I’ve had minigrafts that are unaesthetic, and have been told that a graft excision with suturing will generally give a better result than FUE extraction, since a graft excision removes the underling scar tissue as well as the plug. In addition, the shape of the follicles in scar tissue are often distorted, making extraction difficult and leading to more transaction (damage to follicles). Is this true?
Thomas, Just in this past month’s Hair Transplant Forum, the official publication of the International Society of Hair Restoration Surgery, an article I wrote on different reparative techniques , focusing on the FUE extraction and linear graft excision techniques, appeared as the cover story.
With the FUE extraction technique, when performed properly, I find that typically 60 to as many as 90% of the hairs we attempt to remove can in fact be successfully extracted- and the advantage is that with these very small punches, scarring is actually minimized.
I am not sure what this other doctor is referring to as “graft excision” but I am assuming extraction of the grafts using a larger punch, say 1.5 to 2.5 mm (vs. 0.8 to 1.0 mm for FUE), which can then be sutured closed- however, without a doubt, this creates increased, not decreased, scarring, due to the linear excision of these grafts. I have seen this many times, and is the reason I now use primarily the FUE extraction technique. The other possible procedure he is referring to as “graft excision” may be an actual linear elliptical shaped incision which is then sutured closed- an no one has performed more of these procedures than I, and in fact I know that many doctors recommend against this technique without knowing how effective it is when performed properly.
Hope this all helps.
Posted by Jeffrey S. Epstein, MD, FACS