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Page 4 of 7 Saxena. Plast Aesthet Res 2018;5:5 I http://dx.doi.org/10.20517/2347-9264.2017.67

Figure 3. Skin stretching during removal of graft (left) and during beard follicular unit extraction (right)

Figure 4. The graft holding plate with KD spreader uses magnets for easy attachment

NOVICE-FRIENDLY IMPLANTATION OF FUE GRAFTS
Past research and my personal experience suggests that implantation in coronal slits gives more coverage
[3,4]
than sagittal slits but there is a long learning curve in this technique when we use forceps .
Unlike follicular unit transplant graft, where extra fat is obtained for insulation, FUE grafts require extra
care during implantation. Several attempts for inserting the graft into a small hole can permanently damage
the graft. Experienced assistants and hair transplant experts can perform implantation without any problem
but novice operators struggle during implantation.

I have been an advocate of properly hydrated and atraumatic insertion of FUE grafts. While exploring why
some assistants or doctors struggle with the learning curve of implantation, I observed several important
hurdles that beginners face, which include the following:
• Dilatation of the premade slit and visualization of hole is insufficient to insert graft.
• Gripping the forceps for dilating the premade slit was not comfortable because non-dominant hand grip
was not efficient.
• Graft manipulation during graft insertion reduces their confidence.
• There is greater risk of graft dehydration due to prolonged time out of the hydrating solution for beginners
compared to trained experts.
• There is an overcrowding of hands when more than one person is performing implantation simultaneously.