Injerto Capilar Dr. Rafael de Freitas experto en Trasplante Capilar
ES | EN | PT | FR | IT
Facebook YouTube Twitter Google Plus LinkedIn Blogspot
DR. RAFAEL DE FREITAS    INJERTO CAPILAR
HOME / Hair grafts / Comparison between capillary grafting techniques

Comparison between capillary grafting techniques

F.U.E

STRIP or FUSS

Definition
Follicular units are removed one by one. The doctor chooses follicles depending on demand (1, 2, 3, 4 and 5 hairs).

Definition

Follicles are removed by extracting a strip or hair skin strip from both sides of the head. We will need the scalpel.

Surgical instruments used 

Show punch 

Surgical instruments used

Show scalpel and glass slide

Hair cut

Total or partial shave.
There is no scar. Our patients will be able to shave heads or have short hair (as much short as they wish) for the rest of their lives. Patient will always choose his hair style.

 

Patient with alopecia scale V

1st Operation. Frontal restoration 

Same days after the procedure

One year after the procedure, there will be a second procedure in order to restore the crown.

There is no evidence of the hair transplantation at a glance.

Hair cut

One of the bad things about this method is big scar.  No matter how good the surgeon is, there will always be a scar on donor site. Even if it is a strip, it would be visible because hair does not grow there. The patient who decides to use this technique won´t be able to have very short hair on donor site for the rest of his life.

 

Anesthesia

Local

Anesthesia

Local

Type of incision for extraction

Cuts with punch/Incisions

The part shown with the arrow is the only thing that penetrates in patient´s skin

Type of incision for extraction

Cut with scalpel/Incision

The glass slide of the scalpel cuts scalp skin in order to extract the strip.  

Extraction

Follicles are extracted one by one by using microsurgical tools (diameter range less than 1mm). Follicles extraction is simple and does not hurt. The area heals from 2-4 days. There is no risk of nerve damage.

 

Extraction

A strip of the scalp is removed (20-25 cm and 1-2.5 cm wide) from donor site by using scalpel which penetrates on dermis and cuts nerves and vessels. 
Later it is sutured and it is needed around 30 days to obtain total healing although sometimes there is an alteration of sensitivity that lasts some months due to nerve damage.

 

 

Hair extraction from other areas of the body
We can obtain hair from the whole body. Many of our patients have a lot of hair in their bodies and would be pleased to use it in order to replace lost hair in scalp. Body hair is used to improve following density; it is never used on frontal line. Not everybody can be a good candidate for this, but it increases our treatment possibilities.

Hair extraction from other areas of the body
Hair can´t be donated from other places of the body. So, a huge donor site is wasted. Scars on pubis have been done, but it is unthinkable to do then in thorax and members to obtain additional hair. 

 

 

 

Follicular damage

No follicular units are damaged during extraction. If the surgeon decides not to remove the follicular unit he had chosen and cut the scalpel, this unit will follow its normal growth the same way as before. 

Follicular damage

More than 30% of follicular units from donor site can be damaged by the scalpel when extracting or when nurses and assistants cut microscope dissection. 

Invasion scale

Non invasive
FUE is considered as a non invasive technique. In fact, it is minor surgery and is classified as a medical act. The surgeon needs to have special training so that he can extract follicular units very well. He will not to damage any of its elements either.

 

Invasion scale

Invasive
Strip is considered as major surgery, it is an invasive procedure because it needs cuts on the skin and nerve and vessel section in the back side of scalp. 
The doctor needs to have special surgical skills so that scars are undetectable. 

 

Follicular units quality

Quality and strength of removed graft are better than those ones extracted by using Strip technique. Follicular units look cleaner if you take them one by one than separating them with the microscope

Follicular units quality

We could cut or damage more than 30% of the follicles of both sides of the strip where the scalpel cuts the skin, since the surgeon can´t see where he is cutting.

Follicular unit selection

FUE technique let us select follicular units that provide more density, which means that more hair can be transplanted for each number of grafts.  To restore frontal line we use 1-hair follicular units.


When the line is restored we will use 2 or 3-hair follicular units. For crown and parietal area we will use 2, 3 and 4-hair follicular units.

Follicular unit selection

This technique is based on extracting a 20 cm long and 1 cm wide strip. If we take into account that average density is around 55-60 follicular units per cm2, we could extract between 1 000 to 1 200 follicular units. That is, if the patient has low follicular density we won´t be able to extract more follicles (with those measures) so we would need to make a bigger cut and the scar would be more anaesthetic. 


This is a disadvantage, since we can´t choose the most useful units for recipient site. 

Quality control

Surgeons are directly implied in the whole surgery process, so graft care is very well looked. The surgeon extracts and places all follicular units. 

Quality control

Another bad thing is that strips are in nurses´ hands for its dissection in the microscope, so the doctor can´t control this step. Also, if assistants are not well trained, they can damage a high amount of grafts. It is basic to have an experienced team. 

Number of follicles per section

1200 to 1500 follicular units in 1 day 
2200 to 3000 follicular units in 2 days
We are limited by the availability of hair in donor sites of the head and body.
Since units are extracted one by one, the doctor decides the exact number he will extract. So, both doctor and patient are happy because they decide to do it step by step or in a row (due to economic matters, tests…).
It is not limited to one area. We can take hair from a larger area and even in patients who have less density we could extract more follicular units per session with this technique. 
Larger number of 3 and 4-hair follicular units.    

Number of follicles per section

Around 1 000- 2 000 follicular units are taken 1 day. Limited by the area, strip size (if a larger strip is needed, there would be a larger scar) and follicular density of it.  
There is a smaller amount of 3 and 4-hair follicular units. The total amount of follicular units depends on follicular size and strip density. When we extract the piece we can´t know the exact number of grafts. It does not allow consecutive tests of procedures 

Implantated

Use of implanters. 
It lets the surgeon control the insertion angle and growth of new transplanted hair. We always have to follow natural angle and growing direction of the patient hair. 
(It controls the angle; there is no fibrosis, higher density and proximity of grafts). 
Read implanters.

 

Implantated

Use of glass slide of the scalpel. 
Higher scale of fibrosis, less density and larger distance of follicular implantation. 

 

 

 

That day after the postoperative 

Stitches heal in a few days and they are undetectable. There are no external influences that affect healing because wounds measure less than 1 mm.

24 hours later fibrin has recovered all stitches.


That day after the postoperative 

After removing strip it is needed to suture stitches. Even in an experienced surgeon´s hands and not using staples, we could find future problems regarding unaesthetic scar. These are factors don´t  depend only on the doctor. A surgeon can´t guarantee final results because he can´t control the attention the patient pays at the wound before it heals definitively.  

 

Postoperative recovery

FUE technique lets the patient play sports and lift up heavy things after 8 days of the procedure. Waiting period is only to let follicle units grow roots in recipient site. Donor site does not worry.

Postoperative recovery

The patient can´t play any sports or go to the gym at least for 30 days after the procedure. Any movements involving head flexion (to tie shoe laces, to read, …) must be done very carefully in order not to inflict traction to the wound

10 days after surgery   

After 48-72 hours there is no sign of scab. After one week, there is no wound. 
No scab and good healing.

10 days after surgery   

Stitches removal

Final result

1 year

Resultado final

1 year

 
CONTACT DRº RAFAEL DE FREITAS
1 FREE CONSULTATION
Call now and ask for your medical appointment.
+34 608 099 617

Our Centers

You can find us Monday through Friday
from 10:00 - 14:00 and 16:00 - 20:00 hours at the following addresses:

Barcelona: Plaça de Calalunya nº 1
Edif. Triangle, 4º B (Regus).
Tel: +34 608 099 617 / +34 963 355 939
Valencia: Calle de Sorní, 34
Tel: +34 608 099 617 / +34 963 355 939
2013© RF - Dr. Rafael de Freitas / Injerto Capilar
by Bluesoft.pt