73 Follicular Unit Excision Complications

Conradin von Albertini

Summary

Follicular unit excision (FUE) complications are caused by either the large number of excisions needed with this technique (“donor issues”) or the high vulnerability of FUE grafts (“graft issues”). While usually not catastrophic, FUE complications can have a detrimental cosmetic impact on the patients, and in some cases can create problems that are virtually uncorrectable. This chapter not only describes the typical complications in FUE, but also offers suggestions as to how they might be prevented and managed. The chapter first discusses the various donor issues of FUE, for example, white dots, surgical pattern, donor effluvium (shock loss), donor necrosis, and local anesthesia overdose. Then the chapter discusses the graft issues an FUE surgeon might encounter, for example, buried grafts and various graft injuries leading to the dreaded failure of poor growth (transection, desiccation, crushing, etc.). The chapter concludes on a quality principle called “MINIMAX,” which stands for “minimizing donor microtraumas per session and maximizing the care of the sensitive grafts.” Under this precept, good FUE practice goes beyond excision and has implications for the entire procedure from planning to placement quality.

Key words

FUE complication - overharvesting - donor effluvium - shock loss - donor necrosis - local anesthetic overdose - buried graft - donor cyst - transection - crushing

• 1 Loganathan E, Sarvajnamurthy S, Gorur D, Suresh DH, Siddaraju MN, Narasimhan RT. Complications of hair restoration surgery: a retrospective analysis.. Int J Trichology 2014; 6 (4) 168-172 PubMed

• 2 Lam SM. Complications in hair restoration.. Facial Plast Surg Clin North Am 2013; 21 (4) 675-680 PubMed

• 3 Konior RJ. Complications in hair-restoration surgery.. Facial Plast Surg Clin North Am 2013; 21 (3) 505-520 PubMed

• 4 Perez-Meza D, Niedbalski R. Complications in hair restoration surgery.. Oral Maxillofac Surg Clin North Am 2009; 21 (1) 119-148, vii PubMed

• 5 Salanitri S, Gonçalves AJ, Helene Jr A, Lopes FH. Surgical complications in hair transplantation: a series of 533 procedures.. Aesthet Surg J 2009; 29 (1) 72-76 PubMed

• 6 Bicknell LM, Kash N, Kavouspour C, Rashid RM. Follicular unit extraction hair transplant harvest: a review of current recommendations and future considerations.. Dermatol Online J 2014; 20 (3) doj_21754 PubMed

• 7 Avram MR, Rogers N, Watkins S. Side-effects from follicular unit extraction in hair transplantation.. J Cutan Aesthet Surg 2014; 7 (3) 177-179 PubMed

• 8 Lorenzo J. FUE complications and difficult cases. In: Lam SM, Williams KL, eds. Hair Transplant 360: Follicular Unit Extraction. Vol. 4. New Delhi: Jaypee Brothers Medical Publishers Pvt. Limited; 2015:331–342

• 9 Bhatti T, Williams KL. Avoiding disastrous outcomes in FUE practice. In: Lam SM, Williams KL, eds. Hair Transplant 360: Follicular Unit Extraction. Vol. 4. New Delhi: Jaypee Brothers Medical Publishers Pvt. Limited; 2015:435–452

• 10 Cole J, Insalaco C.. State of the art FUE: advanced non-shaven technique.. Hair Transpl Forum Int 2014; 24 (5) 161-169

• 11 Vogel JE, Jimenez F, Cole J et al. Hair restoration surgery: the state of the art.. Aesthetic Surgery Journal 2013; 33 (1) 128-151 PubMed

• 12 Sezgin C. FUE donor site ischemia and necrosis.. Hair Transplant Forum International. 2014; 24 (1) 12-13

• 13 Karaçal N, Uraloğlu M, Dindar T, Livaoğlu M. Necrosis of the donor site after hair restoration with follicular unit extraction (FUE): a case report.. J Plast Reconstr Aesthet Surg 2012; 65 (4) e87-e89 PubMed

• 14 Gabel S. Megasessions: surgical indications and technical perspectives.. Facial Plast Surg Clin North Am 2013; 21 (3) 419-430 PubMed

• 15 Daskaya H, Toptas M, Yazici Ü, Uzman S, Uludag Yanaral T, Idin K. Methaemoglobinaemia due to prilocaine usage after hair transplantation: case report.. Turkiye Klinikleri J Anest Reanim. 2014; 12 (3) 154-157

• 16 Harris JA. Follicular unit extraction.. Facial Plast Surg Clin North Am 2013; 21 (3) 375-384 PubMed

• 17 Beehner MN. FUE vs. FUT-MD: study of 1,780 follicles in four patients.. Hair Transplant Forum International 2016; 26: 160-161

• 18 Poswal A, Bhutia S, Mehta R. When FUE goes wrong!. Indian J Dermatol 2011; 56 (5) 517-519 PubMed

• 19 Cooley JE. Optimal graft growth.. Facial Plast Surg Clin North Am 2013; 21 (3) 449-455 PubMed

• 20 Devroye J. Improving graft survival: extraction techniques and transection management. In: Lam SM, Williams KL, eds. Hair Transplant 360: Follicular Unit Extraction. Vol. 4. New Delhi: Jaypee Brothers Medical Publishers Pvt. Limited; 2015:133–150

• 21 Parsley WM, Perez-Meza D. Review of factors affecting the growth and survival of follicular grafts.. J Cutan Aesthet Surg 2010; 3 (2) 69-75 PubMed

• 22 Dua K, Dua A, Chahar M. Dos and don’ts of follicular hair transplantation. In: Mysore V, ed. Hair Transplantation. New Delhi: Jaypee Brothers Medical Publishers Pvt. Limited; 2016:205–212

• 23 Sethi P, Bansal A. Direct hair transplantation: a modified follicular unit extraction technique.. J Cutan Aesthet Surg 2013; 6 (2) 100-105 PubMed

• 24 Bradley WR. The art and craft of recipient site creation and graft placement.. Hair Transpl Forum Int 2014; 24 (2) 46-49