In 2003, FUE or Follicular Unit Extraction was far from an accepted procedure. In fact, surgeons would often find any excuse to NOT attempt to perform this technique--citing poor growth rates, transection, etc. At the ISHRS Annual Scientific Meeting in New York City, I presented this case of a small FUE procedure I had performed a few months earlier for a gentleman who was left with areas of traction alopecia from hairpiece use. Although tedious and difficult to perform with the instruments available at the time, this small FUE procedure was a success as were the other FUE procedures I had attempted in the years 2001-2003. These early procedures led me to develop the "Bauman-MINDEX"--the first commercially available instrument for physicians designed specifically to help them extract hair follicles with the FUE approach. At the next ISHRS Orlando Live Surgery Workshop (Spring 2004), I became the first surgeon to demonstrate the FUE technique in a Live Surgery setting to an audience of hundreds of skeptical surgeons and surgical assistants. Collaboration with other surgeons who were also trying this new technique helped advance our skills. -Alan J. Bauman, M.D.

1. Hair Transplantation in the Treatment of Hairpiece-Induced Traction Alopecia:
A Follicular-Unit Extraction Approach
ISHRS Annual Meeting -- October, 2003
Alan J. Bauman, M.D.
Introduction:
Traction alopecia, occurring in areas of prolonged tension on hair
PREOP Photos
shafts, is a well-known complication of hairpieces that are repeatedly 38 y/o Male, NW7 w/ defects x 4:
attached using clips in the same anatomical position on the scalp.  Left-Occipital
 Mid-Occipital
 Right-Occipital
Objective:  Right-Parietal
To illustrate by case report a unique surgical approach to the cosmetic
correction of stable, well-circumscribed areas of hairpiece-induced
traction alopecia using the technique of direct follicular unit extraction
PHASE 1: Direct extraction of 91 follicular units for restoration of right-parietal defect
in a 38 year-old NW7 male patient.
Intra-op Donor & 24 hrs post-op Recipient: 24 hrs post-op Donor: 5 days post-op
91 fu’s extracted
Methods: 78 non-transected
14.3% transection rate
After extensive patient education and informed consent, the planned
restoration was performed in two phases spaced six months apart.
Follicular unit extraction was performed using 1mm punches to separate
individual follicular units from the surrounding donor tissue down to the
mid-dermis under turgid tumescence, followed by extraction of the
follicular units with forceps and counter-traction. The follicular unit Donor & Recipient areas 6 months post-op with satisfactory coverage of right-parietal defect
micrografts were microscopically sorted to track transection rates. All
harvested tissue was implanted into recipient sites created with a 1.3mm
minimal depth (Minde) knife.
Results:
After phase 1 of the prescribed treatment sessions, acceptable
cosmetic results were obtained in both the donor and recipient areas.
PHASE 2: Direct extraction of 402 follicular units for restoration of Left, Mid and Right-Occipital defects
Donor and recipient healing of phase two was also acceptable. Final
photographic results (hair growth in the recipient area) of phase two Donor & Recipient Areas:
are expected to be available in Spring 2004. Intra-op 24 hrs Post-op 4 weeks Post-op
402 fu’s extracted
346 non-transected
Conclusion: 13.9% transection rate
As with the success of any hair restoration procedure, patient selection
is critical when treating patients using follicular unit extraction
techniques. Guidelines for the appropriate application of the
technique of follicular unit extraction are still being developed (as are
specific nuances of the technique itself). An acceptable result can be
obtained if all treatment options (and their associated risks and benefits)
are discussed with the patient and properly considered. (Final post-op photos will be available Spring 2004)