Follicular Unit Excision-Linear Ellipse Donor Harvesting Technique: Combining Standard Follicular Unit Excision with Follicular Unit Excision inside a Linear Strip (Modified Linear Strip Excision) to Optimize Graft Yield

Sharon A. Keene; Alejandra Susacasa; Paulo Miranda; Henrique Radwanski

doi:10.1055/a-2198-2703

Facial Plastic Surgery, Table of Contents

Facial Plast Surg 2024; 40(02): 205-213
DOI: 10.1055/a-2198-2703

Original Article

Follicular Unit Excision-Linear Ellipse Donor Harvesting Technique: Combining Standard Follicular Unit Excision with Follicular Unit Excision inside a Linear Strip (Modified Linear Strip Excision) to Optimize Graft Yield

Sharon A. Keene

¹Physician's Hair Institute, Tucson, Arizona

,

Alejandra Susacasa

²Hair Recovery, Buenos Aires, Argentina

,

Paulo Miranda

³Clinica Pelle, Nova Redentora, Sao Jose do Rio Preto, Brazil

,

Henrique Radwanski

⁴International Society of Hair Restoration Surgeons (ISHRS), Rio de Janeiro, Brazil

› Author Affiliations

Abstract

Follicular unit excision (FUE) graft dissection has become the dominant method of donor harvesting globally, however, only a percentage of donor hair can be excised inside the safe donor area before visible donor thinning occurs. Compared to linear strip excision (LSE) where all follicular units inside the harvested ellipse of hair are used, FUE poses substantial limitations for lifetime graft yield and, therefore, cosmetic coverage in patients with advanced pattern hair loss. This paper reviews how combining the donor harvesting methods of FUE and LSE has been shown to optimize graft yield while minimizing the risk of donor depletion from overharvesting. It then describes a surgical technique called FUE-Linear Ellipse (FUE-LE) where FUE dissection of grafts inside a demarcated linear ellipse eliminates the need for a large dissection team which has posed a barrier for many new practices that offer both the donor harvesting methods. For practices that currently offer only FUE, the addition of the LSE method by the modified FUE-LE technique is possible without specialized staff training or associated equipment costs. In this paper, surgery practices that have adopted this technique will report on their experiences. Hair restoration surgeons are encouraged to provide both methods of donor harvesting (FUE and LSE using FUE-LE) in order to optimize graft yield for patients and avoid long-term donor depletion. Based on limited experience, it appears the technique of FUE-LE will help achieve this goal.

Keywords

follicular unit excision - linear strip excision - combined donor harvesting - follicular unit excision-linear ellipse - residual density

Full Text

References

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