This is a video manual training for Automated FUE Tools .

 

This is a video manual training for CIT manual punch handle - Extracting Grafts.

 

Not all FUE punches for hair restoration are created equally.  Other than the punches Cole Instruments created, FUE punches have a thicker wall and are not as sharp.  Cole Instruments created the thinnest wall and sharpest punches on the market.  This is very important to the success of FUE hair transplant surgery.   

Removal of hair follicles in FUE depends on two forces.  One is the axial force or the inward pressure on the skin.  The second is the tangential force created by rotation or oscillation.  Both forces will be less with a thin wall and a sharp punch.  Lower forces create less fluid movement of the follicles.  This helps to reduce follicle transection or amputation of the follicles, which often results in such damage to the follicle that follicular survival is impaired.   

Cole Instruments recently created a new surgical punch that is serrated.  These punches reduce the surface area in contact with the skin. This reduces the force required to incise around the follicles even more.  Cole Instruments calls these new punches, the Surrounded punch.   

The Cole Instruments Graft Chiller Plate reduces the temperature of the follicles so that any follicles traumatized by extraction have a higher probability of survival. Follicle trauma with the Cole Punches and other extraction tools is very low compared to other FUE punches and extraction tools, however.  

We were very pleased to host Dr. Patrick Mwamba today at our office in Alpharetta, Ga.  Dr. Mwamba practices hair transplant surgery in Brussels.  He has 12 years of experience in hair transplant surgery.  Dr. Mwamba wanted to evaluate the PCID, the surrounded punches, and the newer battery powered Cole Isolation Device (BCID).  Dr. Cole demonstrated these devices to Dr. Mwamba today.  Dr. Mwamba was very impressed with the ease of extraction that these devices afford the physician.  Dr. Mwamba currently uses the manual devices for CIT that Dr. Cole developed.

Hair Restoration Meeting in Atlanta

 

(Click to enlarge)

Cole Instruments attended the 2011 ISHRS meeting in Anchorage, Alaska in September. Over 300 ISHRS members registered for this meeting. Physicians enthusiastically purchased the Cole Instrument line of surgical tools. The graft chiller plate and the CIT method of FUE instruments were in high demand. A number of instruments were completely sold out at the meeting. Physicians recognized the superiority of the Cole Instrument FUE punches over all other punches in terms of a sharp edge, thin wall, and hardened steel. Physicians were also impressed with the accuracy and low transection rate of the power follicular isolations devices produced by Cole Instruments (PCID).

The Cole method of harvesting follicular units is three to four times as fast as the ARTAS robot FUE system and has a follicular transection rate less than one-half as high as the ARTAS FUE robot. Physicians who purchased the ARTAS robot immediate obtained a device that is well behind in safety and technology as compared with the Cole Instrument line of FUE equipment. Not only this, physicians who purchased the ARTAS robot paid Restoration Robotics $200,000.00 USD, as well as $1.00 USD per graft. The ARTAS robot has only a handful of patient results, while Cole Instruments have produced over 4000 patient results and counting.

 

(Click to enlarge)

Recently, Dr. Cole visited HDC in Cyprus to allow the staff physicians there to experience the new items available from Cole Instruments.  Dr. Cole originally trained the staff at HDC in both FUE and strip surgery in 2003.  Since this time, HDC has done a wonderful job and produced many outstanding results for their patients.

Dr. Cole demonstrated his new Power Cole Isolation Device, PCID, along with his new line of punches.  The staff physicians were able to see the advantages of the punches Dr. Cole manufactures along with the speed and accuracy of the PCID.  Dr. Cole easily extracted grafts on a patient using the 0.85 mm punch set at a 2.3 mm depth.  The patient had a previous strip procedure at another clinic and desired to fill the area in with additional hair, as well as treat the unsightly strip scar.

Dr. Cole then discussed the advantages of sharp punches over dull punches along with the theories behind FUE harvesting of grafts with minimal transection.  The staff was very pleased with the sharp, thin walls of Dr. Cole’s punches.  They immediately ordered 30 punches for use on their patients.

 

(Click to enlarge)

Introduction

FUE is becoming increasingly popular with both physicians and patients. As patient demand increases, the need for more physicians to provide the procedure is essential. Unfortunately, the procedure is difficult to learn for many physicians. There is a need to reduce the learning curve so that consistent results are possible. In addition, there is a need to provide logistics so that physicians are able to carry out large procedures in a shorter span of time. This presentation will detail how to provide the FUE rapidly while insuring quality grafts that insure consistent results.

Methods

I will discuss the overall planning and design I use to produce large procedures exceeding 2000 grafts with speed and efficiency. This discussion refers primarily to patients who are a Norwood class 3 or greater.

Results

Proper planning and instrumentation allows physicians to provide well over 2000 high quality grafts to a patient in a single day.

Discussion

Patients with advanced degrees of hair loss are often treated with between 2000 and 3500 grafts to the frontal 1/3Rd of the scalp. Such large sessions require considerable planning and expertise in order to perform in a timely fashion.

I begin by determining the surface area we will treat in a similar manner as that one does in strip harvesting. I then design my donor area. I split my donor area into 8 major regions and 6 minor regions. I design the donor area using a donor template that I attach to the patient’s scalp with an elastic band. The template allows me to design a consistent donor area for each patient. The template has holes in it large enough to place a dot with a gentian violet marker. Once each dot is made, the template is removed and I draw in the boxes by connecting the dots with a gentian violet marker.

Speed in any procedure depends on subdividing the work among as many individuals as possible so that multiple tasks are carried out simultaneously. The objective is to get as many hands as possible on the scalp at one time. Patient positioning plays a major role here. More hands can come in contact with a patient who is in the seated position so more simulataneous tasks may be carried out.
Once my boxes are designed dividing the donor area into 14 distinct regions, I will anesthetize two of them. I anesthetize two boxes that are widely separated from one another. I begin by anesthetizing box 2 and box 8 quite often because each box yields a different type of hair in terms of caliber, calculated density, and propensity to loose pigment. The wide separation between these two boxes allows two people to work in the donor area simultaneously. I begin by using a test kit. My test kit contains different diameter punches that may be set at an infinite number of depths. I choose the appropriate size punch and depth from the test kit. Once I choose my punch, I will either mount a the desired size on the Programmable Cole Isolation Device or I will mount the punch on a manual handle. I then begin extracting follicular groups. After cutting 50 to 100 grafts, I will move to the opposite side box, for example to box 8. While I move to the opposite side, my assistant begins removing grafts from Box 2 using the ATOE or aide to extraction. At the same time we begin evaluating our transection rate. Based on the transection rate, we will make changes if necessary to improve the quality of the grafts. I also get continuous feedback from my staff regarding the depth of the incision and the quality of the grafts. At any point they will notify me if the quality is compromised. While my staff member removes grafts from Box 2, I will begin cutting grafts from Box 8. I can usually cut much faster than my assistant can remove. After cutting approximately 100 grafts from Box 8, I will mark an area on the top for local anesthesia. I will generally begin centrally so that three or four people can work simultaneously. While my Registered Nurse gives anesthesia, I begin extracting from Box 2. My assistant continues to remove grafts from Box 8. My assistant removes 25 grafts at a time and places the 25 grafts on a pad. The pad is then placed in a chilled holding solution. As soon as the anesthesia is delivered, I begin making recipient sites on the top. Often times I give PRP, Thrombin, and Acell prior to making recipient sites. As soon as I cut a few hundred recipient sites, I begin to harvest once again from Box 2. As soon as my assistant has removed all the grafts from Box 8, I will return to this Box 8 to cut more grafts, while my assistant removes grafts from Box 2. As soon as my assistants finish placing the grafts on the top, I will make more recipient sites so that the procedure moves along as quickly as possible.
Once the grafts have been cut and removed entirely from Box 8, the left side of the scalp is open for a surgery tech to place grafts on the left side of the hairline or anywhere on the left side of the scalp.
Hair line preparation is different than other regions of the scalp where larger full size follicular groups are placed. On the hairline, I generally place predominately smaller grafts containing only one hair. Behind several rows of single hair grafts I place two hair grafts in at least two rows. Behind this I place several rows of three hair grafts. The number of one and two hair grafts depends on the caliber of the hair and the contrast between the hair and the skin. The larger caliber hair or when the contrast between the scalp and the skin is greater, I will place more single hair grafts.

Graft Processing

By the time if begin preparation of the single hair grafts, I will generally begin harvesting from the central boxes of the donor area. This allows at least two surgery assistants to place grafts following preparation of the recipient area while I harvest from the central boxes. This allows for the most number of hairs to have contact with the scalp at any given time.

Harvesting Speed

There are many ways to harvest grafts in the performance of FUE. The chief differences are in a manual approach and a mechanical approach. The fastest way to harvest grafts is to use the Programmable Cole Isolation Device. All other mechanical extraction methods are no faster than my manual method of extraction. Transection rates are slightly lower with my manual method in many instances, but the transection rate can be quite low with the PCID. Other forms of extraction tend to have significantly higher transection rates.