In follicular unit hair transplantation, the surgeon removes a strip of skin from the donor’s head and stitch it back by Trichophytic closure using absorbable and non absorbable sutures. This strip then undergo slivering and individual hair follicular units are separated out of it.These follicular units are then transplanted in the tiny slits prepared in the scalp where hair is thin or nonexistent. This procedure does not produce an unnatural look as produced in punch grafting where larger grafts are used. The results of this newer method mimic the way hair grows naturally.
Key principles of follicular unit extraction
Preservation of follicular viability
- ■ Follicular unit is an anatomic entity. This entity is preserved intact during graft dissection and while the graft is transplanted. It gives good results after transplantation.
- ■ In FUT, using a high end magnification microscope the individual follicular units are separated with utmost care.
Ensuring natural look in the transplanted hair
- ■ This procedure aims to produce a natural look both at the follicular unit level and at the overall graft distribution level.
- ■ A follicular unit consists of about 4 hairs, transplanting hair as follicular units ensures that the transplanted hair units will be identical with those existing in its surroundings.
- ■ When the transplanted hair grows, an overall natural look will be produced.
- ■ In trichophytic closure hair grows through the scar line also in FUT technique.
Proper surgical planning is possible
The follicular units of hair have a density of one unit per square millimeter. This enables the surgeon to make a clear estimation about the number of follicular units that can be obtained from a strip of a given thickness. Normally, the donor area of the patient will be having sufficient density of hair. If the density of hair is less in this area, the surgeon may suggest suitable treatment modality.
To induce normal hair growth after transplantation, the trauma caused during the transplantation has to be minimized. This is achieved by trimming the extra tissues around the follicular units and then inserting them into the small ports in the patient’s bald area. Larger wounds that caused during plug grafting can create cosmetic problems like dimples, pigment change, elevations or depression around the grafts.
As no extra tissues exist around follicular units and as the site for the implantation of these grafts are made very thin, no difficulty occurs in placing the follicular units in an exact fitting manner.
Large hair transplant is possible in a single day
In follicular hair transplant, the surgeon will be able to transplant large number of grafts in a single day. Its benefits include:
As the transplantation can be completed in one sitting minimal interference in the normal activities of the patient.
Large number of grafts compensates for the shedding of hair called telogen effluvium.
Scar line is very minimum and natural hair grow through it .
FUT versus FUE
- ■ In FUT hair is harvested as strips and is dissected with the help of special microscopes to get follicular units.
- ■ In FUE follicular units are removed from the scalp using a specialized punch like instrument which is less than 1 mm thick.
- ■ FUE does not leave a scar, causes relatively less bleeding, less discomfort and requires no sutures.
- ■ FUT procedure leaves a very minimum scar line in donor area but hair growth is seen in that area as well as it is closed using Trichophytic closure.
- ■ The experience of the hair transplant team, combined with the quality of the extracted graft is the most important factor which determines the success of a hair transplant.