Category: FUE

I had the the Artas® procedure performed on me, but unfortunately. I ended up with tinnitus (ringing in the ear) in my left ear. I would appreciate telling you the the potential hazards of the Artas® procedure to warn unsuspecting “hair transplant” people.

Yours is actually the second email I’ve received from someone asking about tinnitus following a procedure done with the ARTAS. I did probe another doctor who has the ARTAS, however, he did not report this side effect on his patients. I do not have this system in my office, so I don’t have personal patients I can reference.

For those of you who do not know what the ARTAS sytem is, it is a robotic hair transplant system used for extracting grafts. You can learn more about it here and here.

Regarding the articles you posted recently about FUE versus strip procedures, I was wondering why FUE 2 isn’t the gold standard for transplant surgery. If the graft yield is just as good as strip from FUE 2, doesn’t that mean It has all the advantages of FUE and none of the drawbacks?

There is a series of reasons as to why FUE2 isn’t the gold standard, and I’ll list and expand upon that to address why the traditional FUE also isn’t the gold standard:

1- FUE2 is not available at this time for commercial use. We have not proven that the FUE2 can be as effective in 100 consecutive patients with comparable results, as we have shown in the two examples we demonstrated here. When we get it manufactured, it will have to compete with all of the other FUE drills out there, including the ARTAS robot. There will be a general reluctance for those doctors who feel comfortable with what they are presently doing, to switch to the FUE2.

2- I’ve discussed in great detail the limitations of traditional FUE in the hands of many surgeons (see part 1, part 2). Doctors may want to believe that FUE is better than strip surgery, something that I presently doubt with traditional FUE mechanical solutions. The strip harvesting produces the best quality grafts in most surgeons’ hands. I am certain there are many doctors who claim FUE expertise, that are not being honest with their patients. I know this because I often see the failures of FUE from known surgeons who claim expertise in this technique.

3- It is not generally agreed by many knowledgeable surgeons that the donor area can supply as many total grafts as strip surgery. In strip surgery, the surgeon always takes out the strip in the “sweet area”, which means its best concentration of quality grafts. This area can be harvested over and over again with only the risk of scarring. FUE, on the other hand, may produce irreparable damage to the donor area as the number of harvested grafts increase. In recent presentations given at physician meetings, there are suggestions that the donor area does get damaged as more and more grafts are excised with FUE.

Have you used this Ugraft tool before ? Is this a next generation FUE tool?

Video link: UGraft FUE tool

I have not used this tool.

Follicular unit extraction (FUE) is a difficult technique for many surgeons. There are many inventions and tools constantly being developed all over the world, but a new tool does not necessarily mean it is the next generation. From what I’ve seen in the video, it appears that it was developed due to difficulties Dr. Umar faced when performing body hair transplants (BHT).

Hello,

i am thinking of having the fue procedure in the uk and would like to know which is the best surgeon to see. Trying to avoid surgeons that have a high rate of fue failure due lack of skill.

many thanks in advance for your help.

You’ll have to do your own research to be sure you’re getting exactly what you want and to be assured that you found a doctor you can trust, but Dr Bessam Farjo is a good place to start (offices in London and Manchester). You can also use our handy guide to selecting a hair transplant surgeon — here.

A report published by the Journal of Plastic, Reconstructive & Aesthetic Surgery a couple years back has recently come to my attention. Here’s part of the abstract:

Follicular unit extraction (FUE) has been developed as one type of follicular unit transplantation surgery, a widely accepted hair-restoration technique. FUE has many advantages, including a small donor area scar, less pain and a slender graft without extra surrounding tissue. Complications are uncommon in the literature. We describe a case of donor-site necrosis after hair restoration with FUE, leading to cicatricial alopecia in the left half of the occipital region.

Read the rest of the abstract — Necrosis of the donor site after hair restoration with follicular unit extraction (FUE): a case report.

I have seen the impact of large sessions of grafts using FUE on patients who came to our office over the past 10 years. Most of these necrotic areas were small, so they were easily addressed by good, traditional surgical care. I expect that we will see more of these severe complications as more and more doctors start pushing the number of grafts performed in a single FUE session, just as we saw when doctors who did not know enough about FUT caused similar degrees of necrosis. I believe that those doing FUE procedures and their patients need to be aware of this risk. This complication, however, was a disastrous problem for the patient referenced in the above report, as he lost part of his scalp.

The full article states, “One hundred fifty cubic centilitres (cc) of 1/100 000 adrenaline solution was injected gradually into a 10 by 12 cm area in the left occipital region during surgery over 4 hours. Nine hundred fifty follicles were removed using 0.8-mm punches connected to the end of an electrical driver drill“. So less than 1000 grafts were transplanted with a small punch and yet the complication occurred. This punch size should have minimized the risk. The article does not discuss the density of the punch holes in the donor area. On the surface, nothing was really done wrong.

The article further reports: “digital gangrene and ischaemic necrosis after the use of local anesthetics with adrenaline and chemotherapeutic agent extravasations have been reported.” Our operative consent discusses this risk. We forget that any hair transplant (FUE or FUT) is a surgical procedure and with it, there are risks that must be discussed with the patient. We have previously reported a patient death in a medical office a few miles away from our office, so necrosis is just another one of these rare risks. Clearly, the death that occurred years ago was probably the result of doctor incompetence, so some of the things that the patient must pay attention to when evaluating asurgeon is: their track record, their experience, and their reputation.

I respect the courage of the doctors in this necrosis case, because by reporting it to the doctors performing this in the field, we become aware that the doctors do not control every risk in every patient surgery. As we know very little about this particular patient’s activities after the surgery or his health before the surgery (e.g. was he a smoker?), I can not discuss the article further.