My personal goal for FUE is to make the results the same as strip surgery. To achieve this I believe the work has to be "clean looking" from start to finish. In fact "ultra-refined" may be articulated as "clean and tight" work, I'm just adapting it to FUE.

When I perform FUE I make sure to put each and every extraction under the microscope to make sure they are in good conidition and to trim away any excess tissue. Excess tissue, usually eptidermis, requires the slit sizes to be larger and makes the skin prone to irritation so I feel it is best to trim the grafts down to minimum epidermis and dermis.

This patient had an excellent donor area with many multi-haired (3,4,5) follicular units. The problem was that his grafts were so large that had I attempted to implant them into the recipient area I would not have been able to achieve as high a density as I would like. So we divided his multihair grafs down to single hair grafts and packed them tightly into the recipient area.

The goal was to match the density of the surrounding hair to fill in the obvious gap. My feeling is that he will hold onto his forelock for a few years, but despite this, I planted his transplants in such a way as to cover the forelock area should he lose it sooner.

As with many FUE patients his goal is to keep his hair short and shave his head.

We packed 1,250 FUE into the frontal area.

Here are his photos before, during, and three days after his procedure hours before he boarded a plane for home.

Note how the donor area holes, which were made with a 1mm Feller Punch, contracted and closed on their own.













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Dr. Feller, when examining the grafts extracted via FUE. do you often have reason to reject them and discard them?
By being extra careful like this, would you say that graft yield with FUE matches, or comes close to matching, that which you can achieve with strip?

Hello Matt,
Thankfully I don't "often" have reason to reject FUE grafts, but every one of them must be inspected under the microscope and nearly everyone needs to be trimmed as excess tissue is usually present.

I think being extra careful does improve yields, dramatically in some cases, but there is still very much an "x-factor" associated with FUE. I still tell my patients that I don't expect FUE yields to match Strip yields, but that doesn't mean they never do or that they often do. As in all surgery it's best to give the patient the education needed to make up their own mind.
For myself I probably wouldn't bother with a strip if the surgery were only 1000 grafts or less. If however I needed more than 1000 grafts I would still opt for strip surgery.

Thank you for your comments. Best to Dr. R.

Dr. F

Dr Feller, great documentation as always. One question I have. You explain that due to dense packing issues with the grafts containing more hairs, you divide these down to single hairs. In this 1250 graft procedure, do each of these single hairs count as a graft, or is the graft count pre seperation?

In this particular case we could not leave his follicular units together because he would have looked very stalky or pluggy that way. To get the homogeneous coverage we needed he had to be cut to pure singles. We would have done this whether it was a strip or FUE and it is usually very very effective.

1,250 grafts, in this particular case, is AFTER separation and preparation, just like strip surgery. In most cases, however, there is parity or near parity as the average number of single hair grafts is about 20-25% and the rest are two and three hair grafts just as in a strip procedure.

Dr. F