Dilemma fue

Dilemma fue

1. 1. Dr. Bishan Mahadevia M.Ch. (Plastic Surgeon) Ahmedabad No disclosure Dilemmas in FUE
2. 2. How to chose between many options <ul><li>Techniques </li></ul><ul><li>Instrumentations </li></ul>
3. 3. Techniques Next Slide 2 steps
4. 4. 2 step technique- most practiced
5. 5. Scored Element
6. 7. Depth Control
7. 8. Elastic skin Vs Fibrous ?
8. 9. Reduce Depth for
9. 10. Direction, Angle & Force www.bernsteinmedical.com
10. 11. Sharp: Less force to cut the skin Minimal distortion Easier transaction More bleeding Blunt: More force to cut the skin so possible distortion but has better control with higher torque low speed motor Funnel: Avoids torsion injury by allowing more space for the cut tissue Contoured edge: less force is required to cut Sharp, Blunt, Funnel and contoured punch?
11. 12. 0.75, 0.8, 0.9, or 1 mm ? 0.75 mm -----1-2 hair graft 3 and 4 haired graft & spaced out follicles with thick hairs ------- 0.9 to 1mm punch
12. 13. <ul><li>Higher the density more the number of grafts one can harvest before </li></ul><ul><li>donor can look thin but higher the chances of lateral damage </li></ul><ul><li>Use TUMESCENCE to increase the spacing </li></ul>0.75 mm Diameter inner punch 1.1 mm ID punch destroys neighboring FU
13. 14. Manual or motorized?
14. 15. Not the one is absolutely best in all situation both type of devices should be handy <ul><li>Better control esp. in fragile skin </li></ul><ul><li>Slower </li></ul><ul><li>Can have less TR </li></ul><ul><li>Beginner should start with </li></ul><ul><li>cheaper </li></ul><ul><li>better control because you do not have to rotate and punch at the same time </li></ul><ul><li>Faster </li></ul><ul><li>Can have less TR with practice </li></ul>Manual or motorized ?
15. 16. <ul><li>Better control </li></ul><ul><li>Minimal torsion injury </li></ul><ul><li>Possible torsion injury to tissue </li></ul>Rotating or Oscillating?
16. 17. <ul><li>All patients are candidates </li></ul><ul><li>First few graft extractions decide parameters like depth control, direction and feel of tissue </li></ul><ul><li>40 to 50 % patients declined on the bases of 10 test grafts </li></ul>FOX test or Test Extractions? Technically demanding – leaves little leeway for error
17. 18. <ul><li>Changes the hair direction </li></ul><ul><li>May not work esp. in fibrous skin </li></ul><ul><li>Lateral damage is reduces </li></ul><ul><li>Final scar is smaller </li></ul><ul><li>Reduced skin distortion by punch </li></ul>Tumescence or Not? Traction or not?
18. 19. <ul><li>Placing the needle centered at emerging hair on the skin is more likely to damage follicle instead place the needle eccentrically and away from the hair follicular direction </li></ul>Skin distortion by the punch Eccentric punch Centered punch Punch placement Central or Eccentric?
19. 20. <ul><li>Step trim or snail track Trim </li></ul><ul><li>Tedious and limits number per sitting </li></ul>Donor Shave or Not?
20. 21. <ul><li>Thick haired short and straight hair FU are ideal for easy extraction whereas thin and curly haired and long follicles requires extra efforts </li></ul>Thin, Curly or splaying hairs with Long FU vs. Thick, Straight, and short FU African Hair DR. M’s Clinic
21. 22. <ul><li>Thin , short , acute ly placed & usually no bony support to stabilize the skin. Hair direction variable </li></ul><ul><li>Manual & sharp punch usually works better in our experience compared to motorized and blunt punch </li></ul>BHT?
22. 23. <ul><li>Pre-shave 4-5 days before to avoid telogen hairs </li></ul><ul><li>40% to 60% telogen hairs which are difficult to harvest intact due to its flimsy extracellular matrix tether at secondary germ between the bulb and dermal papilla. </li></ul>
23. 24. Uniform or localized over harvest? Educated & Uniform distribution Over harvesting from one area
24. 25. Doctor patient position? Patient lying Doctor towards back Patient lying Doctor towards head Patient seats Doctor standing
25. 26. Man behind and not just the tool No one option for all situations