A formal classification system to cope with the problems and difficulties that arose in the follicular unit excision technique is not updated. The practitioners are still working hard to identify the factor that affects the results of these cosmological techniques. The results may vary on the texture of the hairs and on the quality of the graft to be planted on the patient’s scalp. Previously the Physicians predict the outcome based on curly hairs (African hair is difficult to handle) versus non-curly hairs (non-African hairs are easy to handle). Lately, some universal FUE classification systems are developed to aid the difficulties in procedures and their outcomes. The Graft Quality Index; this model predicts the results based on morphological aspects of the graft which is to be planted on the donor scalp. The Sanusi Score Scale is an updated pre-surgical system that studies both the texture of the follicular unit and the skin features in classifying and estimating difficulties and their upshots. This Sanusi Score Scale is considered as universal FUE classification system.
Graft Quality Index
The worth of graft is a noteworthy aspect of Follicular Unit Excision surgery. There is a deliberate discussion on the quality of graft in the field of hair restoration techniques. The results of any cosmetic surgery for hair re-growth are influenced by the quality of the graft. In Hair restoration techniques the main challenge is to obtain a graft that has the same size and characteristics as the strip graft. Mostly the harvested graft gives a restricted yield than the expected due to a bad shafted punch. Initially, Graft Quality Index was universal FUE classification system.
Graft Quality Index, These grades are given according to their shape and are helpful for their applicability. The graft worth can be used as a quality checking tool. It will explain the difficulty in graft placement
Grade A: there are no transactions or injured follicles, and a flat smooth margin graft was obtained. This Graft reserved all the dermal layers beneath.
Grade B: They are like Grade A, but have some damage to perifollicular cells.
Grade C: These grafts have twisted edges and damage to the surrounding tissues of the follicular unit. These types of grafts yield less restoration.
Grade D: Grafts D has many transections and injured follicles, with irregular margins. Their survival rate is the least.
Sanusi FUE Score Scale
There was no standard measuring scale that foresees the Follicular Unit Excision difficulties and acceptability. Previously, it was commonly classified on the basis of the degree of curliness of the patient’s hair. The FOX scale was there which has 5 degrees of hair based on curliness. This scoring system completely ignored the texture of the surrounded skin. This was the main drawback of this system. The SFS, a universal FUE classification system gives an effort score to the skin texture as well. The Sanusi Score Scale (SFS Scale) characterized the combination of the skin and hair properties in a wide range of people and interprets the results of follicular unit excision on them. Hence, the SFS scale serves as a universal FUE classification system.
There are three divisions on the scale chart based on nature or texture. These features make it universal FUE classification system.
Type 1: these are mostly straight hairs. These are the easiest specimens to handle in the incision and excision of follicles. They are used in a punch of flat origin with a length of 2-5mm graft.
Type 2 : the hair may be a bit wavy but it will be of medium to low degree curliness. The same treatment methodology will be applied for the type 1.
Type 3 : This hair is curly but at a medium level. These are not as hard to handle as the coiled curly hairs. These hairs have a clear direction of growth and the dermal layer is also well defined. Follicular units follow a straight line or gentle curve pattern on the scalp.
Type 4 : they are commonly known as Afro texture. These hairs are much curly like noodles. They are naturally very dry and squishy but can be soft sometimes. These give a hard task to partitions to cope with them.
The skin texture of the Scalp
A dense and strong type of skin:
These skins are turgid, shiny, and orange in color. They are very hard to pinch. These patients face difficulties in needle penetration, especially for anesthesia. Resist punching grafting and its penetration too. The physician required much force to get a flat punch from the donor scalp. In this type of scalp, the obtained graft will retain its shape more firmly.
Delicate and thin type skin:
This type of scalp needs more caution because of its delicacy. These are so thin that they rupture easily during the pitting of a punch. The graft will be twisted easily.
Average dense and tight type skin:
This type of skin behavior averages in pinching and penetration too.
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