The “KEEP”: An FUE Placing Instrument That Protects Graft Integrity and Increases Hair Survival

47B The “KEEP”: An FUE Placing Instrument That Protects Graft Integrity and Increases Hair Survival

Koray Erdogan and Bayramoğlu Alp

Summary

It is fairly well accepted that follicular unit excision (FUE) grafts have characteristics that make them more difficult to place as well as more at risk of decreased survival due to trauma suffered at this step. The “Koray Erdogan Embedding Placer” (KEEP) was developed in an effort to address this situation. In particular, we notice decreased hair yield we felt was due to graft bending (curving) and trauma that occurred during the implantation phase of FUE surgery when forceps were used. One reason FUE grafts are more susceptible to bending and damage is because the grafts have less tissue and increased splay at the bottom portion, making it more difficult to insert into tiny incisions with forceps without trauma. The KEEP was found effective in preventing bending and minimizing trauma when placing grafts, ultimately leading to better hair yield. This was true for standard FUE, long hair FUE, and in more difficult cases where hard skin, excessive bleeding, increased splay, or curly hair were present.

Keywords: KEEP regrowth rates graft placement graft bending and damage long hair FUE follicular unit excision

Key Points

•The Koray Erdogan Embedding Placer (KEEP) is a placing instrument that falls into the category of an “inserter.”

•The KEEP has a unique “no-touch” loading system.

•The KEEP protects grafts from bending and trauma during loading and insertion of grafts, which translates into increased hair survival.

•Using the KEEP increases hair count in difficult surgical cases including hard skin, bleeding, splay, long hair, and curled or fragile grafts.

47B.1 Introduction

During routine postoperative checkups, especially in the immediate 24-hour period following surgery, we noticed that graft bending (curving) was occurring at an unacceptable rate. This bending has also been referred to as J-grafts. We felt follicular unit excision (FUE) grafts were more susceptible to bending and damage because they have less tissue and increased splay at their bottom portion, making them more difficult to be handled with forceps atraumatically. This bending and damage was felt to be caused by two factors: (1) trauma caused by unconscious grasping of the grafts with excessive pressure by technicians, especially after numerous hours of tedious placing and (2) the technical difficulty, increased manipulation, multiple failed attempts, and trauma associated with the initial insertion of grafts into tiny premade incisions that tighten and constrict over a short time (Fig. 47B.1).¹

Fig. 47B.1 (a) Placing with forceps into small incisions is difficult. (b) Forceps placement can result in trauma and bent J-grafts.

This phenomena was found to be especially true in the cases where hard skin, excessive bleeding, increased splay, longer grafts (6 mm), or curly grafts were present. Studies were done that determined that graft bending was associated with lower hair yield.

With this knowledge, the challenge was to replace the commonly used forceps with an alternative instrument that would address these problems. The Koray Erdogan Embedding Placer (KEEP) was designed to respond to these needs.

The “KEEP” decreases trauma through a “no-touch” loading system, followed by protection and greater control of the grafts during insertion (Fig. 47B.2).² This in turn leads to increase hair yield by eliminating graft damage and bending during the placement process.