FUSE (in-vivo follicular unit separation extraction) is a knife and stitch free hair restoration method. It is safe, minimally invasive, virtually non-scarring technique of extracting single follicular units (FU).
It involves separation of the graft bearing skin till the level of mid dermis with tiny but sharp micro punches, followed by the separation of the FU by careful microscope/ magnifier aided dissection (under direct vision) from its remaining dermal attachments, before gently sliding it out of its location for grafting into the recipient bald area.
Apart from the fact that the FU’s are carefully separated under direct vision to avoid any inadvertent damage in FUSE; it is... A freely taught and shared technology – Dr. A has distributed knowledge about performing FUSE freely on the net for other doctors to emulate and improve. It, therefore, is widely seen, emulated, examined, verified and replicated. Moreover it is a dependable and logical technique. FUSE is the only technique to be examined by the maximum number of doctors including many so-called competitors for flaws. FUSE has been widely discussed & debated among doctors as well as patients. We believe this transparency in our operating procedures is your guarantee to getting a safe and good technology. We also hope that open debate may lead to further improvements.
It is possible to achieve near natural apparent density in FUSE. We have till March 2004 been able to place upto 90 to 110 FU/sq cm. And we aim to be able to further increase the density. But one has to keep in mind- (i) The availability of FU’s: A person with lots of donor area & limited bald area will definitely qualify for more FU’s placed per sq. cm. than a person who has virtually no hair on chest, back etc., limited scalp donor hair & extensive baldness to cover. (ii) The artistic merits of placing the FU’s in different areas of baldness specially if the donor hair are less.
We are currently using a range of needles varying from 20 gauge to 24 gauge. Often the choice of the gauge depends on the girth of the FU to be placed. We value safety above all. It is no point trying to place a graft thicker in diameter than the diameter of, say, a 24-gauge needle into a 25 gauge needle hole. Remember, not only do we have to create minimal trauma in the recipient area by the needle, we also have to ensure minimal trauma to the FU during placement. Keeping both these variables in mind we have used needles as per the requirement of each patients hair. Single hair follicle (medium thickness) – 24 gauge needle...... Single hair follicle (curly & above average thickness) – 23 gauge needle...... 2 hair FU – 21 to 22 gauge depending on hair thickness...... 3-4 hair FU – 18 to 20 gauge needle.
The punches used for FUSE vary from 0.75mm to 0.9mm (average 0.8mm) The punch to be used depends on how widely the hair of a FU is spaced out while emerging from the skin. Trying to extract larger FUs with punches whose diameter is less than that of the FU at point of emergence from the skin is, obviously, illogical. We, however, do not use 1mm or larger punches.
Yes, hair can be grafted in between existing hair. We normally prefer to trim the existing hair if we are to graft hair in between them. But whether or not it will actually lead to an increased apparent hair density depends upon the individual patients genetically programmed hair loss pattern too. In simple terms, we graft hair, which will keep growing thereafter, but even we cannot predict when and if you will lose your pre existing hair.
We perform both FUSE/fue grafting as well as Follicular micro grafting (strip method of harvesting the donor area). We feel neither of the procedure is perfect for everyone. While follicular micro grafting does give a line like scar in the donor area, it is normally not visible even under a hair growth of 1to 2 cms. Similarly, FUSE gives no obviously visible scarring but the person does have to roam around with a shaven head appearance for a couple of weeks after the procedure which does not suit some patient’s schedule. We leave it to the individual patient to decide on the type of procedure they wish to opt for while at the same time giving pros & cons of both of them. We believe our patients can make their own intelligent choice instead of being forced in to any one procedure.
On the human scalp, hair grows in form of naturally occuring groupings containing 1, 2, 3 or, rarely, 4 hair follicles each. These groupings are called follicular units. Also reffered to as follicular unit grafts by hair transplant clinics.
In certain locations, like the hairline, the temples and the swirl, nature shows a preponderance of 1 hair follicular units.
While performing a hair transplant, in the refined procedures, care is taken to place the 1 hair grafts in the hairline, temples, centre of the swirl area etc. The multi hair follicular unit grafts are placed in the areas behind the front feathered hairline zone to buit up the density.
Similarly, in the more advanced combination procedures where the scalp grafts are augmented by facial and different body hair grafts, the doctor has to plan the location of the different types of grafts according to the hair's individual characteristics.
When planning a hair restoration using body or beard hair, it is important to start with the assumption that the transplanted body (and/or beard) hair will not change their characteristics. True, some patients note an increase in length of transplanted body hair. However, length is not the only characteristic. Moreover, not every patient notices this increase in length of transplanted body hair. Therefore, its prudent to start with the premise that the transplanted body hair will not change their original characteristics. This is especially true about the remainder of the characteristics, viz., calibre, color, curl, predisposition to greying, hair growth cycles etc. In suitable patients, body hair can be used for transplanting in the scalp recipient areas, even though they do not change their characteristics. This has to be decided by the physician after examining the body hair.