1937 FUEs by Dr. Lindsey McLean VA

[Dr. Lindsey]

This UK fellow came over last week and wanted repair of balding frontal triangles and the anterior hairline. I thought that would take 13-1500 grafts. He wanted to have additional grafts placed into a thinning hair region behind the frontal “tuft”. I have posted and explained to him that I was not in favor of putting a lot of grafts here, as I think it will only temporarily fix the balding…and that when additional hair destined to bald goes, that he may think my transplants “didn’t work”. Rather, I’d push for waiting until balder and then hitting that area with a big case. He thought about these issues and came prepared to do a smallish case in the thinning areas, hitting only places that really didn’t have any hair in them and acknowledging that he’ll need more work with future loss.
We did 1110 FUEs on day 1, and he returned the next day and we did 827. Feller 1.0 and a modified 1.1mm hand punches were used. He tolerated the procedure well and flew out the next day, hopefully he’ll chime in and describe his experience. The grafts looked really good, and I’m hopeful that he’ll get a nice result.

Dr. Lindsey McLean VA

[Follicle Death Row]

Very neat work doc. I'm looking forward to seeing the end result. I'm beginning to think that FUE could be the way to go for men that aren't yet extensively bald. Perhaps Replicel or Aderans will come up with the goods in the next few years so they may have the chance that they could maintain or restore a nice head of hair without having to undergo a FUT down the line and have the strip scar. Certainly a HT shouldn't be based on this premise and they should be prepared to undergo a FUT down the line if needs be but maybe FUE in cases like this is a better starting point. Just an interesting thought I had recently. Thanks for your time.

[Dr. Lindsey]

I still feel that strip is cheaper, more consistent, and easier on everyone than FUE. For patients who need significant hair...unless they require a crew cut hairstyle, or have some scar issues, I strongly recommend strip. I'm sure that FUE stresses the root bulbs of the grafts way more than strip dissection does, hence the more variable results.

That is a critical part of patient education and part of the equation that the patient needs to do when deciding on which route to go.

Thanks

Dr. Lindsey McLean VA

[Follicle Death Row]

Yes, I guess the skinnier grafts can be a problem. The ARTAS mchine is supposedly taking chunkier grafts though. I also wonder if the liposomal ATP solution that Dr. Cole is using now can really help FUE yield and consistency. How quick is the turn around with a FUE graft? A hair follicle is an organ of sorts so surely the time out of body so to speak will effect the yield.

Where do you stand on the donor thinning tissue? How much can we extract? I know it can be dependent on the hair characteristics but I have heard Dr. Cole mention 50%. I get the impression it's only generally pushed to 35% tops in practice. Thanks again for your time. I'm looking forward to seeing this result.

[Dr. Lindsey]

I use a hand punch or a feller motorized punch. All the automazation devices that I have seen in person really are harsh with the grafts....as compared to my gentle-handed female extractors.

The out of body time is an issue....It takes a long time to get 1100 FUEs out, and although we keep the grafts cool and moist, they are out longer than with strip.

No idea on your other questions.

Dr. Lindsey McLean VA

[Follicle Death Row]

Would it be possible to work in bursts? I mean extract 100 FUE grafts and then implant them. Then extract another 100 and place them, so on so forth. I know it would be inefficient time wise but it would certainly limit time out of body.

The liposomal ATP solution Dr. Cole uses sounds interesting. I'll have to read up on it.

[Dr. Lindsey]

It probably would be doable, but its so critical to get "into the groove" when making the FUE punch holes, that I'd be worried that turning the fellow over, placing and then going back to an area, where the numbing medicine is wearing off...and then trying to get in the correct angle to get a good harvest....would all be too much for patient and doctor. Plus, I would worry that with the head down for harvesting, that some of the just placed grafts could get dislodged.

Dr. Lindsey McLean VA

[Follicle Death Row]

Thanks doc. That makes sense.