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A Morphologic Classification of Follicular Unit Excision (FUE) Grafts

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A Morphologic Classification of Follicular Unit Excision (FUE) Grafts VOLUME 28 I NUMBER 2 MARCH/APRIL IN THIS ISSUE Graft Quality Index: A Morphologic Classification of Follicular Unit Excision (FUE) Grafts The Evolving Role for Robert H. True, MD, MPH, FISHRS I New York, New York, USA I [email protected] Autologous Adipose Tissue (Fat) in Treating GRAFT QUALITY INDEX Hair Loss Graft quality is a significant component of all hair restoration surgery, especially Follicular Unit Excision (FUE). There is much discussion in our professional community about the impact of graft quality on the cosmetic results of hair restoration surgery, particularly with FUE.1-4 The gold standard remains that micro- A Case Report of scopically slivered and created grafts obtained by strip surgery are ideal. The challenge for FUE harvesting Subclinical Lichen methods is to produce grafts that are similar to or exactly the same as strip grafts. FUE grafts are often Planopilaris after Hair characterized as having lower yield than microscopically dissected grafts produced in FUT surgery. Transplantation Grafts of high quality, whether produced by strip or FUE, have supportive tissue throughout and contain minimal transections, follicle fractures, and crushed follicles. Transection and stripped and severely splayed Spotlight on Ethical follicles are by-products of the punch insertion technique. Follicle fractures and crush injury are consequences Marketing of the amount and type of force used to remove the grafts once they have been scored and dissected. The gold standard remains that microscopically slivered and created grafts obtained by strip surgery are ideal. The challenge for FUE harvesting methods is to produce grafts that are similar to or exactly the same as strip grafts. Grafts of high quality are amenable to placement without undue manipulation or placement trauma. Grafts of lesser quality present more risk of damage during processing and implantation. In inspecting FUE grafts produced by a wide variety of techniques, one can observe that the grafts have different mor- phologies. On closer analysis, FUE grafts fall into four morphological types. Although there is general consensus in our field that some graft morphologies produce better yields than others, we do not know what the impact of these different morphologies is on transplant outcomes. These morphological types are the basis of my novel concept, Graft Quality Index (GQI). I propose that this index can be used in all hair restoration surgeries—including FUE—to grade grafts. The graft quality grade can be used as a quality control tool to 1) predict the difficulty of graft placement, 2) guide the best implan- tation technique, and 3) relate graft morphology to the results of surgery. Perhaps this will help to answer the question of the effect on graft morphology on outcomes in FIGURE 1. GQI Grade 1 grafts future studies. GQI has four grades: 1. Grade 1: Grafts have no transections or damaged follicles, a smooth regu- lar border, perifollicular tissue throughout the follicle length, and non- follicular tissue below the bulbs (Figure 1). Ø PAGE 51 March/AprilMarch/April 2018 2018 HAIRHAIR TRANSPLANT TRANSPLANT FORUM FORUM INTERNATIONAL INTERNATIONAL 45 VOLUME 28 I NUMBER 2 I MARCH/APRIL TABLE OF CONTENTS HAIR TRANSPLANT FORUM INTERNATIONAL is published bi-monthly by the 47 President’s Message International Society of Hair Restoration Surgery 48 Co-editors’ Message First-class postage paid Milwaukee, WI and additional mailing offices. 49 Notes from the Editor Emeritus: Dr. Michael L. Beehner POSTMASTER Send address changes to: Hair Transplant Forum International 54 The Evolving Role for Autologous Adipose Tissue (Fat) in Treating International Society of Hair Restoration Surgery Hair Loss 303 West State Street Geneva, IL 60134 USA 58 A Case Report of Subclinical Lichen Planopilaris after Hair Trans- Telephone 1-630-262-5399 plantation U.S. Domestic Toll Free 1-800-444-2737 Fax 1-630-262-1520 60 Medical and Professional Ethics: Spotlight on Ethical Marketing 63 Controversies: The Temporary Hair Transplant: A Novel Idea or President Sungjoo (Tommy) Hwang, MD, PhD, FISHRS Making a Virtue Out of Necessity? [email protected] Executive Director Victoria Ceh, MPA 64 Cyberspace Chat: A Tribute to Dr. Jim Arnold [email protected] Editors Andreas M. Finner, MD, FISHRS 67 Hair’s the Question: Red Hair Bradley R. Wolf, MD, FISHRS [email protected] 69 Meeting Review: 2018 WLSW Dubai Managing Editor & Cheryl Duckler, 1-262-643-4212 Advertising Sales [email protected] 77 Regional Society Profile: Thai Society of Hair Restoration Surgery Controversies Russell G. Knudsen, MBBS, FISHRS Cyberspace Chat Robin Unger, MD 78 Message from the ISHRS 2018 World Congress Program Chair Difficult Cases/ Marco Barusco, MD, FISHRS Complications 79 Message from the ISHRS 2018 Surgical Assistants Chair & Vice Chair Medical & Gregory Williams, MBBS, FISHRS Professional Ethics 84 Classified Ads Hair’s the Question Sara M. Wasserbauer, MD, FISHRS 85 Calendar of Events How I Do It Timothy Carman, MD, FISHRS Literature Review Jeffrey Donovan, MD, PhD, FISHRS Nicole E. Rogers, MD, FISHRS The views expressed herein are those of the ISHRS a guaranty or endorsement of the quality or value Copyright © 2018 by the individual author and are not necessarily those of the of the advertised product or service or of any of the International Society of Hair Restoration Surgery, International Society of Hair Restoration Surgery (ISHRS), representations or claims made by the advertiser. its officers, directors, or staff. Information included Hair Transplant Forum International is a privately 303 West State Street, herein is not medical advice and is not intended to published newsletter of the International Society of Hair Geneva, IL 60134 USA replace the considered judgment of a practitioner with Restoration Surgery. Its contents are solely the opinions respect to particular patients, procedures, or practices. of the authors and are not formally “peer reviewed” Printed in the USA. All authors have been asked to disclose any and all before publication. To facilitate the free exchange interests they have in an instrument, pharmaceutical, of information, a less stringent standard is employed cosmeceutical, or similar device referenced in, or to evaluate the scientific accuracy of the letters and otherwise potentially impacted by, an article. ISHRS articles published in the Forum. The standard of proof makes no attempt to validate the sufficiency of such required for letters and articles is not to be compared disclosures and makes no warranty, guarantee, or other with that of formal medical journals. The newsletter representation, express or implied, with respect to the was designed to be and continues to be a printed forum accuracy or sufficiency of any information provided. where specialists and beginners in hair restoration To the extent permissible under applicable laws, ISHRS techniques can exchange thoughts, experiences, specifically disclaims responsibility for any injury and/or opinions, and pilot studies on all matters relating to hair damage to persons or property as a result of an author’s restoration. The contents of this publication are not to statements or materials or the use or operation of any be quoted without the above disclaimer. ideas, instructions, procedures, products, methods, or The material published in the Forum is copyrighted dosages contained herein. Moreover, the publication and may not be utilized in any form without the Official Publication of the of an advertisement does not constitute on the part of express written consent of the Editor(s). International Society of Hair Restoration Surgery 46 HAIR TRANSPLANT FORUM INTERNATIONAL March/April 2018 President’s Message Sungjoo (Tommy) Hwang, MD, PhD, FISHRS I Seoul, South Korea I [email protected] Dear Colleagues, As many of you may know, the ISHRS made the decision As most of you know, we held to change the term FUE from FU Extraction to FU Excision. our second World Live Surgery The reason for this was that excision is a word involving inci- Workshop outside the United sion + extraction, and the word extraction has the potential States. On 8th-10th March 2018, I to give the wrong impression to the public, such as meaning met many familiar and new faces no incision, no scar, or no pain. I would like to thank Drs. at the WLSW in Dubai. I would Bill Rassman and Bob Bernstein, who first proposed the term like to thank all those who made the Dubai workshop hap- Follicular Unit Extraction in the field of hair restoration, for pen, with special thank-you’s to Dr. Conradin von Albertini, agreeing to the use of the new term FU Excision. Chair, Dr. Bessam Farjo, Co-chair, and all of the ISHRS staff. In mid-June 2017, the 2017 ISHRS Practice Census Also, I would like to extend my thanks to the local doctors was conducted online. The content of the research was and assistants in Dubai. We would not have been able to developed by the ISHRS Communications & Public run the programs smoothly without their help and support. Education Committee. The results showed that worldwide At the Dubai WLSW, a total of 36 international faculties the Surgical Hair Restoration market size is $4.1 Billion served, with 4 of them being local faculties. I would like to USD. This represents a 64% increase since 2014. In thank them for their contributions and efforts. addition, we’ve seen a 60% increase in the number of On 16th-18th February 2018, I had the greatest pleasure in surgical hair restoration procedures performed worldwide, attending the 10th Annual Conference of the Indian Society with 635,189 procedures in 2016. From these results, we (HAIRCON 2018). India is a Global Council member society can see that more and more hair transplants are being and has the second most members in the ISHRS after the performed globally. With this in mind, I realized that it is United States. The Indian society has a total of 300 mem- imperative for the ISHRS and the Global Council member bers and approximately 200 doctors attended this meeting, societies to provide better education for newcomers who including many from Iran and Bangladesh.
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