Dr. Bhatti, Let’s say a patient gets 4000 grafts implanted via follicular unit extraction (FUE. The second time they come back, let’s say in a year, for another 4000 would it be very difficult because of the fibrosis build up?”
Scar tissue can indeed create problems if we do not approach the situation with care, experience and understanding. The scars have matured mostly in 9 months time after which the skin is soft enough for a sharp punch to enter easily. In addition, when we use smaller punches common today the space between the extractions is equally just as small so there is greater room for variance between previous exactions thus reducing the peripheral impact of the resulting subdermal scarring.
As you may know I use the Harris blunt punch. However, for the second and subsequent sessions I use the sharp punch used in CIT.
I have a simple way to calculate the number of grafts I will get from the patient in a lifetime through my technique of leaving one follicle (what I call the ‘sentinel follicle’) in between 2 punch holes (1:5 or 20% harvest). Assume I get 4000 scalp grafts in the first session. The second shall give me half the amount- 2000 and similarly sessions that follow decrease the amount that is harvestable by 50% each session.
If we say the back has 20,000 follicular units, we should not harvest ever beyond 40% or the skin starts to show. Much like the baldness in the scalp starts to appear when 50% hair are lost.
There is no great limit of grafts from the scalp available through FUE compared to follicular unit strip surgery (FUSS). I do not think there is any marked difference in lifetime yield from the scalp as compared to FUSS. And remember we do not expand the crown. And then we have the luxury of a whole lot of body hair that the strip only surgeon cannot get to.
Dr. Tejinder Bhatti
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