In this paper, Dr. James Harris presents a blunt tip instrument to be used in a 3-step FUE hair transplant procedure. The instrument is described as a 1-mm dissecting punch that has a tapered blunt edge. After scoring the skin with a sharp punch, the dissecting punch is advanced to a depth of approximately 4-mm.

This instrument is similar to the one recently described by Bernstein and Rassman in New Instrumentation for Three-Step Follicular Unit Extraction, recently published in Hair Transplant forum International New Instrumentation. Dr. Bernstein’s instrument was, in turn, based upon ideas presented in a paper written by Dr. Harris in 2004.

Although Follicular Unit Extraction (FUE) has potential advantages, such as faster surgical recovery, less postoperative discomfort, less noticeable scarring, and possible expansion of the hair transplant patient’s donor area, the acceptance of the technique is limited because it is technically demanding, has limited patient candidacy, and can potentially result in high rates of follicle transection. There are also problems of buried grafts, the inability to transplant large sessions at one time and inefficient use of the mid-portion of the donor area. The proposed methodology and instrumentation may allow more widespread use of the technique.

In the current study, using the SAFE System for surgical hair restoration, 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.

Dr. Harris calls the procedure using this instrument, the SAFE (Surgically Advanced Follicular Extraction) System. Interestingly, in an editorial commentary by Dr. Walter Unger that follows this article, Dr. Unger suggests that the SAFE system should be more appropriately called the “SAFER technique,” since it is better than traditional 2-step FUE, but it has not eliminated the issue of follicular transection or some of the other problems of follicular extraction.

Harris JA. New Methodology and Instrumentation for Follicular Unit Extraction: Lower Follicle Transection Rates and Expanded Patient Candidacy. Dermatol Surg 2006; 32: 56-62


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