It is important to note that the tightness with follicular units is held in dermis varies and hence Follicular Units Extraction may not be suitable in all patients. Therefore, before undertaking any patient for FUE hair transplant, the surgeon should certain whether the patient is suitable for all candidates. In FOX test, the surgeon takes about few grafts from the donor area and then evaluates how many complete follicular units are extracted. If the extraction is easy and complete units are extracted, then the surgeon should go ahead with FUE otherwise shift for strip procedure technique. According to the completeness of extracted grafts these are classified into five grades. In grade one when intact follicular units literally pop out of the scalp or when there is only occasional transaction of individual hairs in the unit.
In Fox grade 2 extractions may be relatively easy in the first session, but as we talk about subsequent procedures it becomes more problematic and the yield starts to decline. These patients the long-term yield starts to decline. In these patients the long term yield can be compromised and planning extremely difficult. In FOX as we discuss for the grade 3 the emergent angle is difficult.
Approximately 200 patients enrolled in a study to access their candidacy for FUE. They found that 74% of all those patients were FOX1, FOX2, or FOX3. The description for each category allows for the considerable individual physician discretion and interpretation. In fox 4to 5 the yield is too low for the FUE procedure to be successful. Here, the decision not to use FUE should be straightforward as the transaction rate would be too high. If your patient is FOX positive, the surgeon can go ahead with FUE in the indications mentioned.