Follicular Unit Ellipse Excision or Strip Surgery (FUT)

This donor harvesting technique is a full thickness, linear excision of skin and hair, from a narrow zone of optimal density in the safe donor area. Every hair from the removed ellipse is carefully dissected with a microscope to create the tiny 1-4 hair follicular unit grafts. While the donor ellipse is being dissected, Dr. Keene closes the incision using a secure, two-layer closure, which include internal and external sutures.  The internal sutures dissolve, and the external sutures are removed 7 to 10 days after surgery. When elasticity allows, Dr. Keene performs a trichophytic closure, overlapping the incision edges to allow hair to grow out through the incisional scar enhancing its camouflage. The advantage to the linear ellipse technique is the high regrowth rate when optimal graft handling and graft preserving techniques are observed. 

It also allows removal of concentrated donor hair from the central area of the safe zone, making it less likely to be affected by progressive hair loss in the case of young patients who may be at risk for advanced patterns of hair loss. The area of scar tissue is isolated to the line of the scar and other areas of the scalp and hair remain scar free. Multiple small studies have revealed >95% graft survival.

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Follicular Unit Excision (FUE)

The donor harvesting technique of follicular unit excision (formerly known as follicular unit extraction) utilizes a small micro punch to excise individual follicular unit grafts. Unlike many clinics today, Dr. Keene performs the FUE procedure herself. She has compared numerous medical devices in order to choose those she has found to be most useful for producing the healthiest grafts. Motorized devices speed the FUE donor removal over removing the grafts manually. The devices Dr. Keene utilize limit the risk of dehydrating the grafts (as can happen with suction used in some devices) and diminishes transection rates. The WAW machine provides both oscillation and rotation to excise the follicular units (1 to 4 hair grafts) one at a time, with minimal transection, while maintaining vital tissue surrounding the follicles. This helps maintain growth factors present in the tissue around the grafts. The WAW FUE donor removal technique is demonstrated : Why Dr Devroye’s WAW FUE System Makes The Difference

Dr. Keene sometimes utilizes the S.A.F.E. machine, which also provides minimal transaction through the use of the dull excision technique. This refers to removing each graft with a rotating biopsy type excision, making the excision deep enough to delineate/outline the circumference of the graft part way, and then pulling the graft from the underlying tissue to avoid cutting off the follicles. At times this device may be chosen depending on your hair characteristics. Dr. Keene will judge which device to choose based on the individual patient. She will continue to update her choice of FUE devices as the devices advance.

Advantages to FUE

Each FUE graft leaves tiny dot scars, and in cases where there are thousands of grafts will leave a thousand small dots, distributed diffusely. However, for patients who prefer to wear their hair in a buzz cut, the small dots created by FUE are typically not visible if hair is at least 2 mm long. The absence of a linear incision means patients can more quickly return to all degrees of physical activity and athletics without concern for protecting a healing incision. The FUE technique is also advantageous when donor laxity is not sufficient for the strip donor removal method due to prior surgeries.

It is important for patients to be aware that despite some misleading advertising claims, neither type of donor harvesting technique is completely ‘scarless’. But the FUE donor removal method results in virtually undetectable scars with a buzz cut hair style, depending on factors such as hair color and skin color contrast.

Combination FUT/FUEs

To safely achieve maximal numbers of grafts utilizing donor hair from where it is genetically permanent (in AGA), a combination of both FUT and FUE donor removal is optimal. Dr. Keene can utilize the linear excision to the extent she considers safe for closure, then take additional grafts using the FUE method of donor removal.

This combination technique can also be utilized to limit the linear excision to specific areas. For example, if you know you can’t limit your exercise to avoid stretching the back of your head, but want to take advantage of aspects of the FUT procedure that allow more grafts in a single session, Dr. Keene can focus the FUT excision to focus on areas that are less likely to stretch and use the FUE method to obtain the remaining grafts.
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