FUE Hair Transplant Graft Abandonment

Abandonment is both a physical and psychologically useful technique that every hair transplant practitioner of FUE will find invaluable, and while its application may seem counter-intuitive at first, its benefits become crystal clear with explanation and practice.

While many grafts will deliver successfully with or without perforation, there is a subset of FU s that simply don’t allow for FUE removal. Even after all the techniques have been properly applied, these grafts will continuously fragment and tear apart. This situation can be very distracting, frustrating and discouraging, but as will soon be learned, not necessarily fatal to that particular FU, nor to the surgery on the whole. The sequence of events leading to this are described as follows.

After the properly scored FU has been grasped by the fine forceps with the proper amount of traction applied, half the graft may catastrophically tear at the level of the forcepts and slide off the hairs contained within their canals. The result is a useless mass of tissue sticking to the end of the instument.

The fragmented portion of the graft that is still attached at the lower dermal and adipose layers will rapidly retract back into the hole leaving one or several hairs sticking out. While this fragment may be removed successfully with some effort, it is best to abort this delivery and leave the FU in the skin. There are two good reasons to adopt this course of action and to resist the sometimes overwhelming temptation to go after it:

The first is that the operating physician’s time is better spent going after better FU s than trying to fish out an obstinate one.

The second, and more compelling reason, is that once the remaining bit of graft and the tissue around it heal, the surgeon can actually re-attempt extraction at a later date. This “second bite at the apple” is unique in the surgical field and is further testament to the power of the FUE technique.

The reason for the sloughing of the follicle probably has more to do with the molecular makeup of the dermal layer than anything else. Anecdotally, I’ve made two separate observations that may be linked.

The first is that fractionating grafts tend to exist randomly throughout the scalp. The second is that there is a higher concentration of these friable grafts in the immediate vicinity of significant scar tissue, i.e.: prior hair transplantation scaring of either the open or closed variety. The obvious connection is that fragmentable FU s began as good Fus but have somehow become weakened by the scar tissue itself. That is, the local scar tissue somehow influenced or modified the molecular makeup of the dermis of nearby follicles leaving them vulnerable to fragmentation. This is supported by the fact that the “look” of these FU s are often similar to the look of the scar tissue itself… smooth shiny texture with poorly defined edges, along with a distorion of both the follicular anatomy and coloration.

Perhaps, however, this weakening phenomena may be caused simply by the stretching of the scalp itself since many fractionable Fus may be found over the anatomically tighter areas such as over the mastoid processes.

As for the random fractionation of follicles throughout the “virgin scalp” as mentioned above, it is probable that there was old trauma to these areas that was so relatively minor as to not leave visible evidence upon the epidermis, but enough to cause the “weakening effect” to the follicules themselves.

Be that as it may, these difficult follicles do exist and should be acknowledged for what they are and accepted as a necessary component of this procedure. To lack an understanding and appreciation of this fact is to invite frustration and unnecessary delays during the extraction process.

Abandonment is an act of surgical prudence that represents both a “frame of mind” and an acknowledgement of the rare but necessary need for immediate inaction.

Upon hitting a snag in a surgery that requires such an intensity of focus and concentration as FUE demands, it allows the practitioner to move on to the next extraction attempt without the reticence or hesitation that often ruins the rhythm of delicate and repetitive work. In other words it is OK to abandon a partially failed attempt, because to do so will allow for a second chance, perhaps a better chance, at some future date.