MedicamatMedicaderm
 
Transplantation capillaire / Punch Hair Matic ® / Étude clinique

AUTOMATED FUE * (* Follicular Unit Extraction )

The benefits of new precision tools in hair transplantation
Marc Divaris Plastic Surgeon
Associate Professor, Hôpital Pitié Salpétrière
Maxillofacial Department
Paris. France

Summary:
F.U.E, the latest development in hair transplantation, is a “scar-free technique” that meets the high demand for follicular units implants. A new robot, called Punch Hair Matic (1), speeds up this lengthy surgery and optimizes the quality of the grafts and hair regrowth.. It cannot, however, replace the strip technique for some patients.

 

INTRODUCTION FUE

is the latest innovative technology in hair transplantation. Since 1959, when Ostenreich standardized hair transplantation, there have been n ume rous advances. After the big punches that gave a moth-eaten appearance to the occipital donor area and a doll's hair look to the recipient area came the era of harvesting using a multi-bladed knife, which had the advantage of leaving only a thin linear scar.

Nevertheless, in view of our patients' demand for less painful and disabling techniques, what is looked for today is redistribution of the hair with no scar and optimum natural appearance in the grafted area. FUE fulfils both criteria. This delicate technique, however, increases the operating time and number of assistants needed, and hair may be lost in the process.

Advanced automation technology now enables the surgeon to harvest follicular units of optimum quality and reimplant them within an operating time that is quite acceptable to the patient. In fact, with the new robot, the surgery takes two to three times less time.

Method :

Follicular micrografting follows the principle of regular micrografting but preserves the follicular units. These are made up of 2, 3 or 4 hairs growing through a single pore. Follicular units are distinct anatomical entities, and each hair within a f ollicular unit has its own follicle. The hairs making up a unit emerge from the scalp through a single common orifice, and sometimes through a secondary orifice. An FU is comprised of 2 to 3 hairs on average, and is harvested using a punch 0.8 to 1.2 mm in diameter. It has been proven that harvesting diameters less than 1.25 mm , due to centripetal healing, leave no residual scar in the occipital or temp ora l donor area. Between each harvest, however, it is necessary to leave at least five follicular units in order not to create a gap, not to hinder healing of the punch hole, and, above all, to leave a dense enough donor area. As the human scalp averages 100 to 150 hairs/cm2, it was previously necessary to harvest one or more strips about 25 cm2 in surface area to obtain 3000 hairs ( 25 cm x 1 cm ).

To obtain the same number of hairs (3000) while leaving sufficient hair behind, the donor area must be prepared by cutting the hair very short (about 2 mm ) over an area that is six times wider ( 25 cm X 6 cm ). The adage to always keep in mind is that “a good grafter is a good harvester”. That is all the truer with this technique as the hairs have to be harvested over their entire length, from the bulb to the shaft, and in very large numbers. One should not hide behind a pseudo-scientific rationale in case of transection, saying that everything will regrow with sometimes additional regrowths. This transection must be very precise in order to get the stem cells responsible for hair multiplication. In the most favourable cases, it gives only a very small percentage  of additional regrowth with 50 % of atrophic hair, after many hours of preparation (5 hours for 300 transected hairs). As we can see, the follicular unit must be removed intact. This requires optimum operator training, optimum cutting equipment, and automation to reduce the operating time.

Instrumentation :

This patented French technology called Punch Hair Matic® (developed by Medica mat in France ) meets the objectives. It is based on a pneumatic suck-and-push system which actuates two types of instruments:

1- A punching-sucking handpiece consisting of an electric micromotor with a hollow shaft receiving a small-diameter ( 0.8 mm , 1 mm , or 1.2 mm ) punch.

Punch: based on the principle of the double-bevelled Australian punch, it allows harvesting FUs of exceptional quality due to its very good rotational concentricity.

Motor: we prefer to use a motor-driven rotary lathe rather than the hand because we can better focus on the orientation of the punch instead of worrying about the force to be exerted and the angular variations that may occur when the punch is twisted between thumb and forefinger.

Handpiece: instead of  the straight handpiece I was using with the Omnigraft (1), I use a contra-angle handpiece to work much closer to the scalp  and have a better view of the operative field. The hand positioning gives support and a very small offset from the axis. This contra-angle handset is connected by tubing to a collector flask. The FUs are aspirated atraumatically and smoothly, and the operative field can be best assessed and cleaned, leaving at least 5 FUs between each harvest. This technique is termed semi-direct because the FUs are sucked into the collector flask and then put on compresses for implantation. In the direct method, the FU is fed directly through tubing into the implanting handpiece.

2- Implanting handpieces, which are transparent hollow cylinders with pneumatic pistons. The transparency of the handpiece makes it possible to view the graft before insertion, if necessary.

The FU is aspirated by the end of the cylinder and re-implanted by smooth, progressive movement of the piston with no risk of trauma to the hair and with reduced risk of “popping” compared to the other implants.

Discussion :

In FUE, the operating steps are the same as with the former punch graft technique, but the punch diameters are smaller (0.8 to 1 mm against 2 to 3 mm ), which makes it possible to obtain FUs (micrografts), leaving, after very quick healing, almost invisible tiny traces in the harvesting zone.

This very popular new hair transplantation technique is also known as suture-free or scar-free transplantation. The drawbacks of this technique are the need for shaving part of the crown, leaving small scabs that are visible for several days if the patient is short-haired, increased operating time, and higher risk of root transection during blind harvesting.

The new technology overcomes to a large extent the last two major drawbacks.

Using the punching-sucking handpiece, we can harvest up to 50 FUs per minute. Actually, it takes us 30 minutes to harvest 1000 FUs.

I first take some ten grafts in order to assess the texture and strength of the skin in the donor area. There are two cases:

- If the tissue is tight, I use 1-mm micro-punches which give very fine grafts. I can then use the 0.8-mm micro-punch for follicullar units with one or two hairs in order not to chance transection.

- If the tissue is soft, while the 1-mm punch may give cutting errors, with the 1.2-mm punches, the result is 99 % satisfactory.

The special shape of this handpiece provides for highly safe and fast harvesting. The advantage of this technique is that it leaves no linear scar, and that grafts can be taken from a sparsely haired, tight crown, or from other parts of the body (back, chest, thighs, etc.), if sufficiently hairy.

There are, however, common misbeliefs:

- It is not true that the FUE technique gives grafts of higher quality than the strip technique.

- It is not true either that the FUE technique gives more density in the recipient area.

In my view the strip technique still has many indications, especially where a large number of grafts (4000 to 5000 grafts) are needed.

Conclusion : Automated FUE is the ultimate technology in hair transplantation. The machine described here makes it possible to harvest FUs of optimum quality, while shortening the operating time. Also, the post-operative outcomes are better, with limited pain, and no scar.

FUE is a very attractive technique, if properly indicated. For the time being, we reserve this technique for about 50 % of our patients: start of hair loss, when the area to be “repopulated” is not too large, where we can propose “lunchtime surgery”, regular sessions of a f ew hundred FUs in order to limit post-operative discomfort and surgical time.

 

(1) : The technique implemented using the Punch Hair Matic can also be implemented using another robot from Médicamat, the Omnigraft, which also works with the strip method, using a cutting tool called Hairtome® to obtain up to 500 grafts of very good quality in a single cutting operation.

References: Dr C.G Gho : British Journal of Dermatology 2004
150: pages:  860-868  Human follicular t stem cells: their presence in plucked hair and follicular cell culture
Dr. P. Poirier;  Revue de Chirurgie Esthétique et du Syndicat National des Chirurgiens de Chirurgie Esthétique, Tome XXIV, Numéro 101, décembre 2000
Micro-greffes de cheveux, étude de la repousse en fonction de la méthode utilisée
Robert M. Bernstein MD : surgery of the skin, chapter 34 ; 2005
Follicular unit hair transplantation