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Hair Transplant Forum International 2000; 10(2): 59
What's in a Name?
Robert M. Bernstein, MD New York, New York USA
Yes, it would be nice if we could define Follicular Unit Transplantation as simply "the exclusive transplantation of intact follicular units" without requiring a specific dissection technique, as Dr. Knudsen suggests (Editor's Note on "A Slot by Any Other Name," Hair Transpl Forum Int. 1999; 9(6); p175). Unfortunately, hair restoration surgeons, in order to "sell" their surgery to the public, have notoriously applied various labels to their procedures, irrespective of what they were actually doing in their own office.
Doctors using plugs, told patients that they were getting mini-grafts (when the latter name was introduced), and those using mini-grafts, labeled them as micro-grafts (when that word became popular), and doctors using all different size grafts told patients that they would get only "single-hair grafts" in the frontal when that came into Vogue. However, what the doctor "said," and what he actually "did," was often not the same. The travesty was that what the patient ultimately saw in the mirror, when the grafts finally grew, did not even remotely resemble what had been represented to him.
Now we have a new "buzz word" Follicular Unit Transplantation, and it is the same old story. Doctors have pressure to say they do the technique, because patients are demanding it, and patients demand it because they see the results for themselves and they can see "clearly" since they have no agenda but to get the best procedure. (In contrast, how many patients now demand to have Laser Hair Transplantation? In spite of Laser being billed as the "State-of the Art" and being probably the catchiest word ever used to denote high tech, the answer is practically none because patients see that it doesn't work and can easily understand its limitations.)
Unfortunately, in spite of rising patient demand, many hair transplant doctors have neither the staff nor the inclination to take on the more laborious and exacting FUT technique. So what are the options? 1) They can be honest and explain the procedure that they do and the reasons why. 2) They can lie, i.e. tell the patient that they are doing FUT when that are doing exactly the same thing that they have always done. 3) They can say that FUT itself is a lie, i.e. it is not any different from the way transplants have been performed in the past. 4) They can invent new names that have "follicular unit" imbedded in them to confuse the consumer (Follicular Unit Couplings using a Redfield punch would be an example). or 5) As the editor suggests, one can keep the FUT procedure itself ill-defined so that, regardless of the technique, as long as follicular units are present in the donor area, the term follicular unit transplantation can be used (irrespective what ends up in the front).
Dr. Knudsen admonishes us with "don't confuse the debate by stating that your technique is, by definition, the ONLY technique." We are not saying that "our" technique is the only technique. We are simply stating the fact that when using a multi-bladed knife, you can't keep follicular units intact. We also feel that in honesty to patients, doctors that use multi-bladed knives and/or techniques where the follicular units can't be properly visualized or isolated, shouldn't say that they are doing Follicular Unit Transplantation, since they are not.
It is an oxymoron to say "the careful use of multiple strips" i.e. those obtained with a multi-bladed knife, are adequate for the generation of intact follicular units, when the multiple-blades break up the units during the harvest. What Dr. Knudsen is suggesting is that any doctor should have the liberty to apply any label to any technique, as long as one has the intentions to do the procedure.
I don't suspect that any of the follicular unit purists would complain about a technique that wasn't "our" technique as long as it worked. For example, the new Mantis microscope is not a 10x stereo-microscope, but it was immediately adopted because of its clarity, wide visual field and excellent ergonomics. The problem with a multi-bladed technique isn't that it is not "ours" (we have all used them), the problem is that the multi-bladed knife was designed for mini-micrografting and just doesn't work for Follicular Unit Transplantation.
So what's in a name? To us, a lot. We "purists" want Follicular Unit Transplantation to mean something more to our patients, than just being a catchy sounding phrase. After what hair transplant patients have been subjected to for the past 40 years, they deserve to be told exactly what they are getting.
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