Review of the World Live Surgery Workshop – FUE Immersion October 1–2, 2017 • Polanica Zdrój, Poland =========================================================================================================== * Andreas Finner * Nina Otberg 1. Andreas Finner, MD, FISHRS 1. Berlin, Germany 2. Nina Otberg, MD 1. Berlin, Germany ## SATURDAY/SEPTEMBER 30, 2017 Attendees of the WLSW gathered at the sensational Dr. Irena Eris Hotel and Spa. Many of us had already toured beautiful southern Poland. We were delighted by the wonderful villas and parks of Polanica Zdrój and enjoyed the fall foliage under sunny skies. ## BASICS COURSE The workshop started in the afternoon with the Basics Course that featured lectures on basic concepts and nomenclature of FUE and anatomic structures of the anchoring system. Practical tips were given regarding donor area management, punch types, incision and extraction techniques, staff and patient ergonomics, and loupes and lighting. Following the Basics Course was a welcome reception where attendees of different backgrounds and experiences got to know each other. ## SUNDAY/OCTOBER 1, 2017 The second part of the Basics Course on Sunday morning started with a discussion on donor and recipient area anesthesia management, which was moderated by Dr. Christian Bisanga. Dr. Akaki Tsilosani presented calculations of maximum dosage of different local anesthetics and injection techniques. Dr. Robert True discussed anatomy, nerve blocks, ring blocks, and application techniques. ![Figure1](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F1.medium.gif) [Figure1](http://www.ISHRS-HTForum.org/content/27/6/242/F1) Drs. Ken Williams, Emre Karadeniz, and Akaki Tsilosani discuss limitations and advantages of FUE. The next topic was the best donor area approach. Drs. Ali Emre Karadeniz, Ken Williams, and Akaki Tsilosani talked about limitations and advantages of follicular unit extraction (FUE). They noted that areas of extraction should be restricted to the safe area in patients with less than 20% miniaturization. No extraction should be performed in the occipital hairline or too high near the vertex to account for future vertex thinning. However, some surgeons, it was noted, create a feathering zone on the edges. The next panel, consisting of Drs. James Harris, Chiara Insalaco, Bessam Farjo, and Parsa Mohebi, discussed the calculation of a hair coverage value and hair diameter index. The application of the Hair Diameter Index (HDI) in obtaining a target hair density was presented along with the mathematical and aesthetic considerations on recipient site planning. The morning continued with a welcome from WLSW chair, Dr. Arthur Tykocinski, and co-chairs, Drs. Jerzy Kolasinski and Ken Washenik followed by five 30-minute panels that each discussed different aspects of FUE. In Panel 1, “Surgeons and Humility,” moderated by Dr. Robert Haber, Drs. Emorane Lupanzula, Ronald Shapiro, and Arthur Tykocinski talked about work ethics, keeping patients expectations realistic and low, and being modest. In Panel 2, “Patient Selection,” moderated by Dr. William Rassman, Drs. Ken Williams, Russell Knudsen, and Bessam Farjo presented considerations on who is a good candidate for hair restoration in general, and for FUE in particular, and on the importance and limitations of hair restoration in combination with medical therapy. It was noted that as patients get older, hair aging occurs even in the donor area. In Panel 3, “Transection Rate,” moderated by Dr. Robert True, Drs. Jean Devroye, Kapil Dua, and Tayfun Oguzoglu presented calculations on transection rates, noting that partial and complete transection have to be taken into account; regrowth cannot be expected in every transected hair, depending on the area of damage within the follicle. Transection rates should be monitored and kept under 10%. In Panel 4, “Punch Types,” moderated by Dr. Parsa Mohebi, Drs. Emorane Lupanzula, Conradin von Albertini, James Harris, Jean Devroye, and Mauro Speranzini presented technical aspects regarding punch types, movements, and speed. Punches can be blunt, sharp, or hybrid; manual or motorized; with or without oscillation. Every surgeon has to find the device that works best in his or her hands. The device can also be chosen depending on the patient’s hair. Suction can help to extract the grafts, but while Fuetor only elevates the grafts, NeoGraft has a higher risk of dessication. In Panel 5, “Exhausted Donor Areas,” moderated by Dr. Emorane Lupanzula, Drs. Christian Bisanga, Paul Rose, Kapil Dua, and Craig Ziering noted that depleted donor areas are a result of poor planning and over-harvesting. Depending on the patient’s density and thickness, safe harvesting is limited. Scalp micropigmentation can be used to camouflage the problem. ### Live surgery viewing, day 1 The afternoon program took place at the Salus Medical Center. Five surgeries demonstrated different FUE extraction techniques. Surgeries were performed by a Polish surgeon together with a guest surgeon. One moderator commented on the surgery in the operating room. Attendees had the choice of viewing each surgery in the room directly or all on a screen in the viewing room. The two moderators in the viewing room, Drs. William Rassman and Russell Knudsen, switched from room to room so that the audience as well as the moderators could ask questions. The surgeries included the following: * Room 1: Extraction with a manual sharp punch (Emorane Lupanzula and Arthur Sandelewski, moderator: Ronald Shapiro) * Room 2: Hybrid/Trumpet punch with oscillation (Jean Devroye and Slawomir Pietruszko, moderator: Robert True) * Room 3: Motorized sharp punch and sharp implanters (Conradin von Albertini and Jerzy Kolasinski, moderator: Robert Haber) * Room 4: Motorized sharp punch with oscillation and suction and demonstration of dull implanters (Mario Speranzini and Malgorzata Kolenda, moderator Bessam Farjo) * Room 5: Manual sharp punch with oscillation (Christian Bisanga and Wojciech Zielinski moderator, James Harris). ![Figure2](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F2.medium.gif) [Figure2](http://www.ISHRS-HTForum.org/content/27/6/242/F2) Attendees observe surgery performed by Drs. Conradin Von Albertini and Jerzy Kolasinski. In addition, five exhibitors were present at the Salus Medical center. The day ended at Zdrojowy Park with a wonderful folk party that showcased traditional Polish folk dancing and traditional Polish food. ![Figure3](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F3.medium.gif) [Figure3](http://www.ISHRS-HTForum.org/content/27/6/242/F3) Attendees enjoyed a traditional Polish Folk Party in the park. ## MONDAY/OCTOBER 2, 2017 Monday started with lectures divided into six discussion panels (6-11). In Panel 6, “Donor Area Reasonable Limits,” moderated by Dr. James Harris, Drs. Chiara Insalaco, Maria Angelica Muricy, Anastastios Vekris, and Christian Bisanga discussed optimal punch size to avoid transection and minimize scarring and donor depletion. They noted that beginners should start with small sessions and, if necessary, on consecutive days. Eight to 12 months should pass before a second session is performed. FUE harvesting should be limited to 20% if no adjacent hairs should be harvested. The maximum yield will depend on hair shaft thickness, length, density, and size of the donor area. In Panel 7, “Combining FUE and FUT,” moderated by Dr. Arthur Tykocinski, Drs. Ronald Shapiro, Anastasios Vekris, Craig Ziering, Márcio Crisóstomo, and Robert True discussed if FUE and strip surgery can or should be combined to maximize the total graft yield, why it is important to learn both techniques, and how it can be combined in the same session. In Panel 8, “Beard and BHT,” moderated by Dr. Mauro Speranzini, Drs. Bradley Wolf, Parsa Mohebi, and Kapil Dua noted that beard to beard transplantation can be used if donor supply under the chin is sufficient. Beard to head can be used if the occipital scalp donor site is depleted or insufficient and the structure of beard and scalp hair match. Body hair can be extracted from every hair-bearing area of the body. Body hair extraction (BHT) should only be performed by experienced surgeons in exceptional cases. In Panel 9, “Implanter Basics,” moderated by Dr. Conradin von Albertini, Drs. Sungjoo (Tommy) Hwang, Mauro Speranzini, Anastastios Vekris, and Bradley Wolf noted the technical aspects of graft implantation Different types of implanters were introduced; loading and implanting with dull and sharp implanters was explained, with Dr. Wolf noting that he prefers differential graft placement with forceps. ![Figure4](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F4.medium.gif) [Figure4](http://www.ISHRS-HTForum.org/content/27/6/242/F4) The panel discusses technical aspects of graft implantation. In Panel 10, “Graft Care,” moderated by Dr. Jean Devroye, Drs. Robert True and Conradin von Albertini discussed how to maximize graft survival. PRP, ATP, and the right temperature can have an impact on graft survival besides a short out of body time. In Panel 11, “New Trends,” moderated by Dr. Ronald Shapiro, Drs. Arthur Tykocinski, Sungjoo (Tommy) Hwang, Mauro Speranzini, and Otavio Boaventura presented the latest trends in FUE surgery such as the hybrid punch, new types of implanters, and a new way to perform FUE in long hair with a slit punch. ### Live surgery viewing, day 2 Attendees spent the afternoon at the Salus Medical Center where they were able to observe the following rooms: * Room 1: Presentation of a motorized sharp punch and trumpet punch with oscillation and graft placement with sharp implanters (Maria Muricy and Arthur Sandelewski, moderator: Conradin von Albertini) * Room 2: Sharp manual punch and sharp implanters for graft placement (Patrick Mwamba – extraction, Sungjoo (Tommy) Hwang – sharp implanter, and Slawomir Pietruszko, moderator: Bessam Farjo) * Room 3: Motorized blunt punch and a scar repair case with fat grafting (James Harris and Jerzy Kolasinski, moderator: Ronald Shapiro) * Room 4: Demonstration of robotic FUE (Craig Ziering and Malgorzata Kolenda, moderator Robert True) * Room 5: Hybrid punch and sharp implanters with implanter ramp to increase speed and optimize ergonomics (Arthur Tykocinski and Wojciech Zielinski, moderator: Robert Haber). ![Figure5](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F5.medium.gif) [Figure5](http://www.ISHRS-HTForum.org/content/27/6/242/F5) Dr. Harris begins extracting grafts. The workshop closed with a wonderful dinner, awards ceremony, and dance party followed by billiards and bowling at the Dr. Irena Eris Hotel.  ## 2017 World Live Surgery Workshop ### Thank you to the many technicians who contributed to the workshop success! ![Figure6](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F6.medium.gif) [Figure6](http://www.ISHRS-HTForum.org/content/27/6/242/F6) ![Figure7](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F7.medium.gif) [Figure7](http://www.ISHRS-HTForum.org/content/27/6/242/F7) Arthur Tykocinski, MD, FISHRS, Live Surgery Workshop Chair, and Jerzy R. Kolasinski, MD, PhD, FISHRS, Live Surgery Workshop Co-Chair, celebrate a successful workshop. ![Figure8](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F8.medium.gif) [Figure8](http://www.ISHRS-HTForum.org/content/27/6/242/F8) WLSW Directors receive certificates and awards. *L to R:* Arthur Tykocinski, MD, FISHRS, Jerzy Kolasinski, MD, PhD, FISHRS, Robert H. True, MD, MPH, FISHRS, Mauro Speranzini, MD, James A. Harris, MD, FISHRS, Jean M. Devroye, MD, FISHRS, Conradin von Albertini, MD, Ken Washenik, MD, PhD, FISHRS ![Figure9](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F9.medium.gif) [Figure9](http://www.ISHRS-HTForum.org/content/27/6/242/F9) **Awards are presented to WLSW Guest Surgeons.** *L to R:* Jerzy Kolasinski, MD, PhD, FISHRS, WLSW Co-Chair, Craig L. Ziering, DO, Maria Angelica Muricy, MD, Emorane Lupanzula, MD, Sungjoo Tommy Hwang, MD, PhD, FISHRS, Patrick Mwamba, MD, Arthur Tykocinski, MD, FISHRS and Ken Washenik, MD, PhD, FISHRS, ISHRS President ![Figure10](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F10.medium.gif) [Figure10](http://www.ISHRS-HTForum.org/content/27/6/242/F10) **Polish surgeons recognized at the Finale Conclusion.** *L to R:* Victoria Ceh, ISHRS Executive Director, Ken Washenik, MD, PhD, FISHRS, ISHRS President, Arthur Tykocinski, MD, FISHRS, WLSW Chair, Jerzy Kolasinski, MD, PhD, FISHRS, WLSW Co-Chair, Wojciech Zielinski, MD, Artur Sandelewski, MD, Malgorzata Kolenda, MD, Slawomir Piertruszko, MD ![Figure11](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F11.medium.gif) [Figure11](http://www.ISHRS-HTForum.org/content/27/6/242/F11) **Moderators receive awards.** *L to R:* Arthur Tykocinski, MD, FISHRS, WLSW Chair, Ron Shapiro, MD, Russell Knudsen, MBBS, FISHRS, Robert Haber, MD, FISHRS, Bessam Farjo, MBChB, FISHRS, William Rassman, MD, Jerzy Kolasinski, MD, PhD, FISHRS, WLSW Co-Chair, and Ken Washenik, MD, PhD, FISHRS, ISHRS President ![Figure12](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F12.medium.gif) [Figure12](http://www.ISHRS-HTForum.org/content/27/6/242/F12) **World Live Surgery Workshop Faculty Members** ![Figure13](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F13.medium.gif) [Figure13](http://www.ISHRS-HTForum.org/content/27/6/242/F13) ***Thank you to the faculty of the 2017 World Live Surgery Workshop—FUE Immersion!*** Polish Assistants: Ewa Czerniak, Mariola Reszke, Hanna Rodykow, Malwina Stasiak, Natalia Wojcik. Assistants of the Guest Surgeons: Marie-Pierre Delier, Tina Lardner, Vivian de Mello, Daniela Ravlija, Danielle Rodrigues, Elizabeth Romero. Assistants for ISHRS: Laurie Gorham, Aileen Ullrich *(not pictured)* ![Figure14](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F14.medium.gif) [Figure14](http://www.ISHRS-HTForum.org/content/27/6/242/F14) **ISHRS World Live Surgery Workshop Staff** *L to R:* Liz Grganto (Meeting Planner), Victoria Ceh (Executive Director), Melanie Stancampiano (Program Manager), Sheri Valskis (Project Manager) ![](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F15/graphic-15.medium.gif) [](http://www.ISHRS-HTForum.org/content/27/6/242/F15/graphic-15) ![](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/27/6/242/F15/graphic-16.medium.gif) [](http://www.ISHRS-HTForum.org/content/27/6/242/F15/graphic-16) **The ISHRS acknowledges the support of the Mayor and the Salus Medical Center President.** Mr. Jerzy Terlecki, Mayor of Polanica Zdrój *(photo on the left)*; Mr. Mateusz Wolfson, President, Salus Centrum Medyczne *(photo on the right)* * Copyright © 2017 by The International Society of Hair Restoration Surgery