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Follicular unit extraction or direct follicular unit microextraction -
It can be argued that the single most important incision made in hair restoration is the donor site incision. As a fellowship trained, board-certified facial plastic surgeon, Dr. Epstein is obsessed with achieving the smallest scar in this area, so as to allow the patient the ability to keep the hair cut short- as short as a #2 or even a #1 razor. In recognition of the quote by Sir Gillies, one of the world's most famous plastic surgeons, "Plastic surgeon, by your incision you will be judged", Dr. Epstein has conducted scientific clinical studies to assess the optimal technique of donor site incision and closure.
Parallel with this research, a relatively new technique was developed, initially by a doctor in Australia , that faced this challenge with a fresh approach- avoiding an incision altogether. Rather, in a pain-staking fashion, individual follicles from the back and sides of the head, could be extracted using a tiny circular-shaped punch- leaving no scar in the donor site. Thus, follicular unit extraction was born.
Over the past 12 months, Dr. Epstein has painstakingly developed his own version of this technique, which he calls direct follicular unit microextraction (or FUM). Using 1.3 mm ultra-sharp punches, (FUM) permits the harvesting of hundreds of grafts in a single procedure- all without the need for an incision in the back of the head. Each follicle, after being extracted, is still carefully dissected free from the surrounding non-hair bearing skin under microscopic visualization, then can be implanted into tiny incisions in the donor site.
There are several limitations and downsides to direct FUM. First, not all patients are candidates- in particular, those with curly hair, or very fine hair, are at too great a risk for damage and thus poor growth of the harvested follicles. Second, the time required to perform the procedure is considerably greater- 400 to 500 follicular units in a single 3-hour procedure is about the maximum number of grafts that can be transplanted. Finally, the cost is greater than the more traditional microscopic follicular unit grafting- 3 to 4 times as much.
But in spite of these limitations, patients regularly undergo FUM by Dr. Epstein. Patients who prefer this procedure are those that are willing to pay the higher fee, undergo several procedures, and have morelimited hair loss which does not lend itself to a megasession (2000-plus graft) procedure. Donor site healing is quicker and sutureless, and healing of the transplants is as rapid as that with traditional follicular unit grafting. |
