The Fox procedure states there are 5 different categories ranging from FOX 1 through FOX 5. FOX 1 states that all the follicles are removed intact using the techniques described by Rassman and Bernstein. FOX 2 states that the trans-section rate is 20% or less but that the surrounding fat is removed from the follicles. Rassman and Bernstein stated that anyone that was a FOX 1 or a FOX 2 was a good candidate for the procedure. FOX 4 is described as most of the surrounding fat is avulsed and a number of distal follicles are avulsed. FOX 5 individuals have significant damage in virtually all the grafts with avulsion of the upper segment from the lower segment. Fox 3 individuals were not well described except to state that they were neutral. This meant that the damage to the follicles was significant and that the FUE procedure was indicated only if there were strong indications for the procedure such as a tight donor area, significant scarring, a depleted donor region that would yield very few grafts by strip harvesting alone.

To the credit of Rassman and Bernstein they enrolled 200 patients in a study to assess their candidacy for FUE. They found that 52.5% of all patients were either FOX 1 or FOX 2. As previously indicated FOX 4 and 5 patients were not candidates for surgery and FOX 3 patients were borderline candidates based on indications for the procedure. The description for each category was quite vague and allows for considerable individual physician discretion and interpretation. The results of this study are outlined below, but the vagueness of each categorical description should be fully understood. It is the opinion of this author that the categories are without adequate description and too subjective to have clinical significance. The most striking objective finding is that in the hands of Rassman and Bernstein and utilizing their techniques only 52.5% of all patients are a candidate for follicular unit extraction (FUE). Furthermore, only one out of four patients has a low trans-section rate and can be considered an ideal candidate for FUE.

Fox Class # Patients % of total
1 53 26.5%
2 72 36.0%
3 23 11.5%
4 20 10.0%
5 32 16.0%
Total 200 100%

Our techniques have shown that almost all individuals are strong candidates for Follicular Isolation or the equivalent to a FOX 1. Furthermore, we have found that no single technique is necessarily ideal for every patient and that a variety of techniques are necessary to convert all patients to ideal donor extractions. This The techniques we utilize are significantly different from those described by Rassman and Bernstein. As a result, we have not difficulty in side stepping the acronym FUE in favor of CIT. We believe that CIT is far more scientific and we know it is far more successful than FUE.

Woods Technique or Top Up technique:

No one knows exactly what the Woods Technique is. Ray and Angela woods were perhaps the first to utilize the extraction of individual follicular groups from the donor region. We know that Inaba described a similar technique for the extraction of single hair grafts in his text that was published in 1996. We do not know if Inaba used this technique earlier than 1996 and we will never know since Dr. Inaba has passed away. Ray and Angela Woods have reportedly used their techniques for follicular extraction since the early 1990s. Over the years some photographs have materialized which indicate their technique once used a larger punch and resulted in more significant scarring. More recent photographs and patient testimonials indicate that their techniques have evolved significantly and now result in far less scarring.