2011 ISHRS Meeting Review, Part 4 – Surgical Techniques

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 4. More to come…

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Which is better: FUE or FUT (strip)?

I (Dr. Rassman) moderated a panel of 6 doctors to debate the merits of follicular unit extraction (FUE) over the more traditional strip harvesting transplant procedure (FUT). I started the sessions showing a case of what I called “follicular holocaust”. It was a case of 6840 FUE grafts performed over two sessions. I showed that the failure was not only on the growth of the grafts, but also on the destruction of the donor area. In all recipient sites and donor sites, there was a loss of 26,000 hairs and a massive failure of the FUE procedure.

The debate followed this foreboding case study with the following insights:

1. FUE is gaining popularity and seems to be demanded more and more by prospective patients. The graphs showed that the number of FUE procedures will surpass the number of FUT procedures in the next few years.
2. FUE is safe in the hands of good doctors. The group all agreed on this because they were amongst the best doctors offering FUE. My only comment is that I can’t imagine any doctor putting themselves in the “bad doctor” category as shown in my presentation of “follicular holocaust”.
3. FUE graft damage is being reduced with building experience resulting in better growth.
4. Dr. Bradley Wolf demonstrated a patient who had 1000 grafts on each side of his head (total 2000 grafts) after 7 months of growth. The two sides seemed to be about equal. The patient reported no significant pain with either procedure (done one day apart) and the scars in both sides healed with minimal scarring.
5. Dr. Suddleson argued that FUT supplied as many grafts as are needed, while FUE was more limiting in a single session. He argued that many of the advocates of FUE routinely offered FUT to their patients and that the FUT was the gold standard by which FUE would be compared. He generated a laugh when he pointed out that at least one doctor promoting FUE on the panel had reported his excellent results on the FUT strip based procedures.

 
FUE and ethnicity

I’m often asked if there a difference in FUE patient candidates based upon ethnicity. This question was raised and answered by a doctor from India who showed that there are clear differences in the Indian population based upon skin types and some geographical areas of India where the skin is much thicker than others with thinner skin. He believes that these differences clearly can impact the difficulties of FUE and the results of transplanted graft growth.

Also of note — it seems that the incidence of balding in the Indian population of India is much higher (62%) in men between the ages of 21-61 years old, than in the Caucasian population from comparable studies done in other countries. The use of finasteride was found to be in the 1% range for these men, while the use of various snake oils seemed to dominate the treatments of many Indian men.

 
I’ve got much more to post, so check back next week for topics on finasteride, the Artas® FUE robot system, and minoxidil.