Techniques FUT
Friday, 09 March 2012 17:36

What is Follicular Unit Transplantation?

Follicular Unit Transplantation (FUT) is a procedure in which hair is transplanted from a permanent zone, the area in the back and sides of the scalp where hair is more resistant to balding, to the bald or balding areas of the scalp. This is accomplished using naturally occurring groups of 1, 2, 3, or 4 hairs, these are known as follicular units. After the patient’s scalp is anesthetized by the Surgeon, the Surgeon removes a strip of tissue from the donor area, an area within the permanent zone. Once extracted, the donor strip is cut into multiple individual follicular units using microscopic dissection techniques. As these follicular unit grafts are being prepared by our highly skilled & experienced techs, tiny little pricks in the scalp are made, called recipient sites, where the grafts are placed.

The arrangement and positioning of these follicular unit grafts determines the aesthetic qualities of a hair transplant, and so this arrangement must be decided on a case-by-case basis, depending on the patients’ history of hair loss and likelihood of future hair loss. Because follicular unit transplants mimic the way hair grows in nature, the results, in expert hands, will look completely natural and be indistinguishable from one’s original hair. See some of these results during your free initial consultation.

The major advance by Follicular Unit Transplantation is that in FUT, the use of special stereo-microscopes enables surgeons and staff to meticulously dissect the hair grafts. This helps preserve the integrity of the follicular units and allows us to keep all of the growth elements of the hair follicle intact. The survival of the grafts is maximized and as a result, both the hair transplant and the underlying skin will look completely natural when the transplant matures over time. With FUT, thousands of grafts can safely be transplanted in one session, allowing the patient to complete the hair restoration as quickly as possible.

Graft Dissection

One of the most key, important aspects of Follicular Unit Hair Transplantation is the use of stereo-microscopic dissection. This allows follicular units to be removed from the donor strip without being broken up or damaged. During the dissection, it is critical that the whole follicular unit is kept intact as this will maximize its growth. Intact follicular units will also give the most fullness to the hair restoration, as they contain the full, natural complement of 1-4 hairs.

Recipient Sites

The recipient sites in all of our hair transplant procedures are generally made using lateral slits (also called coronal or horizontal slits). Lateral slits have the advantage of orienting the hair within the follicular unit to match the way it grows in nature. They give the hair transplant surgeon and technician the highest degree of control over the direction and angle in which the transplanted hairs will ultimately grow.

Follicular units placed in lateral slits will provide more coverage than those placed in vertical slits, as the hair tends to fan out over the surface of the scalp rather than lying on top of one another. Lateral slits also helps to angle the grafts more acutely and to follow the natural angle of the patient’s original hair. This is particularly important at the temples, in the crown, sideburn areas and in eyebrow restoration.

To create the recipient sites, we use a variety of instruments depending upon the patients situation. In all hair transplants, the goal during the procedure is to create a snug fit between the follicular unit and the skin surrounding the graft. This will maximize oxygenation of the grafts, promote healing and increase graft survival. Tiny recipient sites also helps to ensure that there will be no visible scarring, pitting or other surface irregularities as a result of the hair restoration procedure.

Controlling the depth of incision is also critical in making the recipient sites, as limited depth incisions minimize injury to the deeper blood vessels in the scalp, allow grafts to be placed more closely together, decrease tissue swelling after hair transplant surgery and facilitate healing.

We use fine hypodermic needles or a series of custom made, ultra-fine blades to create the hair transplant recipient sites. The chisel-shaped blades differ in size by increments of one tenth of a millimeter and range from 0.6mm for single-hair follicular unit grafts to 1.5mm for 4-hair follicular units.

Before site creation begins, the different size follicular units are fitted to specific site sizes to determine exactly the best size instrument to use for each graft.

Donor Area

Minimizing the scar from the donor incision is a critical part of a successful hair transplant procedure. A fine donor scar allows a person to keep his/her hair relatively short after the hair restoration (if one wants to do so) and increases the amount of hair that can be harvested (removed) in subsequent hair transplant procedures if desired. For patients with short hair, this offers an acceptable alternative to FUE (Follicular Unit Extraction), which is typically a less efficient (and often times more expensive) way to harvest hair from the donor. A number of techniques have been developed to minimize donor scarring when using a strip excision during follicular unit hair transplants. These include the use of tumescent anesthesia, undermining, absorbable sutures, buried sutures, staples, and trichophytic closures. The technique of FUE Follicular Unit Extraction, where follicular units are removed directly from the scalp without a linear incision, is covered in another section. Follicular Unit Extraction FUE.

Strip incisions are widely used because they enable the hair transplant surgeon to efficiently perform large hair transplant sessions and, at the same time, minimize damage to hair follicles. The reason this is possible is because the strip of donor tissue that is removed from the scalp is placed under a series of stereo-microscopes where the individual follicular units can be dissected from the tissue under direct visualization.

There are five main aspects to having the donor incision heal in a fine line; 1) placing the incision in the proper location 2) using the correct donor strip dimensions, 3) removing the strip without damage to the tissue, and 4) closing the donor area with impeccable surgical techniques, and 5) having a Board Certified Plastic Surgeon.

Position of the Donor Incision

The ideal placement of the donor incision is in the mid-part of the permanent hair zone located in the back and sides of the scalp. This area lies in a band that starts above the occipital protuberance (the bump felt in the middle part of the back of the scalp) and extends to either side in a gentle, upward sloping curve that follows the contour of the scalp. If hair is harvested below this region, there is a greater risk of scarring from the wound stretching, since the incision will be too close to the muscles of the neck. If the incision is above this area, the hair may not be permanent and may fall out as the baldness progresses.

Size of the Donor Strip

Although the length of the donor incision is determined predominantly by the number of follicular unit grafts required for the hair restoration, the width (height) of the donor incision depends upon the patient’s scalp laxity. This is a genetic attribute of the patient’s scalp that must be carefully measured by the hair transplant surgeon during the pre-operative evaluation. With good scalp laxity, a wider strip may be harvested from the donor area without the risk of scarring. If the scalp is too tight, taking a normal size strip may be impossible.

Natural follicular unit hair transplantation is best for:
1. Treating baldness, thinning hair, & receding
hairline.
2. Growing the widow's peak/charming.
3. Covering any scar on the scalp. For example, 
scars from a face-lift surgery.
4. Growing/Thickening eyebrows.
5. Growing a beard, moustache, or sideburns.
6. Growing pubic hair, umbilical hair, chest hair,
nipple hair, body hair, etc.
7. Finalizing touches for a feminine hairline from
sex reassignment surgery.

Follicular unit hair transplantation steps:
1. Consultation: to find out exactly what can be done;
the amount and density, number of sessions, etc.
2. Morning of surgery: shampoo with an antiseptic shampoo
to kill all the germs in the scalp.
3. Drawing the Hairline and locates where to transplant hair.
4. Hair transplantation surgery is performed at our office following strict sterilized techniques.
5. Anesthesia:
Clients can be either asleep or fully conscious using
a local anesthetic cream and spray with an injection.
6. Donor harvesting: removing permanent hair from the  
back of the scalp.
Strip harvesting: using the follicular splitting technique
to avoid damage to the hair root.
Or Follicular Unit Extraction (F.U.E.): extracting only
the hair root to avoid scars after surgery.
7. After the skin and hair root is obtained from harvesting,
the scalp's skin is further dissected into smaller follicular
units using a microscope.
Follicular units can be 1 hair unit, 2 hair units, 3 hair
units,and infrequently 4 hair units.
Follicular units from the body can be 1 or 2 hair unit(s).
8. Donor harvesting: removing permanent hair from the  
back of the scalp.
Strip harvesting: using the follicular splitting technique
to avoid damage to the hair root.
Or Follicular Unit Extraction (F.U.E.): extracting only the
hair root to avoid scars after surgery.
9. Implanting or inserting the follicular unit into the slit hole from the first FU to the last FU; 500-5000 follicular units.

10.Dressing the wound: light dressing or no dressing
depending on the style of hair and amount of follicular
units transplanted.
11. Clients leave our office with pain medications
and antibiotics.

12. Some clients will experience swelling of the forehead
for 2-7 days.
13. The red dots from the hair transplantation are scabs
(dry blood from surgery) and they will fall out in
10-14 days.
14. Return 7 days after surgery to our office for
stitches to be removed (clients who use absorbable
stitches will not need them removed).
15. In 2-3 months, new hair will start to grow and clients
may have some cysts or acne like lesions on the
transplanted area. About 5% of the transplanted site
will develop into a cyst. The cyst will completely
disappear after all the new hair grows. A cyst may be
caused by:
Ingrown hair.
Oil accumulated under the skin from a newly
functioning sebaceous gland that cannot get through
the skin's surface because there is no hair shaft.
Clients can use a hot pack on the cyst to help or just
leave it alone and wait it out.
16. 3 months after surgery, new hair will start to grow.
6-8 months after surgery, 95% of the newly
transplanted hair will have grown. The remaining 5%
will keep growing within 3-5 years.

 

Excellent Hospital of Cosmetic Surgery

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