How I Do It: Using Velcro to Assist with Non-Shaven FUE
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* Timothy Carman
* Marie A. Schambach

1.  Timothy Carman, MD, FISHRS (tcarmanmd{at}mac.com)
    1.  La Jolla, California, USA

2.  Marie A. Schambach, MD (marieschambach{at}schambach.clinic)
    1.  Guatemala City, Guatemala

## Abstract

Non-shaven follicular unit excision (FUE) can have cosmetic advantages over the traditional method wherein the donor area is routinely shaved completely. Dr. Marie Andree Schambach de Bouscayrol shares with us a unique implementation of Velcro for assisting in this procedure. It’s these “Aha!” moments that we each may experience that we can share with each other here in “How I Do It.” Sharing our ideas with one another makes us clinically stronger as a collective group in the ISHRS. Please feel free to email me your ideas at tcarmanmd{at}mac.com for consideration.

  
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As a scientist, making a true discovery can be an amazing achievement. Accidental discoveries, however, have taken place throughout medicine’s history and have resulted in some very important breakthroughs that have affected/enhanced human survival, with such examples as penicillin, Viagra, X-rays, and warfarin, to name a few.

In the case presented here, I accidentally figured out Velcro could take on an important and facilitating role during my surgeries after my own hair got tangled in a piece of Velcro while helping my son with a science project. How was it possible that such a little piece of fabric would remain so stuck in my hair? Yet, I found that, with patience, I could remove my hair, strand by strand, without it being torture (Figure 1).

![FIGURE 1.](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/28/1/14/F1.medium.gif)

[FIGURE 1.](http://www.ISHRS-HTForum.org/content/28/1/14/F1)

FIGURE 1. Velcro attached to my own hair.

I have been trying to perform a faster version of the non-shaven FUE procedure, yet I needed something that would keep my patients’ hair in place while extracting and also allow me to remove small strands of hair in “lines,” so that I could have access to almost all available follicular units by just moving this “something” upward. I had thought of curved combs, headbands, and elastic bands, but could not come up with the solution. But then it happened! My hair accidentally got stuck—really stuck—on Velcro! So, I ran to a hardware store and saw two different types of Velcro: the dual lock and the hook and loop (Figure 2). I further realized that Velcro is available in many different design variabilities: thickness, tightness, long loops, and small loops. So, I bought one of each and tested them.

![FIGURE 2.](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/28/1/14/F2.medium.gif)

[FIGURE 2.](http://www.ISHRS-HTForum.org/content/28/1/14/F2)

FIGURE 2. Types of Velcro: dual lock *(left)* and hook and loop *(right)*.

After testing them all, I found that medium-long loops work the best, holds the hair tight enough, and yet allows me to extract the small strands of hair as I need with the tail of a small comb. I found a brand of Velcro that has adhesive on the opposite surface, and this allows me to place the “soft loop” part of the Velcro to the forehead from temple to temple (Figure 3). I then secure the “hook” strip of the Velcro from one temple around the back of the head to the opposite temple. As I wrap the Velcro around the back of the head, I comb the hair upward, advancing the Velcro with the hook side facing towards the hair (Figure 4). I finish by attaching the hook end tip to the soft loop side at the other temple point.

![FIGURE 3.](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/28/1/14/F3.medium.gif)

[FIGURE 3.](http://www.ISHRS-HTForum.org/content/28/1/14/F3)

FIGURE 3. Remove cover from soft loop side as shown *(left)* and stick at forehead from temple to temple.

![FIGURE 4.](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/28/1/14/F4.medium.gif)

[FIGURE 4.](http://www.ISHRS-HTForum.org/content/28/1/14/F4)

FIGURE 4. Velcro wraps around the back of the head with hook side facing towards hair.

Now you can remove hair from under the Velcro with the thin tail of the comb and make sure it’s a straight line where you can visualize the follicular units and their inclination (Figure 5). This allows you to visualize the exit angles of follicular units and start your excisions, moving along the whole Velcro border line, as your technician extracts right behind you, giving you feedback on the excision quality (Figure 6).

![FIGURE 5.](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/28/1/14/F5.medium.gif)

[FIGURE 5.](http://www.ISHRS-HTForum.org/content/28/1/14/F5)

FIGURE 5. Remove hair using thin tail of comb.

![FIGURE 6.](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/28/1/14/F6.medium.gif)

[FIGURE 6.](http://www.ISHRS-HTForum.org/content/28/1/14/F6)

FIGURE 6. Visualization of exit angles and technician extracting for immediate feedback

Once you’ve finished with the extractions in that particular line, just pull the Velcro a couple of millimeters towards the vertex, and remove small strands of hair from under the Velcro with the thin tail of your comb along the whole perimeter as described previously (Figure 7). Comb these strands of hair to see the natural exit angle of the follicular units. Start excisions again, moving along the lower Velcro border within the safe donor area (Figure 8).

![FIGURE 7.](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/28/1/14/F7.medium.gif)

[FIGURE 7.](http://www.ISHRS-HTForum.org/content/28/1/14/F7)

FIGURE 7. Remove small strands from under the Velcro along the perimeter.

![FIGURE 8.](http://www.ISHRS-HTForum.org/https://www.ishrs-htforum.org/content/htfi/28/1/14/F8.medium.gif)

[FIGURE 8.](http://www.ISHRS-HTForum.org/content/28/1/14/F8)

FIGURE 8. Excisions move along the lower Velcro border within the safe donor area.

Having perfected this trick, I can now perform non-shaven FUE surgeries more efficiently without “precutting” a larger amount of hair. This allows more styling options for my patients following surgery. Best of all, Velcro is an inexpensive and disposable!

Like Thomas Edison said, “Ideas of genius are 1% inspiration and 99% perspiration.”

*   Copyright © 2018 by The International Society of Hair Restoration Surgery

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