It has taken decades for surgical hair restoration to arrive at the current state-of-the-art techniques. Over the years there has been a number of donor harvesting and graft placement techniques. All with varying degrees of risk. That included unsightly scarring to unnatural hair placement and poor yield. Older methods included punch grafting, flap surgery and scalp reductions. Before finally arriving at Follicular Unit Grafting techniques of donor management and graft placement. Follicular Unit Transplant (FUT) and Follicular Unit Extraction (FUE).
Permanent Hair Restoration
Surgical hair restoration (hair transplantation) permanently moves hairs follicles to areas previously affected by hair thinning and loss. Even with advanced stages of male pattern baldness. Men retain a band of hair around the sides and back of their heads. This hair is genetically strong. Being immune from the affects of the DHT hormone. That triggers the male pattern baldness gene. Affecting the hair over the top of a man´s head. With a hair transplant. The doctor “harvests” hair follicles from the back and sides of the head. When transplanted correctly the hair grow. Permanently in the new area.
Follicular Unit Grafting
Regardless where on the scalp hair grows in groups. Hair groups are called “follicular units”. They vary in size from a single hair to a four hair follicular units. With an average of two hairs per follicular unit or graft in relation to a hair transplant procedure. Following the dissection, trimming and cleaning under magnification. Technicians start to place the follicular units in the recipient sites.
One hairs units are used along the hairline. Along the very front three or four irregular rows. Two-hair follicles are positioned behind the single hairs. Then followed by the three and four-hair follicles. Attention is paid to the correct angulation and direction. Along with the increase in density. The surgeon can mimic nature, ensuring the outcome is completely natural.
Follicular Unit Techniques
The latest hair transplant techniques largely differ in respect to donor hair management. The extraction techniques to remove the hair follicles from the donor area. Each technique has pros and cons. Some candidates are more suitable for one technique over the other. Some have the luxury of choosing the technique they prefer. While some benefit from combining the techniques into one session. As a result, maximising the number of grafts that can safely be removed in one session. Also help repair patients maximise their donor hair characteristics.
The donor hair management is the main difference in the techniques. The remaining aspects of the hair transplant procedure are relatively the same. The grafts are divided, cleaned and checked by the hair technicians. Performed under magnification. Separated into the natural groups of one to four hair follicular units. The placement of the hairs is the same. The technicians place the hairs units into the ready made recipient sites created by the Doctor.
Follicular Unit Transplant -FUT
FUT has been the standard donor harvesting method for many years. Follicular Unit Transplant removes a hair bearing strip from the donor area. The technique is commonly known as “Strip” as it denotes the method of extraction. The strip is taken from an area rich in a high density of hair follicles from around the back and sides of the head. Situated well within what is considered to be the donor area safe zone. The area affected by the male pattern baldness gene. Along the occipital bone that slightly protrudes at the back of the head.
The length and width of the strip is dependent on certain factors. The number of grafts required to treat the area of hair loss is calculated. The next step is to measure the donor hair density. This is a calculation of how many follicular units there are per cm 2. At least three measurements are taken around the back and sides of the head. Within the area the strip would be removed. The skin laxity is measured. Too tight or too loose can affect the closure by suture. This can be tempered by the width of the strip to remove any undue tension when being closed.
Once the strip length and width is calculated the area can be shaved and cleaned. Prepared with a local anaesthesia ready for the Doctor to make the incision to remove the strip and then suture the area. The sutures can differ dependent on the Doctor. From self dissolvable to permanent to staples. Suturing and closure techniques can allow for hair to grow back through the scar line. This can help to camouflage the area. Even with a short hairstyle a good FUT suture line can be hard to detect.
The strip is then divided into smaller sections and distributed amongst the hair technicians. Each technician working under magnification to first separate the individual units from the strip. Then clean and trim each unit. They are stored in a holding solution to keep them well hydrated and to stop from drying out.
A candidate with good healing can have multiple FUT procedures over time. With each session removing the old suture line to leave only a minimal change to the donor area. The strip is then divided between the hair technician to be carefully separated into the individual follicular units.
Follicular Unit Extraction – FUE
FUE is the newer of the two donor management techniques. This technique removes the need to use many surgical skills such as suturing. Often known as a blind technique as it is not possible to see below the surface of the skin. The Doctor relies on experience to judge the exit pint of the hair shaft to determine the hair follicle angle below the skin.
The FUE donor surface area is wider than that of the FUT technique. But it is harder to determine the safe zone. Especially when treating minor hair loss patterns. The donor area is first shaved. This allows the Doctor to measure the average hair density over the entire surface area. By using the widest surface area possible to extract the hairs minimises any hair density loss in the donor area. The hair density is highest around the back of the head. Also having a higher concentration of three and four hair follicular unit units. The area is also checked for any signs of hair miniaturisation. That would affect the quality of the hair transplant result.
Follicular Unit Extraction traditionally used a manual hand-held cylindrical punch instrument. This would make the incision around the hair follicle. ready for the graft to be extracted. In recent years motorised and now robot punches are also used to extract the hairs. The size of the punch instrument used can vary in diameter. Generally considered that under 1mm in diameter gives the best results in respect to the skin healing. Each follicular unit is extracted one at a time. Making each punch like an individual procedure. It can be a longer procedure to perform compared to FUT as a result. Often being performed over two consecutive days. If the number of graft required is high.
Even though the hair follicles have been removed intact. They are still checked under magnification. This ensures the quality of the hair transplant result. The grafts are cleaned and trimmed of any excess tissue and then separated into the natural sizes of the groups.
Superficially donor healing is fast. Often with no need for any bandage to cover. The small wounds close and scab over. As a result after post-healing any loss of hair can be hard to detect. The small punch marks once healed can disappear within the remaining hair in a random pattern. A good FUE candidate can have multiple procedures overtime with good donor hair management. Using the donor surface area to spread the extraction reduces the risk of any noticeable loss in hair density.
Healing and Hair Growth
Each Clinic will have their own protocol for post-op care. It is important to follow the instructions provided to you. If in doubt ask the Doctor who performed your hair transplant procedure. It is normal to take a few days away from work after your hair transplant. Follicular unit procedures typically heal relatively fast. Crusts form over the recipient area. Over the area of graft placement. The crusts may last a few days after the procedure. With careful washing the crust are released from the skin. The donor area care will vary dependent on the technique used. Patients often wear a hat or a cap temporarily. Most patients choose to take a few days off work, until the grafts are not evident. Refrain from strong sunlight, chlorinated water and heavy exercise for the period specified by your Doctor.
About four weeks after surgery the transplanted hair will fall out. This is perfectly normal. The transplanted hairs start to regrow around three months post-op. Typically the yield of transplanted grafts is greater than 90% on a virgin scalp. Lower yields can occur when performing a repair of a previous hair transplant. Over the next twelve to eighteen months the transplanted hair grows and matures month on month.