Follicular unit transplantation
Follicular unit transplantation (FUT) was the most significant advance in hair restoration since hair transplants were introduced in the U.S. in 1959.
In follicular unit transplantation, hair is transplanted from the permanent zone (from the back and sides of the scalp) into areas affected by balding, using only the naturally occurring, individual follicular units. Drs. Bernstein and Rassman first described this procedure in the 1995 Journal of Aesthetic and Restoration Surgery. Because of its superior aesthetic results, follicular unit transplantation soon became the gold standard for hair transplantation surgery worldwide.
An essential component of FUT is the use of stereo-microscopic dissection — a technique developed by Dr. Limmer in the late 1980s for dissecting micrografts. Applying this technique to FUT, all the follicular units are removed from the donor tissue under microscopic control to avoid damage.
Complete stereo-microscopic dissection increases the yield of the number of follicular units as well as the total amount of hair (upwards of 25 percent). The hair seems to come out of a single hole and that the hairs are bundled together in their naturally growing groups.
The essence of the follicular unit approach to hair transplantation is that the characteristics of the patient’s hair dictate the size of the implant (rather than the doctor or the surgical team). For example, single follicular units are placed in such a way as to create the natural look of gradually increased density as you go further back behind the hairline.
Still, the surgeon determines distribution, hair direction, and the balance between smaller one-hair grafts and larger two-, three-, and four-hair grafts. By preserving both the natural physiologic and aesthetic elements of your own hair, the best cosmetic results can be achieved.
While the term “follicular unit transplant” may be in vogue with most savvy patients and doctors today, not all doctors and their staff have the knowledge or the technical capacity to perform a large transplant made up exclusively of follicular units.
Very few surgeons and practices have mastered the ability to adequately control quality while performing FUT and follicular unit extraction because the learning curve is very slow and the doctor must commit considerable time and money to this endeavor.
Instead, some medical groups may use different graft sizes and hybrid techniques to speed up the process — at the expense of the final result.
Here are some of the many advantages of FUT over minimicrografting or DFUs:
FUT, when placed in adequate quantities, produces a fuller look because the grafts can be of the same size (or even smaller) than micrografts yet contain more hair and less skin.
The growth is more consistent with FUT than when the follicular units are split up, and dividing the units increases the risk of follicular injury.
Because follicular unit grafts are less bulky than DFUs, recipient wounds heal more quickly. The sites in the recipient area are smaller, making the results look more natural.
FUT allows the surgeon to distribute grafts to mimic the way hair grows naturally in the patient’s own scalp.
Because of the greater precision of the harvesting process, FUT enables the surgeon to restore more hair using a smaller amount of donor tissue than with minigrafting, micrografting, or DFUs.
The skin between the follicular groups is trimmed away when only follicular units are used, and the vital support structures around the unit are preserved. Cobblestoning (irregularities in the surface of the scalp) and depigmentation (the appearance of whitish blemishes on the transplanted skin) are avoided because excess skin in the grafts is removed, making the grafts significantly less bulky and the holes that they’re placed into much smaller.
Because of the very small recipient sites, larger concentrations of follicular units may be safely placed into the bald area, opening the possibility of creating a higher hair density in a single session. More density in these recipient sites reduces the necessity for multiple procedures. The patient benefits significantly with less time devoted to hair restoration surgery without sacrificing the quality of the grafts on close inspection.
With the goal of harvesting follicular units from the back of the scalp without a linear scar, a number of doctors began working on a direct extraction technique. In 2002, Drs. Rassman and Bernstein described their technique, called follicular unit extraction (FUE), which we discuss next. This procedure allows the surgeon to remove individual follicular units directly from the donor scalp with a punch of 1 millimeter or less in size instead of a linear donor incision.
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Note: This article was sent to us by: Lionel Venera at 06192010
1. Minigrafts and micrografts consist of multiple follicular units
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