Dr. Josephitis
Valued member
The 2015 Third Annual Mediterranean FUE conference took place in beautiful and historic Istanbul, Turkey. This colorful and exciting city on the border of both Europe and Asia brings a combination of interesting cultures together. This meeting brought together physicians from across the globe and was very well attended including beginning and experienced hair transplant surgeons alike. The conference consisted of three days of morning lectures and discussions followed by actual FUE procedures every afternoon by an esteemed faculty of the world`s leaders in FUE. The conference was hosted by Drs. Erdogan, Ginzburg, and Lorenzo. Each afternoon took place in the surgical offices of Turkish surgeon Dr. Koray Erdogan. Four different surgeries occurred daily, showing a wide variety of surgical techniques and instrumentation.
Day one of the workshop started off with a great review of anatomy and the structures of the hair follicle. The specialty of transplantation is advancing so quickly, that new ideas are constantly being added. A common language with regards to discussing FUE is essential. Terminology regarding different parts of the graft as well as different types of transections were discussed. With these tools, physicians can better monitor their patients and develop studies to further improve the field. Later that morning, lectures were given on the various types of instruments used in FUE. A few physicians found that the manual punch creates very reliable grafts in various types of patients. A number of motorized punches were discussed as well. Dr. Harris, who developed the SAFE scribe, discussed a new hexagonal dull punch he is now using which he said helps to lower his transection rates. Dr. Cole discussed the use of the sharp punch and reviewed the various types of sharp punches that exist. There are a few other motorized punches available including one which is handheld and battery operated.
There was much talk over trying to maximize the donor area while still minimizing damage to it with FUE. Each patient has various donor characteristics which make them a good or poor candidate for FUE. The outer limits of the SAFE donor area were discussed. Some physicians felt that the donor area included those areas within the relatively permanent zone as well as those areas that have a higher risk of future loss. Dr. True discussed some of the finer points of beard hair for use as donor hair.
Then the lectures turned to the use of various ways of placing grafts. Many FUE surgeons are now using implanters. Some feel that the implanters are less traumatic for the already fragileFUE grafts. Dr. Lorenzo showed his experience with the use of implanters and why he prefers them over forceps.
The afternoon took place at the surgical office of Dr. Erdogan. Four surgeries took place each day. In one surgical room Dr. Lorenzo demonstrated his use of the manual punch and the implanter on a patient who needed some repair work. Drs. Ginzburg and Feriduni showed their techniques with the sharp punch. Dr. True showed how beard hair below the chin can easily be extracted and used as donor hair for the scalp.
Day two started with Dr. Harris giving a brief introduction to robotic FUE. Some discussion went into the pre-operative evaluation of a patient and the potential for a dermatologic referral. There was much talk about very large FUE sessions. These Mega sessions are being done by more surgeons as their level of experience improves. The definition of mega varied among the group, as some surgeons thought of procedures of 2500+ grafts as mega sessions, while others believed 4500+ grafts should be considered mega. Management of the donor area was also discussed when doing such large surgeries.
At the surgery center there were again four great cases with different surgeons performing FUE. Dr. Harris performed his SAFE scribe techniques with his new hex punch. Dr. Lorenzo was also assisting in this case and used the implanter to transplant the grafts. Dr. Erdogan demonstrated his sharp manual punch technique with the patient in the seated position. Finally, Dr. Cole showed his non-shaven FUE technique in a woman with a scar. The process appeared very time consuming and tedious, but very useful for patients wishing to keep their hair long directly after the procedure.
The third day began with some physicians demonstrating how useful FUE can be for scar repair from FUT as well as into scar from other causes. From some of the before and after photos, the results and graft survival are very good with the use of FUE grafts. Some time was dedicated to optimizing FUE survival. Because the grafts are typically more fragile than those of FUT, extra care has to be taken to ensure their survival. Physicians are incorporating additional medications and therapies into their FUE cases. Acell is a popular additional therapy used for many FUE patients. Although many physicians use Acell, not all are convinced of its benefit. In a study done by Dr. Lorenzo, he found no real benefit with Acell, and because of that, he doesn`t currently use it in his patients.
FUE has many known benefits, but also some risks as well which were discussed in a few midmorning lectures. There is a real risk of shock loss in the donor area with aggressive FUE. Although rare, it can happen but does resolve on its own. Transection is also an ever present risk in FUE. There was some discussion about how to minimize it. Depletion of the donor area and the potential for visible FUE scars was another topic.
The final afternoon at the surgical center had cases demonstrating the techniques of Dr. Erdogan and Lorenzo. Dr. Devroye created some excellent looking grafts while demonstrating his technique with the use of his specially designed motorized system.
Overall, the 3rd annual FUE workshop brought together some of the best extractors in the world. It was an excellent educational experience for all of those present. Much of the discussion centered on improving patient satisfaction by delivering optimum results with the use of FUE.
Day one of the workshop started off with a great review of anatomy and the structures of the hair follicle. The specialty of transplantation is advancing so quickly, that new ideas are constantly being added. A common language with regards to discussing FUE is essential. Terminology regarding different parts of the graft as well as different types of transections were discussed. With these tools, physicians can better monitor their patients and develop studies to further improve the field. Later that morning, lectures were given on the various types of instruments used in FUE. A few physicians found that the manual punch creates very reliable grafts in various types of patients. A number of motorized punches were discussed as well. Dr. Harris, who developed the SAFE scribe, discussed a new hexagonal dull punch he is now using which he said helps to lower his transection rates. Dr. Cole discussed the use of the sharp punch and reviewed the various types of sharp punches that exist. There are a few other motorized punches available including one which is handheld and battery operated.
There was much talk over trying to maximize the donor area while still minimizing damage to it with FUE. Each patient has various donor characteristics which make them a good or poor candidate for FUE. The outer limits of the SAFE donor area were discussed. Some physicians felt that the donor area included those areas within the relatively permanent zone as well as those areas that have a higher risk of future loss. Dr. True discussed some of the finer points of beard hair for use as donor hair.
Then the lectures turned to the use of various ways of placing grafts. Many FUE surgeons are now using implanters. Some feel that the implanters are less traumatic for the already fragileFUE grafts. Dr. Lorenzo showed his experience with the use of implanters and why he prefers them over forceps.
The afternoon took place at the surgical office of Dr. Erdogan. Four surgeries took place each day. In one surgical room Dr. Lorenzo demonstrated his use of the manual punch and the implanter on a patient who needed some repair work. Drs. Ginzburg and Feriduni showed their techniques with the sharp punch. Dr. True showed how beard hair below the chin can easily be extracted and used as donor hair for the scalp.
Day two started with Dr. Harris giving a brief introduction to robotic FUE. Some discussion went into the pre-operative evaluation of a patient and the potential for a dermatologic referral. There was much talk about very large FUE sessions. These Mega sessions are being done by more surgeons as their level of experience improves. The definition of mega varied among the group, as some surgeons thought of procedures of 2500+ grafts as mega sessions, while others believed 4500+ grafts should be considered mega. Management of the donor area was also discussed when doing such large surgeries.
At the surgery center there were again four great cases with different surgeons performing FUE. Dr. Harris performed his SAFE scribe techniques with his new hex punch. Dr. Lorenzo was also assisting in this case and used the implanter to transplant the grafts. Dr. Erdogan demonstrated his sharp manual punch technique with the patient in the seated position. Finally, Dr. Cole showed his non-shaven FUE technique in a woman with a scar. The process appeared very time consuming and tedious, but very useful for patients wishing to keep their hair long directly after the procedure.
The third day began with some physicians demonstrating how useful FUE can be for scar repair from FUT as well as into scar from other causes. From some of the before and after photos, the results and graft survival are very good with the use of FUE grafts. Some time was dedicated to optimizing FUE survival. Because the grafts are typically more fragile than those of FUT, extra care has to be taken to ensure their survival. Physicians are incorporating additional medications and therapies into their FUE cases. Acell is a popular additional therapy used for many FUE patients. Although many physicians use Acell, not all are convinced of its benefit. In a study done by Dr. Lorenzo, he found no real benefit with Acell, and because of that, he doesn`t currently use it in his patients.
FUE has many known benefits, but also some risks as well which were discussed in a few midmorning lectures. There is a real risk of shock loss in the donor area with aggressive FUE. Although rare, it can happen but does resolve on its own. Transection is also an ever present risk in FUE. There was some discussion about how to minimize it. Depletion of the donor area and the potential for visible FUE scars was another topic.
The final afternoon at the surgical center had cases demonstrating the techniques of Dr. Erdogan and Lorenzo. Dr. Devroye created some excellent looking grafts while demonstrating his technique with the use of his specially designed motorized system.
Overall, the 3rd annual FUE workshop brought together some of the best extractors in the world. It was an excellent educational experience for all of those present. Much of the discussion centered on improving patient satisfaction by delivering optimum results with the use of FUE.
