| Objective | | | | To circumvent the problem of "follicular unit splay," |
| The purpose of this study is to describe a simple | | | | they considered Inaba?s technique of removing hair |
| instrument that can be used in the blunt dissection | | | | from the donor area with a punch that was used to |
| phase (second step) of the three-step Follicular Unit | | | | cut only part of the way down the follicle. The depth |
| Extraction technique and to measure its | | | | of the traditional punch (used in older hair transplant |
| effectiveness in a controlled study. | | | | techniques) was difficult to control, however, and |
| Materials and Methods | | | | transection resulted in many cases. The FOX test |
| In patients undergoing hair transplantation, the hair in | | | | was able to screen out the patients who were most |
| a 2x4 cm patch in the mid-portion of the donor area | | | | likely to be subject to excessive transection and thus |
| was clipped to approximately 1-mm in length and | | | | improve patient selection, but it did not improve the |
| anesthetized. Ten follicular units were extracted from | | | | quality of the grafts. |
| one half of the patch using two-step FUE and ten | | | | The three-step FUE technique of Harris overcomes |
| follicular units were extracted from the other half of | | | | the limitation of the original technique, as the blunt |
| the patch using the three-step technique. The two | | | | tipped instrument is advanced into the dermis, |
| step technique was performed using a 1-mm Miltex | | | | splayed follicles are gathered together avoiding |
| punch and fine rat-tooth forceps. In the three step | | | | transection. In effect, Harris? dull-punch technique |
| technique, a 1-mm Miltex punch was used to score | | | | allows a full realization of the "extraction concept." |
| the skin, a thin cylindrical stainless steel tube was | | | | One untoward result of the three-step technique is a |
| used for the blunt dissection and then fine rat-tooth | | | | possible higher incidence of buried grafts. It also adds |
| forceps were used for the extraction. The sides | | | | an additional step to an already tedious hair |
| were alternated on different patients. After | | | | restoration process. |
| extraction, each graft was examined under a | | | | There are many possible permutations of blunt |
| stereo-microscope and the following information was | | | | instrument design. Possibly the most straightforward |
| recorded: 1) hair characteristics; color, wave, and | | | | is to use a cylindrical instrument whose walls are thin |
| thickness, 2) anticipated yield - the number of hairs | | | | enough to dissect though dermal connective tissue |
| visible with the stereo-microscope on the surface of | | | | with a simple rotating movement, yet thick enough |
| the extracted graft, 3) actual yield - the number of | | | | so that the advancing edge avoids follicular |
| intact follicles in the follicular unit visible under the | | | | transection. The instrument design used in the current |
| stereo-microscope. Intact hair yields and graft yields | | | | study will be presented. The current study confirms |
| were calculated for the two techniques and | | | | the advantage of the three-step procedure over the |
| compared. | | | | standard method of follicular unit extraction. |
| Discussion and Results | | | | Conclusion |
| In the two-step follicular unit extraction technique, | | | | The three-step FUE technique proposed by Harris |
| proposed by Rassman and Bernstein, there was an | | | | offers significant improvement over the two-step |
| attempt to "separate follicular units from the | | | | technique. The main advantage of the three-step |
| surrounding tissue down to the level of the mid | | | | technique for hair transplantation is that it minimizes |
| dermis." The rational was that because of the | | | | follicular transection. The main disadvantages are the |
| anatomic divergence of individual follicles as the | | | | logistics of the extra-step and the increased incidence |
| follicular unit entered the fat, a punch that neatly | | | | of buried grafts. A new type of blunt instrumentation |
| encompassed a follicular unit on the surface would | | | | is described in this study. The ideal tool design that |
| amputate the splayed bulbs as it cut through the | | | | will minimize both transection and the possibility of |
| deeper tissues and result in unacceptable rates of | | | | buried grafts still needs to be determined. |
| transection. | | | | |