Defining the most effective way to reduce rates of hair transplant graft transection has long perplexed leading FUE (Follicular Unit Excision) practitioners from all around the world. Previously, it was widely believed that the morphology and curliness of the hair shaft is what determines the susceptibility to damage during the procedure. However, this did not explain why individuals with extremely curly hair may end up with lower transection rates compared to patients with more relaxed hair. Based on direct patient experience, across numerous cases, Dr.U has found a much clearer and stronger correlation with a different variable, the firmness and softness of the skin compared to hair curvature. This insight led to the development of a new and unprecedented paradigm called Intuitive FUE which serves as the basis for the engineering of his Dr.UGraft ™ technology.

 

 

Intuitive FUE offers a new and unprecedented approach for minimizing hair transplant graft transection rates.

Intuitive FUE offers a new and unprecedented approach for minimizing hair transplant graft transection rates.

The Limitations of Hair Shaft Curliness as the Explanation for Graft Transection

Since general FUE punches are built with a basic cylindrical configuration, it is assumed that they are able to encompass and align more easily straight hair shafts compared to curly or wavy hair types. Practitioners must rely on the angle and position of the visible hair shaft as an important cue for adjusting the basic FUE punch device in order to find the actual follicular unit. With straight hair and a straight shaped punch, this can be expected to be a more straight-forward feat. When applying this type of instrument to curly hair, the graft may become damaged due to the unpredictable change of hair direction beneath the skin. Hence, the difference in these scenarios has long been attributed as the main explanation for how transected grafts occur.

Skin thickness differences for FUE transplant relate more closely to transection rates compared to hair shaft curliness

Skin thickness differences for FUE transplant relate more closely to transection rates compared to hair shaft curliness

 

However, as a specialist who performs hair transplant surgeries in black patients, Dr.U noticed that transection rates for individuals with highly curly hair were not necessarily higher than patients with straighter or more relaxed hair textures. In fact, the degree of hair curl when measured against graft damage appeared to be unrelated. Some patients with less curly hair would display significant transection rates.  

Dr.U observed a wide variation in graft damage rate in patients with African hair types. Individuals whose hair is characterized by significant curl could often produce grafts that came out fine, while some with more relaxed hair would sometimes prove difficult extract from. These anomalies also reveal themselves in other populations where the hair is generally more straight, such as in Middle Easterners and some Asian and Caucasian types.

The skin texture in those with lower success rates tended to be thicker and firmer. Similarly, even in other races, this trend was realized to some degree.

Additionally, it was found that another population of patients with extremely soft and extremely thin skin would often register a rather high graft transection rate for the opposite reason.

Dr. U also noticed that graft attrition rate could also change, even in the same individual between one area of the scalp or body and another.

Due to these accounts and the consistency of these patterns,  Dr.U concluded that the characteristic of skin thickness actually correlates much more closely with graft transection, compared to hair type.

How Does Skin Thickness Affect Transections in FUE Hair Transplant Procedures?

The overall success of a hair transplant surgery will largely be due to the number of viable grafts. This is heavily contingent on how well an FUE punch device is able to separate the follicle from the structures anchoring it in its place of origin. Failures in this area can cause grafts to fall victim to various forms of mechanical injuries.

Skin thickness affects the strength of the anchoring attachments and how easily an FUE device can free the graft from these connections.

The two major types of skin Dr. U aims to address with the Dr.UGraft ™ FUE system are as follows:

  • Skin that is thick and hard – Thick skin is unyielding, and composed of many more layers of interconnected tissue. This gives the FUE punch much more to work through, as the hairs themselves are attached more intimately to the sheath that envelops them. With thicker skin generally comes a longer follicle, as well. When the length of the follicle is underestimated, the base of the follicle bulb may not be fully excised, resulting in torsional damage, impaction, and graft death. FUE systems of the past have failed to accommodate patients of African and Arab descent for these reasons, and not because of the angulation of the hair they grow, as was previously believed.
  • Skin that is thin and soft – Conversely, skin that is exceptionally thin brings to the table its own set of challenges. The delicate dermis of thin-skinned individuals is easily torn by FUE equipment, making excising a viable graft suitable for transplantation much more challenging. Remember: for a graft to grow successfully in the recipient area, it must have a sufficiently bulky skin graft still attached and intact.

The Dr.UGraft ™ Technology Overcomes Skin Thickness Differences For FUE Transplant In Scalp and Body Areas

Across all individuals, the scalp will be more difficult to penetrate compared to body donor regions.

Since the Intuitive FUE capabilities of Dr.UGraft ™ devices can adapt to extremely thick or soft skin thicknesses, it offers the versatility to be used effectively on either the scalp or body areas within the same patient.

Dr.UGraft ™ technology can perform extractions either on the head alone, or on body areas (i.e. such as the beard, neck, chest, and abdomen) to supplement and enhance the patient’s overall donor graft count.

The Dr.UGraft Intuitive FUE technology offers the ability to customize both the speed and the torque of the punch's rotation to best suit the skin thickness of individual patients.

The Dr.UGraft Intuitive FUE technology offers the ability to customize both the speed and the torque of the punch’s rotation to best suit the skin thickness of individual patients.

Intuitive FUE – The Dr.UGraft ™ Difference

The Dr.UGraft Intuitive FUE technology offers the ability to customize both the speed and the torque of the punch's rotation to best suit the skin thickness of individual patients.

The Dr.UGraft Intuitive FUE technology offers the ability to customize both the speed and the torque of the punch’s rotation to best suit the skin thickness of individual patients *

 

Skin thickness differences for FUE transplant also resides across body donor areas within the same individual. The Dr.UGraft Intuitive FUE technology addresses these differences, making it possible to extract grafts from regions like the face and nec. This patient's final results were created entirely from beard hair.

Skin thickness differences for FUE transplant also resides across body donor areas within the same individual. The Dr.UGraft Intuitive FUE technology addresses these differences, making it possible to extract grafts from regions like the face and neck. This patient’s final results were created entirely from beard hair. *

 

Dr.UGraft ™ offers the world’s first Intuitive FUE technology which addresses individual differences in skin thickness. Patients can now benefit from a more reliable means for achieving a reduced FUE transection rate and thus achieve improved forms of growth and coverage in their final results.

At the heart of the Dr.UGraft™  concept is an immensely intelligent approach to FUE. This technology strikes a delicate balance between gently informing the user to the correct setting for his or her patient’s skin type while simultaneously putting control directly into their hands.

Rather than adopting a basic cylindrical structure, the Dr.UGraft ™ punch is designed with an unprecedented conical or funnel shape which allows it to respond to depth. Whereas a cylinder will exhibit the tendency to slide vertically straight down, a conical shape will encounter more resistance as it goes deeper into the skin. This type of device will then stop at the ideal speed and strength (i.e. torque) settings, where it will either be prevented from breaking the graft, or continue until it succeeds at separating the follicular unit from its surroundings before it stops.

The Dr.UGraft ™ hand is innately sensitive to the resistance of the punch to the skin. It then reacts to this resistance by slowing or stopping the rotation of the punch.

If the skin is extremely thick, the Dr.UGraft ™ punch will have difficulty penetrating the skin at the baseline speed and torque settings. It may even stop prematurely before it has separated the graft from its connections. These phenomena serve to alert the operator to adjust the speed and/or torque parameters accordingly.

Likewise, if the skin is too soft, the Dr.UGraft ™ punch may continue rotating downward, failing to reach a reasonable stopping point. This signals the practitioner to lower the settings to reduce the power of the device and determine the parameters needed to safely excise the follicular unit grafts.

Dr.UGraft™ Versus Other FUE Punch Systems

The analogy of a car provides a clear and easy to understand illustration of the difference between Dr.UGraft ™ Intuitive FUE technology and other FUE punch systems. The accelerator can be likened to the features and settings which increase the speed of the punch. The various gears are analogous to the settings which increase the strength of the punch device across different terrains, or skin types.

All other FUE technology systems are built with the equivalent of a single gear and a single speed within the single context of flat roads. Their general cylindrical structure makes them incapable of stopping on their own at a precise and accurate point of depth. Instead, they depend on the operator’s ability to time the duration of the punch rotation in order to manually stop the device.

Dr.UGraft’s Intuitive FUE paradigm is built to account for a variety of terrains, so to speak, in the form of different skin thicknesses. The actual punch technology which has been built around these principles includes adjustable settings for multiple speeds and torque strengths. Unlike other FUE systems, these parameters can be customized for different patients.

Because  Dr.UGraft ™ has identified, the common denominator responsible for graft transection among all populations of patients, it is able to offer the very first all-in-one system which achieves the goal of reducing mechanically incurred damage to the graft. So far, practitioners have been relying on switching between multiple systems to achieve acceptably low transection rates for specific patients.  Dr.UGraft ™ completely replaces this cumbersome practice of utilizing more than one device.

The Additional Supporting Features Behind the Dr.UGraft ™ Advantage

Besides of its customization settings based on a patient’s skin type, Dr.UGraft ™’s Intuitive FUE technology includes additional other features which work together to lower transection rates for patients.

The hybrid shape of the punch includes a dull, curved surface which constantly interfaces with the graft. At the same time, the sharp cutting edge points away from the graft and will therefore not come into contact with the follicular unit.

Furthermore, the attachable Dr.UGraft ™ Revolution console irrigates the grafts and provides hydration while they are being extracted through a controlled drip-fluid mechanism. The hydration works to lubricate the punch tip at its point of contact with the skin allowing the device to advance more smoothly into the deeper tissue layers. This serves to then facilitate the process of severing the interconnecting attachments

Additionally, the fluid hydration also lubricates the interior lining of the punch, reducing friction between the inner metal surface and the graft tissue. Coupled with an expanded, roomed interior, the hydration prevents the follicular unit from adhering to the inside of the punch and turning with it as it rotates, a common dynamic responsible for transection through torsion based injuries. This type of graft injury occurs when the base of the follicular unit remains attached to its source as the top part turns and twists off.

All of these features and functionalities culminate into Dr. U’s notion of intuitive FUE. Intuitive FUE reduces the guesswork that used to be an unavoidable part of the FUE process. It allows the practitioner to assess the set of circumstances before them objectively with the help of their tools (namely, the Dr.UGraft ™ system as a whole), freeing them to focus on the task at hand fully, allowing them to work at length effectively and without fatigue.

Dr.UGraft ™ Makes FUE Hair Transplant Possible for All Types of Patients, Regardless of Ethnicity or Donor Area

The aspects described above are what make Dr.UGraft ™ so radically different from every other FUE system available on the market today. No other suite of tools is able to perform adequately and consistently on all types of patients and in any donor area. The versatility offered by Dr.UGraft ™  is indispensable for any hair surgeon seeking to treat a wide variety of patients, without exception.

Frequently-Asked Questions – Intuitive FUE

What does intuitive FUE mean?

Intuitive FUE is a descriptor that can be applied to any FUE system optimized to sense and respond to individual differences in patient skin type, allowing the human operator to then select the customized settings for excising grafts without transecting them.  This quality is what makes Dr.UGraft ™ so powerful when dealing with all types of patients, hair types, and skin textures.

Does hair type or skin type matter more in FUE hair surgery?

Traditionally, hair texture was thought to be the dominant variable in terms of achieving the best FUE results possible. Thanks to Dr. U, however, we now know that skin type (i.e. thickness) is much more strongly correlated with transection rates. Dr.UGraft ™ is the first of its kind to cater specifically to the needs of all types of skin, both thick and hard and soft and thin.

How can the Dr.UGraft ™ system tell what settings are best applied to different types of patients to lower the FUE transection rate?

The hyper-sensitive Dr.UPunch i ™ is tested on the dermis. Due to the funnel-shaped aspect of the punch, the device encounters resistance. As noted earlier, the handpiece attached to the punch will sense this resistance and slow or stop the rotation of the device. If the instrument fails to reach a halting point (i.e. due to the skin’s softness), or if it does not turn or rotate sufficiently (i.e due to the thickness), the operator can then modify the speed and/or torque settings accordingly.  

This ability to adapt is what allows Dr.UGraft ™ to successfully lower transection excise hair from all skin types.

The Dr. U Hair Clinic is located in Redondo Beach, Los Angeles, California. We serve patients of all backgrounds and conditions; if you’re interested in receiving treatment yourself, you can fill out our free online consultation form. Those interested in learning more about FUE with questions that weren’t addressed in the previous section are invited to send them our way through our Ask Dr. U button:

Further Reading

Learn more about Dr. U’s revolutionary FUE system on our sister site for the Dr.UGraft ™ brand

A formal study on the Dr.UGraft ™ system’s ability to increase the expected graft yield of body hair transplant procedures