FUE - lo Stato dell'Arte

[MathiasREX]

x Morselli: credo che i pori a cui GHO fa riferimento nella HM non siano altro che i fori da cui spuntavano i capelli.

[Aragorn]

Cole su FUE/FIT vs Strip e relative transection rates.

Come dice il doc è solo questione di tempo....

 

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We have studied transection rates very carefully with strip harvesting, slivering, and graft preparation. it is one thing to say that your rate is 2 to 5 %, but it is another thing to monitor it on a daily basis especially if you find new staff. also this rate will vary from one person to another.

 

two physicians have looked at the transection rate comparing a single blade to a double blade. the phsycians are dr. pathomvanich and the other is cole (bisanga, cole, and mawamba). we both found the rate is statistically significant and higher with a double bladed knife and that a single blade creates an average transection rate of 2%. the percentage will be lower if the density is higher, but the total number of transected hairs will be higher if the density is higher. the most important finding of the Cole study was that the transection rate for the second cut is almost every patient is twice as high on the second cut of the ellipse. again, the density increase on the second cut due to skin relaxation and you loose some control of the scalp (it becomes looser) with the second cut.

 

i cannot say about FUE or the Woods technique, but our procedure is not blind. we watch as we cut and we correct our angle as the angle of hair growth changes. this is especially important with fragile hair, body hair, and cases of significant scarring.

 

the person most often quoted about transection rates with strip harvesting is dr. limmer. the 2 to 5% number is his. i will say that he and i have disagreeded for years regarding hair density and total hair counts. he belives he is right while i know that i am right.

 

total transection rates with strip harvesting can be much higher than you think. this is especially true for fragile hair, scarring, and dense dermis. what is dense dermis? it is an opaque dermis that limits visiblity. it is like trying to cut grafts in a smoke filled room or like trying to drive in a fog. it just isn't as easy. i know that dr. limmer knows what he is talking about since he can cut grafts. i've seen him do it. most docs never cut graft and don't know how. myself - i've regualarly cut well over 1000 grafts in a single case though this is uncommon for me these days. i can tell from the strip that dr. hasson showed that he has not spent a great time studying how to reduce graft cutting time. the reason is simple. his strip has several mm of fat below the bulbs. this fat has to go somewhere. it is not going back in the recipient site. it must therefore be trimmed. i found many years ago that it was far faster to trim most of the fat away from the strip during strip removal rather than having to individually trim it away after the strip is removed and the individual grafts are cut. this is not a slight on his technique but is a recomendation based on my vast exepreince cutting grafts. the other problem from so much fat removal is that a dead space is left in the donor region. this must be filled in by something or closed in two layers. what fill in is scar and it creates a mushroom scar effect in the lower areas if it not closed in two layers. minimizing the amount of fat on the strip is risky to the hairs though and you must be very careful so that you minimize transection. of course you could test dr. gho's theroy of hm by trimming all the bulbs into two pieces as you remove the strip to see if the whole thing regrows in the original donor area. wouldn't this be something.

 

in our office we use fiberoptic lighting to improve our visualization through the slivers. we patented a system to do this. each fiber optic follicle cutting board costs me about 300.00 and each lighting system is another 500.00 but will give light to two cutting stations. this is very expensive but is well worth the money to our patients. currently, we are the only facility with this equipment to the best of my knowledge. it is especaily benefical to those with white hair.

 

transection rates probably are much higher than 2 to 5%. i don't know many physicians that routinely monitor this and i must say that even in my office we have not monitored this as closely as we should for many years. since most physicians don't even measure density prior to surgery, i can't see how the majority of them could stand behind the "transection" arguement in defense of their strip surgery. there is one way to assess your staff easily and routinely. that is to monitor the calculated density for each tech. you will find that some will not be as good as others. you will find that some don't even need a microscope at some point in their life. since most physicians don't monitor the calcualted density and since most don't even know what it is, and since most don't measure density, and since most don't count hairs, as well as grafts, it is far too cavalier for us to stand behind the 2 to 5% transection rate especially when we know full well that it is often much higher especially in the hands of physicians whose staff are not as good as dr. hasson's staff.

 

no, fue, fit, and the woods technique are the future. it is just a matter of time.

 

i will say this though. after much careful contemplation, i do think it is best to limit surgery size. while we can perform much larger sessions, it is probably wiser to stay will smaller session in the early stages of this transformation.

 

remember there were those that thought the earth was flat at one time. there were those that thought the earth was thousands of years old rather than billions of years old, there were those that thought we could predict volcanic eruptions unitil mt st. helens, there were those that doubted the theory of relativity, there were those that doubted that the earth's magnetic field could reverse itself, there were those that thought the dinasaurs gradually died out rather than abruptly ceasing from a catyclysmic event and there are those that doubt fue/FIT and woods will replace the strip. it will replace them, however, becasue it is a far better procedure. it will take time though and i would not encourage pateints to jump with both feet into it especially with new physicians. i turely belive that patients should have smaller session done rather than larger ones. why? because there is no doubt that our techniques and experience will grow expotentially. taking your time will only insure that you receive a better procedure every time you come in for more hair. strip surgery is very inefficient. follicular extraction is very efficient. transection rates are tolerable, now, but will most likely get even lower.

www.forhair.com

 

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John P. Cole, MD

75 14th St.

Suite 3260

Atlanta, GA 30309

800 368 4247

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[garcia76]

Dott.Morselli,Aragorn..che ne dite delle foto su hairtransplantnetwork nella sessione Post your hairtransplant photos riguardanti il risultato dopo 5 mesi del ragazzo operato da Alvi sulla linea frontale.(1500 grafts)Io trovo che sia fantastico!E pensare che ci volevo andare pure io da Alvi!

[Visitatore Dott. Morselli]

Le foto sono suggestive, ma come dice Geronimo sono suscettibili di manipolazioni.

Dovrebbero servire a far conoscere lo specialista, ma il giudizio finale deve risultare anche e soprattutto da altri parametri, come la fama di serietà che si sia costruita con anni di onesto e qualificato lavoro.

[Visitatore Dott. Morselli]

MathiasREX:

il dott. Gho si riferisce proprio ai condotti delle ghiandole sudoripare (del resto "pores" in anatomia non ha altro significato), li cita varie volte. D'altra parte, altri fori aperti sulla cute non ve ne sono, a parte i follicoli dei capelli terminali e quelli pressochè virtuali di quelli miniaturizzati.

Introdurre cellule di follicoli in un condotto escretore è come seminare in un torrente.

(noi modenesi siamo anche agricoltori)

[GanjaMan]

Dottore le ho spedito un PM

[MathiasREX]

interessante osservazionde dottor .Morselli...

bisognerebbe chiedere un chiarimento a GHo...

[Aragorn]

Ha ragione il doc.

Da Gho:

"HM is administered by injecting cultured cells into the sweat pores"

Anche a me sfugge il razionale di introdurre cellule all'interno del condotto sudoripero, posso ipotizzare che Gho abbia verificato la stimolazione del follicolo adiacente anche perche più avanti parla di "ringiovanimento" di follicoli miniaturizzati.

Speriamo dica qualcosa di più preciso a Ottobre, alle volte le scoperte scientifiche sono casuali e ad una prima analisi possono sembrare assurde.