Follicular Unit Transplantation (FUT)

Hair transplantation is the process of moving donor hair to a bald or thinning recipient area. We want to accomplish this in a manner that ensures the patient will be satisfied with the results. Patient satisfaction is dependent on meeting his / her expectations of naturalness and density

There has been a revolution in hair transplant techniques in the last 10 to 15 years. In the earlier days of hair transplants, punch grafts were used which led to the pluggy look. This is no longer the method used - the desire to improve the 'naturalness' of the results has led to the use of progressively smaller grafts. This significant advance was made possible when surgeons observed that, when examined through a microscope, hair could be seen to grow in small, naturally occurring groups of 1-4 hairs called Follicular Units (FU). Following this observation, surgeons began using microscopic magnification to take grafts that keep these natural groupings intact and the procedure called Microscopic Follicular Unit Grafting was born. With these tiny grafts the surgeon can replace hair exactly as it is found creating results so natural it is virtually undetectable even under close examination.

Continual improvements and advancements have occurred in the field. Some of these innovations include Follicular Unit Extraction (FUE), mega-sessions, dense packing, lateral slit technique, trichophytic closures and more.

Follicular Unit Grafting

Follicular Unit Transplantation (FUT) is the state-of-the-art procedure used in hair transplantation. Hair grows in natural groupings called follicular units. With this procedure hair is removed from the donor area and microscopic magnification is used to create grafts that keep these natural groupings intact. The grafts are then placed in tiny micro incisions created in a pattern and distribution that mimic nature. An overview of the procedure is seen below:

As you can see, the procedure can be divided into four main parts: Donor Harvesting, Graft Preparation, Creating Recipient Sites and Graft Placement. Each step is an integral link in the chain that creates a successful hair transplant.

Meeting a patient’s expectations of both naturalness and density are the two most important goals in hair restoration surgery. With the modern technique of FUT we can accomplish these goals on a consistent basis. However the tiny grafts used in FUT are delicate and the procedure has to be performed correctly in order to ensure good survival and natural results. Over the past decade each step in the procedure has continuously been modified and improved to ensure better and more consistent results.

The first step in this procedure is the removal of the donor strip from the recipient site in a way that ensures minimal damage to the donor hairs and minimal scarring to the donor area after the tissue is sutured together. First the surgeon identifies the safe donor area (the portion of donor hair that is meant to last forever). Then the hair is cut short at the site where the strip is going to be removed.

Before removing the donor strip it is important to evaluate the donor area density so the correct amount of tissue can be used and the correct amount of grafts created. We also test the laxity of the scalp in order to calculate the safe amount of tissue we can remove without causing tension or scarring. After the strip is removed the donor area is sutured closed with a recent advancement called a trichophytic closure. This technique helps limit any scar that develops in the donor area because it allows hair to grow through the scar to minimize its visibility.

GRAFT PREPARATION

Once the strip is removed it has to be dissected down into the individual 1-4 hair follicular unit grafts. This is a vulnerable point in the procedure that risks trauma to the grafts. It must be performed with skill and efficiency.

The first step in graft preparations is to “sliver” the donor tissue under a microscope into thin sections only 1-2 hairs wide. It is similar to cutting a loaf of bread only on a microscopic level. With the use of a high-powered microscope the tissue can be converted into thin slivers with almost no trauma or transection. Next the slivers are cut down into the individual 1-4 hair follicular unit grafts and trimmed of as much excess tissue as safely possible. This trimming creates the smallest possible graft that then enables us to use the smallest possible incision which ultimately means less trauma and better graft survival. This step is also done under microscopic magnification.

It is important that the grafts remain hydrated, be kept at the proper temperature and receive nutrients. We use special holding solutions to help maximize survival.

CREATING THE RECIPIENT SITES

While the grafts are being prepared the surgeon is creating the recipient sites. This part of the procedure is extremely important and uses a combination of skill and experience. Before any incisions are made the surgeon plans the best pattern and distribution of grafts by evaluating the patient's donor supply, balding area and expectations.

In addition to planning the recipient sites the surgeon has to have the skill and technique to create the incisions successfully. This means the surgeon has to be able to make thousands of tiny incisions in such a way that will ensure maximum survival of the grafts, minimal trauma to pre-existing hair and the proper exit angle and direction of the grafts.

PLACING

Placing is the final step in the hair transplant process. It is also a critical step because poor placing can lead to trauma and poor graft survival. The technical skills required in placing are experience, dexterity and using the gentle touch placement of the grafts which allow the placer to focus on direction and orientation to ensure each graft is inserted with as little trauma as possible and good growth is obtained.