Since the introduction of Follicular Unit Extraction in 2003, we have witnessed significant progress in the speed of extraction& the quality of the extracted hair follicles In the recent years, FUE techniques have gained wide acceptance around the world & they have become very popular between hair restoration specialists as well as patients suffering from hair loss In general, there is a rapidly spreading worldwide trend towards minimally invasive hair restoration procedures that will provide the best possible results with the least possible discomfort & the minimum possible damage of the donor area

1. Comparative study of follicular unit extraction between different ethnic groups with 0.9 mm & 1.0 mm punches Dr Anastasios Vekris MD, Konstantinos Giotis, Dr Viral Desai MD DHI Medical Group 19th ISHRS ANNUAL MEETING Anchorage, September 14-18 2011

2. Since the introduction of Follicular Unit Extraction in 2003, we have witnessed significant progress in the speed of extraction& the quality of the extracted hair follicles In the recent years, FUE techniques have gained wide acceptance around the world & they have become very popular between hair restoration specialists as well as patients suffering from hair loss In general, there is a rapidly spreading worldwide trend towards minimally invasive hair restoration procedures that will provide the best possible results with the least possible discomfort & the minimum possible damage of the donor area

5. High partial or total transection may affect final hair growth

6. Struggle for balance Smaller punch Vs bigger punch Higher yield of extraction Vs faster healing & less marks

7. There is proof that there are differences in the caliber, length & density of the hair follicles between different ethnic groups (e.g. Caucasians Vs Asians)In daily practice, there is evidence that patients from different ethnic backgrounds respond differently during extraction in the hands of the same surgeon, using the same technique & the same tools

9. Is there a punch suitable for all patients?

14. Selection of distinct ethnic groups that the doctors participating in the study have sufficient experience with

15. Selection of one Caucasian ethnic group, the Greeks

17. Indians A large, distinct Asian population resident to the Indian subcontinent with a variety of origins & characteristics, ranging from the Dravidian people of the south to the Indo-Aryan of the north. Long, thick dark colored hair with thicker & longer hair follicles. Usually straight hair but wavy or curly hair can be found mostly in south India

19. Random selection of age, grade of alopecia & condition of the donor area

21. The same doctor would cut the same number of hair follicles in each marked area

22. The caliber of the punch used would be 1.0mm or 0.9mm & it would be given randomly to the doctor by the supervisor

23. The doctor would perform a test extraction before the comparative study, to establish the depth & direction of the hair follicles

24. After the cutting of the hair follicles, the doctor would extract the hair follicles & the assistant would count the exact number of extracted hair follicles & those that were totally transected & separate them according to the number of hairs per hair follicle (singles, doubles, etc)

25. The supervisor would estimate the average ratio of hair per hair follicle

26. The hair follicles would then be transplanted to the recipient area with implanter devises

27. Photos were taken after the extraction & placement in both donor & recipient area

29. Results

30. Results-Greeks

31. Results-Indians

32. Results-Comparison

33. Total transection rate

34. Ratio hairs/hair follicle

36. The use of smaller caliber punch (0.9mm) seems to significantly affect both the total transection rate (30% Vs 19%) & the ratio of hair/hair follicle (1.85 Vs 2.04) in Indian patients

37. Despite the caliber of the punch used (0.9 or 1.0 mm), it seems that there is significantly higher total transection rate in Indians in comparison to the Greeks (19% & 30% Vs 10% & 12%) & lower ratio of hairs/hair follicle (2.04 & 1.85 Vs 2.27 & 2.28)

38. While the use of smaller caliber punch in Greeks seems to have no negative effect to the quality & quantity of the extraction, it seems to largely affect in a negative way the quality & quantity of extraction in Indian patients

40. The hair follicles in Indians are longer and deeper in comparison to the Caucasians. This may lead to difficulties during the extraction that may lead to increased transection, partial or totalThere must be a balance between the need to extract good quality hair follicles and the need to respect the donor area

42. It is quite safe to use smaller caliber punches (0.9mm) in Caucasians without compromising the quality or the quantity of extraction

43. In Indians, keep all your guns on the table but you’ll most probably need the big ones

44. Always respect each individual. There is no “magic” tool that can meet the needs of all patients