title: New methodology and instrumentation for follicular unit extraction: lower follicle transection rates and expanded patient candidacy.
abstract: BACKGROUND
  Follicular unit extraction (FUE), as described in the literature for harvesting follicular units, is technically demanding, has limited patient candidacy, and can potentially result in high rates of follicle transection. Although FUE has potential advantages, such as faster surgical recovery, less postoperative pain, less noticeable scarring, and possible expansion of the donor area, the acceptance of the technique is limited by the problems noted above. The proposed methodology and instrumentation may allow widespread adoption of FUE.
  
  
  OBJECTIVE
  To present the SAFE (Surgically Advanced Follicular Extraction) System, a new methodology and novel instrumentation for FUE. This article presents the efficacy of this methodology and addresses patient candidacy.
  
  
  METHODS
  Twenty-two patients undergoing standard strip excision were enrolled in a pilot study to assess follicle transection rates using the SAFE System. Based on the success of the pilot study, an additional 37 patients receiving a total of 6,947 grafts were examined. Transection rates were recorded, and patients were examined for complications or adverse reactions.
  
  
  RESULTS
  The average follicle transection rate was 6.14%, with a range of 1.7 to 15%. The only adverse reaction was the occurrence of two buried grafts, resulting in inflammatory subcutaneous cysts requiring excision.
  
  
  CONCLUSIONS
  It appears that the SAFE System provides the methodology and instrumentation to enhance current FUE techniques and expand patient candidacy. The transection rate of this method compares favorably with traditional microscope graft dissection. Physicians with a modicum of technical skills can use the technique, and there does not appear to be a significant adverse reaction rate.
authors.affiliation: Dept. of Otolaryngology/Head and Neck Surgery, University of Colorado Health Sciences Center, Denver, CO, USA. jharris@hsccolorado.com
authors.forename: James A
authors.initials: JA
authors.lastname: Harris
mesh_terms: D004867:Equipment Design; D018859:Hair Follicle / Q000293:injuries / Q000601:surgery*; D006801:Humans; D018579:Patient Selection; D010865:Pilot Projects; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome