Hair Restoration with Follicular Unit Extraction (Part 4)

With traditional Follicular Unit Extraction (FUE) grafting, the hairs are pulled out (like a banana being pulled out of its skin from one end) and the grafts may be stripped of their outer root sheath (ORS). If that happens, the hairs may lose the dermal papillae and possibly the bulb as well. The good news is that the growth elements of the mature terminal hair shaft are multifocal (have more than one site controlling the growth) so hair bulbs and dermal papillae cells that may be damaged may still produce full terminal hair, albeit less thick.

The two strongest growth areas of the mature terminal hair include (a) the dermal papillae and (b) the area near the insertion of the tiny muscle attached to the hair in the vicinity of the sebaceous gland. Any damage to the growing hair will produce a weaker and thinner hair. The research to show the damage to a follicular unit stripped of its dermal papillae and its ORS has not been well documented, but the conclusions drawn here are logically based upon the science of hair growth as we know it.

In a landmark study on hair transplant surgery, Dr. Kim, a noted Korean researcher, demonstrated that attempts to cut one hair into two parts to grow more than one hair from parts of a single hair, failed to grow more than one hair. When the (a) transected lower half of the hair was placed in a patient, it often grew a finer, weaker hair and (b) transected upper half of hair was placed in a patient, no hair grew.

Potential issues of using FUE for hair restoration.

• Loss of hairs inside the grafts from amputation/transection of the hairs; i.e. some of the amputated hairs die.

• Stripping of the critical growth centres of the hairs within the graft during the extraction process.

• Loss of the hair bulb or dermal papillae (the dermal papillae, which is located at the very bottom of the hair bulb, is responsible for hair re-growth after hair cycling from the telogen phase into the anagen phase).

• Buried grafts (grafts that are pushed below the skin becoming foreign bodies with potential cyst formation or even abscesses producing possible infections) thus wasting valuable hair resources.

• Necrosis (gangrene) of the donor area in large FUE sessions has been recently reported at the September 2008 ISHRS meeting in Montreal. It is not clear why this has occurred, since so little information on this potential complication has been presented.

For more information on FUE and hair transplant surgery visit www.cosmeticclinics.co.uk to find your nearest hair restoration specialist.

by Dr S R Bassi