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Refined FUE ( Follicular Unit Extraction) is a type of modified follicular unit extraction technique. As the name suggests it is a refinement over the normal FUE that we perform. The main different components are:

  • Use of mamba technique to extract hairs.

  • Immediate insertion of the hairs.

  • Insertion via the no root touch technique.

To understand each of these we need to look at each component and compare it with normal FUE.

Use of Mamba Technique:

This Instrument is used for extraction of the hair or grafts from the back of the head. In normal FUE we use a rotatory device for extraction. The hair is more strongly attached in the upper part of the skin, as we go deeper we notice that the attachment becomes more and more flimsy or loose. So logically we need more force in the upper part where the attachment of hairs is stronger, and as we go deeper we need lesser force as the attachment in the deeper part is not so strong.

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Photo of Diagram of Attachment of Skin

In normal FUE, as we are using only rotational force, we are entering with strong force in the upper part of the skin, as we do not have any means to reduce the force as we go in, we enter the deeper parts with the same strong force that we used in the upper part. These rotational devices have only one phase (Monophasic devices) and we cannot reduce the force as we proceed. So we are applying a strong force in the deeper part where we have the important root segment of the hairs. The chances of damage to the deeper part are increased in these kinds of devices.

Dr Trivillini from Paraguay, identified this part and he devised the Mamba instrument, which is a biphasic device. In this device we have different kinds of movements like Rotation, Oscillation and Vibration. We also have the option of changing from one kind of movement to another seamlessly. The force with which we want the movement to happen can also be changed. We keep rotation movement in the upper part of the skin, as this is the part that has maximum attachment of the hairs, and needs a strong force to act here. And as we go deeper we can change the type of movement and force of movement. So in the deeper part we have the option to use oscillatory force. Oscillatory force is a weaker force when compared to a rotational force. So the chances of damage to the deeper part of the hair root is reduced.

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Photo of Doctor Getting the Mamba Instrument

This is a very new concept and very few clinics in the world are using the Mamba instrument at present. We believe that this is going to become quite common in the coming future. As the number of vendors producing biphasic devices is very limited in the world, the number of Surgeons using the same are also less. But because the benefits of getting a very good graft increases dramatically with biphasic devices this is going to be more commonly used in the future by more and more surgeons around the world. We are one of the first to use mamba device in India. We believe that the better the graph we get the better is the results that we can give to our patients.

Immediate Insertion of Grafts:

In normal FUE, first we turn the patient prone and then we remove all the graft from the back side of the head. On an average if we remove around 2500 to 3000 grafts we take about two to two and half hours to extract the grafts. All this time the grafts are lying out of the body. After removing the grafts we turn the patient straight and we make slints in the front part to insert the grafts into the body. This could take about 30 minutes to 40 minutes. All this while the grafts, that we have extracted from the body, are lying outside. They are part of your body and the sooner they are inserted back into the body the better it is for them.

In refined FUE we turn the patient on one side and extract the grafts, from the back of the scalp that is exposed to us. And then we immediately insert the grafts into the front side. Hence the waiting Period of the graft out of the body is reduced, in other words we have reduced the out-of-body time of the grafts. The sooner we insert the grafts, the better is the result.

No Root Touch Technique For Graft Insertion

We can insert the graphs using a forceps. In doing this we generally catch the root of the graft and insert it into the slit. There is always a chance of some damage to the roots. Imagine if we were to put a rose plant into the soil, we would take all efforts not to damage the roots while inserting the plant into the ground. The same principle holds goods over here. We can insert the graft into the body by using an implanter. Here we hold the graft from the top part and not from the root and using an implanter to dilate the slit we just push the graph into the slit. Thereby reducing any chanches of damage to the grafts.

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Grasping the grafts at the roots can cause some damage to the roots.

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Figure showing the use of KEEP implanter. Here we are holding the grafts in the top part, which is safe to hold. Not holding in the root area prevents the damage to the roots.

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