[3] Loose connective tissue between the periostium and the aponeurosis makes these two rigid structures easily slide over each other and contributes to skin movement. Thus, if vascular and nervous anatomy is respected, the skin, subcutaneous tissue and galea aponeurotica can be lifted off the skull with minimal bleeding, nerve damage, or chance of necrosis. This method was first described by Orticochea in 1967, but has been updated to minimize scarring.[5] The fifth layer is the Periosteum of the skull, also referred to as pericranium. It can be separated from the skull, except near the sutures. The skull consists of an inner and outer table, with spongy bone in between known as diploë."
That means, even if "subcutaneous tissue and galea aponeurotica can be lifted off the skull with minimal bleeding" (to get the "visual cavity" for the tools enlarged by techniques like "humidified insufflation, external traction, or balloon expansion") - you must always CUT (or drill) through all large blood vessels and nerves which are located above these layers - in the subCutis, to get the grafts.
That would mean (besides damaging large blood vessels and nerves), that grafts would have lots of tissue attached beneath the follicle bulbs - which adds absolutely nothing for hair growth in the recipient area.
But that's actually not what Dr. Wesley describes in his patent (lifting off the skull the subcutaneous tissue and galea aponeurotica layer to prevent damage to the vessels and nerves) ...
This is what he describes ...
"20. The system of claim 14, wherein the extraction module is configured to subcutaneously extract a hair follicle."
... namely, movements of the tools as well as extraction of hair follicles straight within and through the large blood vessels and nerves containing subCutis layer! And doing this, can cause:
- enlarged scars,
- necrosis (dead tissue) in the donor area,
- hematomas,
- prolonged nerve hypersensitivity,
- and infection.
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