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Page 2 of 7 Saxena. Plast Aesthet Res 2018;5:5 I http://dx.doi.org/10.20517/2347-9264.2017.67

INTRODUCTION
Follicular unit extraction (FUE) is a minimally invasive hair transplantation procedure, where each hair
follicular unit is individually harvested from the donor area on the scalp or from other parts of the body
and then implanted directly into the recipient area. FUE hair transplant surgery has gained popularity in
the last few years among patients due to its simplicity and ability to produce less visible scarring, allowing
the patients to wear their hair short. The technique of the FUE procedure not only attracts patients who
have fear of knives, stitches and linear scarring over the donor site but also physicians who wish to start hair
restoration procedures at their clinics. With the evolution of the FUE method, this hair restoration surgery is
gaining popularity all over the world.

After working in the field of hair transplantation for more than a decade, the authors have realized there is
a definite learning curve in this field of medicine. Many physicians do not continue hair restoration practice
because of the repeated initial failures.

Repeated improvement in technique and instrumentation may improve ability of beginners to perform
FUE extraction and implantation smoothly. The goal of any technique or instrument in FUE is to extract
an individual follicular unit without transection and implant it in the recipient site without producing
physical trauma to the follicular unit. As hair transplant is a time-consuming procedure, your technique and
instruments should also give you opportunity to work without fatigue and exhaustion. To fulfill these goals,
this author created an instrument which can address the existing limitations of the FUE hair restoration
procedure.

EXISTING INSTRUMENTS AND ITS LIMITATIONS
• Manual stretching does not provide sufficient traction for scoring.
• Manual traction can cause operator fatigue especially during procedures which can last for several hours.
• Tough scalp requires extra stretching of tissue that cannot be achieved by available methods.
• Conventional skin hooks do not provide efficient gripping for desired stretching force.
• FUE over lower occipital region require maximum scalp stretch near the FUE site that is not possible by
current available methods.
• While performing body hair transplant, skin is extremely pliable and tensioners or spreaders are needed to
stabilized flexibility of the tissue.

Looking at these hurdles, the authors desired to develop a user - friendly instrument that can provide donor
tension or traction without producing operator fatigue, specifically their hands.

[1]
I have developed a unique instrument - the KD’ spreader - in response to this problem [Figure 1] . This
device is comprised of a shaft and a hook connected to the shaft that are configured to allow the user to work
efficiently. The device uses two finger grips which are positioned on the surface of the shaft for providing
efficient grip so that the desired stretching force may be applied without much fatigue to the operator
muscles. This device is extremely useful while FUE is performed on tough scalp where manual stretching
does not provide sufficient traction for scoring.

While performing FUE extraction, we start with a circular incision with average rotational force in which
our power machine is set. We adjust rotational force as per our requirement. When scalp is tough we have
to increase rotational force while when the scalp is soft, we have to decrease rotational force. When we
increase rotational force to initiate circular incision on tight scalp, an opposing friction or resistance force
is generated. If the applied force exceeds the friction force, chances of transection of grafts greatly increases.
[2]
KD spreader provides desired stretching exactly at the site of FUE [Figure 2] .