Long Hair Preview Follicular Unit Excision Techniques

72B Long Hair Preview Follicular Unit Excision Techniques

Marie A. Schambach

Summary

Patients do not like to shave their head to perform hair transplantation. This is true for both the donor and the recipient area. The primary reason is that when one shaves, it draws attention to the patient and the procedure is much noticeable to peers and friends. If one does not shave, it is much easier to hide. In the previous chapter, techniques to perform nonshaven follicular unit excision (NS-FUE) transplantation were discussed. However, although the donor area is not shaved, it still involves clever ways of trimming donor hair short. These techniques are discussed in Chapter 72a, Nonshaven FUE Techniques. Nonshaven FUE leaving the donor hair long is a more advanced method of nonshaven hair transplantation. It is also called preview long transplants, and it has been done in follicular unit transplantation (FUT) for a while. For many years, performing this with FUE seemed impossible. This is because you have to figure a way to punch out a graft with a small punch while leaving the hair long. Recently, long hair nonshaven FUE has become a reality. Theoretical benefits are that you (1) get a wow factor immediately post-op, (2) may be able to see the effect of donor harvesting in real time and therefore have better control over done management, (3) have immediate feedback with respect to the look of the recipient area and have better control over planning the recipient area. Negatives are that it is much slower, there is a greater risk of transection and poor survival, and only smaller session can be currently done.

Keywords: long hair transplants preview transplants FUE long hair transplants open slot punch Trivellini long hair punch oscillation

Key Points

•Long hair preview follicular unit excision transplants are doable today.

•The Trivellini punch that has both a sharp cutting section and protective dull section and uses oscillation is probably the best current tool.

•Benefits include wow effect and real-time evaluation of donor and recipient areas.

•Problems are degree of technical difficulty, slow speed, and smaller session, but it keeps improving with time.

72B.1 Introduction and Indications

Patients do not like to shave their head to perform hair transplantation. The primary reason is that when one shaves it draws attention to the patient and the procedure is much noticeable to peers and friends. If one does not shave, it is much easier to hide. With simple nonshaven follicular unit excision (FUE), although the donor area is not shaved, it still involves clever ways of trimming the donor hair short. These techniques are discussed in Chapter 72a.1^,²

Nonshaven FUE, leaving the donor hair long, is a more advanced method of nonshaven hair transplantation.³ It is also called preview long hair transplants and it has been done in (FUT) for a while.⁴ “Preview” long hair FUE is an innovative technique reserved for those who consider themselves advanced in FUE. It is time-consuming and requires patience, precision, and overall good eye–hand coordination. To achieve good-quality grafts during excision and extraction, you must understand the dynamics of the excision and all factors involved in this technique.⁴

With preview long hair FUE, we have not reached the speed necessary to make it a standard technique for hair transplantation; nevertheless, it arises as a solution for some specific cases, for example, those patients who do not want a postsurgical shaved look for any given reason, like, very bad scarring from previous scalp surgeries or trauma, the need of returning back to work immediately after surgery, being at the center of public eye, etc. That is why some doctors call it “celebrity FUE.” Other precise indications for its use are when there are doubts about donor area availability and for other type of surgeries that require long hair grafts for better curvature control such as eyebrows or eyelashes.

It is imperative that all patients who undergo this type of procedure know that the surgical time doubles due to the complexity of the surgery, which means only half the amount of grafts can be achieved per surgery. Because of the time used, this surgical procedure tends to be more expensive. And last but not least, post-op care is usually a little more complicated (Video 72B.1).

72B.2 Materials

Most of the materials used for preview long hair FUE are the same as a regular FUE. The author strongly recommends the use of Velcro for keeping the hair shafts out of the surgical field. Velcro (the “hook-and-loop” type) is placed around the occipital area, the hook side facing the skin. With a thin-tail comb, you can shift the hair from under the Velcro for clearing the view of the surgical field (Fig. 72B.1).