CONTRAINDICATIONS FOR FUE

ContraIndications For FUE

Following are the contraindications for FUE:[10]

1. Inexperience in performing FUE techniques
2. Unavailability of proper instrumentation
3. Unrealistic patient expectations
4. Inadequate donor supply
5. Scarring that makes both the two- and three-step procedures problematic
6. FOX grade 4 and 5 categories
7. Patient who is not willing for long sessions for several hours or multiple sessions as needed due to the slowness of the process
8. Patient who is not willing to cut his hair short and for this reason women are not good candidates for FUE
9. Large bald areas needing more than 4500 grafts

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ADVANTAGES OF FUE

Surgeon’s perspective

• It needs less manpower than FUT; One doctor with one or two assistants can run a centre.
• The procedure is less traumatic and surgical experience is not essential.
• Graft preparation is minimal.
• Less equipment is needed.

Patient’s perspective

• Can sport short hair
• Minimal post-operative recovery time
• Microscopic scars in donor area are almost invisible
• No need to visit surgeon again for stitch removal
• Can use body hair for added density with this technique only
• Can cover preexisting scar of strip surgery with FUE[23]

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LIMITATIONS

1. FUE is a tedious procedure that takes its toll on the surgeon’s patience, energy levels, neck muscles and enthusiasm. Anderson[13] has advised to take short breaks, frequently adjust the posture and to use the assistants well.
2. There is a long learning curve in FUE. Newcomers to this technique find multiple sources of difficulty in performing FUE.
3. Higher transection rate: This remains the main area of concern with this technique. The frequent lack of association between the exit angle of the hair and the subcutaneous course of the follicle is particularly problematic. When this is coupled with frequent changes in follicle direction, the follicular transection rate (FTR) is more.[17] In order to maintain the reliability of FUE, it is indispensable to remain within a permissible level of follicle transection rate (FTR), at least comparable to the standard technique of strip harvesting and microscopic dissection, which has a transection rate of approximately 2%.
4. Tethering of the follicle to dermal components may require either time-consuming dissection or shearing of the follicles as extraction is attempted.
5. The procedure is long and hence tiring for the patient. Patient also has to lie in the prone position which adds to the discomfort.
6. Finally, the number of grafts extracted per day is limited, leading to multiple sessions over several days. To overcome this, surgeons have introduced megasessions. Currently, in some clinics, FUE megasessions up to 2000 grafts over 10–12 hours session in a day are performed. One recent study reports extracting up to 4400 grafts over 3 days.[14]
7. Some surgeons in order to extract higher number of grafts may risk going into the temporary zone; the hair follicles extracted from this region may be lost forever.
8. Very fine trimming of donor hair which is disadvantageous to many people.
9. Only one case can be done in one day. Because of the time spent, the procedure is more costly, almost three times that of FUT.[24,25]

Table 1

Comparison of FUT strip method and FUE

CONCLUSION

FUE is an exciting advancement that propels the field of hair transplant surgery one step closer to the elite minimally invasive status. The promise of an almost scarless surgery is enticing to both patient and the surgeon. The reasons for selecting FUE rather than a strip harvest may be the avoidance of a linear scar, the desire for a naturally pain free post-op period or simply the idea of having a minimally invasive procedure.

The technique can serve as an important alternative to traditional hair transplantation in certain selected patients. More research is needed to render the procedure faster, cut short the surgery time and improve the transection rates, so that it can be adopted in greater number of patients.

mentioned.

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INDICATIONS FOR FUE

Following are the indications for FUE:[10]

1. Patients who want to wear their hair very short (and hence very thin linear scar is unacceptable)
2. When a patient specifically requests an FUE procedure and enough grafts can be harvested to meet his or her needs.
3. In patients with limited hair loss or those who require small sessions. This group includes patients with androgenetic alopecia in Norwood class 3 pattern or small vertex balding areas, limited cosmetic areas such as widow’s peaks (a triangular area of hairloss usually seen in the front of forehead in women), eyebrows, eyelashes, moustaches and limited areas of alopecia secondary to dermatologic conditions.
4. In the treatment of widened scars resulting from traditional strip excisions [Figure 2].
5. Patients having inadequate laxity for a strip excision (too tight skin).
6. For scarring from dermatologic conditions, trauma or neurosurgical procedures.
7. When previous scars of strip surgeries make further strips impossible, then FUE is an indication for further extractions.
8. In patients, who tend to heal with wide or thickened linear scars.
9. In athletes, who must resume full activity immediately after the procedure.
10. For patients with an inordinate fear of pain or scars.
11. When body or beard serves as a donor area.
12. FUE technique is the only technique useful in body hair transplantation. The earlier indication of limited areas of donor site has been overcome by Body Hair Transplant.