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Follicular Unit Hair Transplants

The average person has more than 100,000 head hairs, plus about 4.9 million more in assorted other places. Hairs on the scalp are arranged in the group of 1 to 4, these groups are called "Follicular Units" or "Follicular Grafts".

Follicular Unit Hair Transplantation (FUHT/ FUT) is a hair restoration procedure where hair is transplanted exclusively in its naturally occurring groups of 1-4 hairs. Because Follicular Unit Hair Transplants mimic the way hair grows in nature so the results, in expert hands, will look completely natural and be indistinguishable from one's original hair.

Hair transplantation techniques-

There are two methods of doing hair transplant- Follicular Unit Hair Transplant (FUHT/ FUT) and Follicular Unit Extraction (FUE). Both technique differs to each other in only how hairs are harvested from donor area, rest part (Hair Graft trimming/ cutting & Implantation to recipient area) are same in both techniques.

  • In Follicular Unit hair Transplantation (FUHT/ FUT) a narrow strip of skin with hair 6 to 15 mm in width is taken from the sides and back of the head. The donor defect is closed primarily with "Trichophytic Closure Technique" with the help of sutures leaving no residual bald area and minimum scarring. The hair from above the incision covers the area so that it is not visible. The donor strip is placed under special dissecting microscopes where the individual follicular units (bearing 1-4 hairs) are carefully dissected. These grafts are stored in a special holding solution and refrigerated while awaiting placement in the bald or thinning scalp (the recipient area).

  • In Follicular Unit Extraction (FUE) Method individual follicular units are extracted one by one directly from the patient's donor area using a specialized extraction instrument/ device with fine punch at its tip.

Properly spaced slits are created with the use of some fine and sharp instruments, in the area where transplant is to be done. In these slits Follicular Units are placed. The 1-hair grafts are placed at the hair line, the 2's immediately behind them and the larger 3- and 4-hair units are placed in the central, forelock area. The depth, angle, and distribution of these slits in the recipient sites are most critical aspect of the hair transplantation if the results are to look perfectly natural. Their proper placement is a special art and skill of the experienced hair transplant surgeon.

Patients can resume normal daily activities on the second/ third day following their hair restoration surgery, although there are some restrictions on strenuous exercise, smoking and drinking. The transplanted hairs may fall in 2 to 6 weeks after the surgery. New hairs start to appear app. 12 to 14 weeks after the surgery and they grow at the rate of about 1-1.5 cm per months.

The transplanted hairs appear just like normal hair, long lasting and grow naturally like other hair and need haircuts later. Shampoo and oil can be applied & they can be combed to the style of your choice.

The entire procedure is done under local anesthesia and the patient is awake and aware during the hair transplantation. Patient listen music or take nape whilst the surgery is done. 08 to 12 people work at the same time, and it takes 7 to 8 hours for a sitting to be complete. The patient goes home immediately after the operation.

One or more sittings of Hair transplant may be required, depending on the severity and extend of baldness. A maximum of, 4000-5000 Follicle Grafts or Follicular Units of hair can be transplanted in one sitting with FUT method and 1500-2500 Follicle Grafts or Follicular Units of hair can be transplanted in one sitting with FUE method. If required, the next sitting can be done after 4 to 8 months.

There are no side-effects of Hair Transplantation. The operation is on the scalp outside the skull bone and the brain is inside the skull, and there are no adverse effects of hair transplantation. Vigorous exercise, swimming, weight training should be avoided for 3 weeks. Light exercise, yoga, stretching can be done 1 week after the hair transplant.

Comparison between FUT & FUE Method of Hair Transplant

  • Both FUT and FUE are excellent techniques, but they have different clinical indications. To deliver the best care for patients, hair restoration surgeon should have expertise in both procedures, and he should offer both the techniques in his practices.
  • Follicular unit extraction (FUE) generally has a quicker patient recovery time and significantly lower post-operative discomfort than follicular unit transplant (FUT).
  • FUE provides an alternative to FUT when the scalp is too tight for a strip excision and enables a hair transplant surgeon to harvest finer hair from the nape of the neck to be used at the hairline or for eyebrows. Follicular unit extraction can also be used to transplant body/ beard hairs to the scalp.
  • There are situations in which both procedures are useful in the same patient. For example, FUT may first be used to maximize yield, but then, after several sessions, the scalp may become too tight to continue to perform FUT, or the donor scar may become wider than anticipated. In the former case, the surgeon can switch to FUE to obtain additional grafts; and in the latter case FUE may be used to camouflage the scar of the FUT procedure.
  • The main advantage of FUT is that it typically (but not always) gives the highest yield of high quality hairs. Therefore, when the patient's primary goal is to achieve maximum fullness, FUT should be performed. The main advantage of FUE is no linear scar. Therefore, when the patient's primary goal is to be able to wear his hair very short, FUE should be performed. FUE is also indicated when there is an increased risk of a widened scar or when body hairs are being harvested.
  • In FUT, the donor strip is removed from the mid-portion of the permanent zone, whereas in FUE, follicular units are harvested from a much broader region to obtain a sufficient number of grafts. Follicles harvested from borderline areas of the donor region may not be truly "permanent, this makes it more likely that, in FUE, some of the follicular units may actually be lost to the balding process over time.
  • FUE harvesting of grafts causes "pit" scarring, small, round, and typically white scars in the patient's donor area where the grafts have been removed. FUT strip harvesting produces a linear scar in the donor area where the strip of skin was removed. Both the pit scarring from FUE and linear scar from strip harvesting are often hard to detect when hair in the donor area is at a normal length and the extraction is performed by a skilled surgeon.
  • In Follicular Unit Extraction the wounds, although small, are left open to heal, leaving hundreds to thousands of tiny scars. Although not readily apparent, this scarring distorts adjacent follicular units and makes subsequent sessions more difficult. This is an additional factor that limits the total available donor supply in FUE. In FUT, the scarring is consolidated into one single line – even after multiple procedures.
  • While FUT procedures using strip-harvesting of follicular units typically guarantees a large number of non-transected high quality follicular units. In FUE, the surgeon extracts follicular units from the donor area one at a time. There is 10-30% risk of transecting (cutting) the follicular units during the harvesting because only the upper part of the follicle can be directly visualized. If the surgeon does not cut deeply enough into the skin, the follicular unit may be extracted without the important lower portion of the follicle and it may not survive the transplant. These factors can result in lower quality or damaged grafts, making them more fragile and subject to poor growth.

LEFT: A 3-hair follicular unit obtained via FUT and dissection under magnification. Note that the follicles and protective connective tissue are intact.

RIGHT: A 3-hair follicular unit obtained through manual FUE. Note the transected follicle and bulbs devoid of protective connective tissue

  • Graft survival is also affected by time out of the scalp and exposure to air (especially in vacuum extraction devices used for FUE).
  • For patients undergoing an FUE hair transplant, in most cases the entire scalp must be shaved in advance of the procedure. For patients undergoing an FUT procedure, only the strip of hair to be removed is trimmed, allowing patients to return to their normal lives much more quickly, without others being aware they have had a hair transplant.
  • FUE takes more time and produce lesser grafts in comparison to FUT method, so FUE is costlier.
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