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Differences Between FUSE & FUE

FUSE (Follicular Unit Separation Extraction) is an improvement over FUE (Follicular Unit Extraction). FUSE technology was invented by Dr. (Capt.) Arvind Poswal and the dedicated staff. FUSE is the safest techniquie for extracting individual follicular units (FU’s) under direct visual control for hair grafting into bald/balding areas of skin.

FUSE has been extensively used in treating patients with varying degrees of baldness as well as in hair loss due to scars in eyebrow, scalp, moustache and beard due to:

  • Operations
  • Burns (fire, chemical, acid etc)

Differences between FUSE and FUE:

The most important difference is the use of the needle for performing the separation of the hair follicle from its dermal attachments.

With traditional FUE, the punch is used to cut the dermis to a level where the hair roots are not damaged, but the FU can still be pulled out. However, the punch often goes deeper than required and hair roots get damaged. The reason for punch damage with FUE is due to:

Hairs emerging at a very acute angle to the skin while the cutting circumference of the punch is flat. So, when a flat punch follows the line of the hair shaft, it cuts the skin to different extents on different sides of the hair shaft. If one remains just within the permissible depth on the lower side of the hair shaft, i.e. just to the level of reticular dermis, the dermal attachments on the upper side are too thick for the FU to be easily pulled out. Therefore, the FU (follicular unit) breaks or can not be extracted. If, on the other hand, one goes deeper, to reduce the dermal attachments on the upper side, the punch usually cuts one of the hair roots of the FU on the lower side. Therefore, the FU is damaged to some extent.

Distortion of the FU structure: When one presses on the skin with the punch, the skin sinks. As a result, hair roots of the FU get splayed/spread apart. This leads to an increased chance of damage to the hair roots as the punch cuts downwards.

It is because of these reasons that most ht surgeons maintain that traditional FUE leads to significant hair root damage.
With FUSE, these problems are dealt with thus:

The FUSE punch goes less deeper than what would normally be considered safe with FUE extractions. The skin depth which is not cut using the punch is what we call the safety margin. The safety margin is deduced by titration in the initial few graft extractions. While inserting the punch, care is taken to visualize that the LOWER side of the punch goes to the mid dermis level only (irrespective of the fact that the upper side of the punch remains in upper dermis). The remainder of the FU micro dissection & extraction is done by needle under direct magnified visualization and mild traction.

Liberally infiltrating the dermis with normal saline helps in reducing the distortion of the FU due to pressure of the punch (i.e. when the punch presses down, the skin does not sink too much).

In traditional FUE methods, only those limited patients with the following qualities get favourable results without unacceptable levels of hair root transections.

Compact FUs without too much and too early a spread of the hair roots
FUs consisting of mostly straight hair,
Comparatively weak dermal attachments

Benefits of FUSE:

We deliberately limit the cutting with the punch to a higher level. The remaining dissection of the FU is done with needle under direct magnified vision before the graft is completely extracted.

The needle based dissection is given more importance than the use of punch. It is not sufficient that the needle be used occasionally to separate a particularly tenacious FU. Rather, the needle is deliberately and regularly used for the final in vivo dissection of the dermal attachments of the FUs.

Mild traction is exerted on the follicular unit, before using the needle, which brings the hair roots closer together. This further reduces the chance of hair root transection.

Thus, FUSE provides a much safer method of extracting FUs compared to traditional FUE methods. Numerous respected hair transplant surgeons have valid doubts about FUE leading to increased hair root transaction. They are entirely justified in that respect. But the way forward is not to stop our attempts of individual follicular unit extraction but rather to improve techniques so that hair root transections are limited to negligible levels.

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