Hair Transplantation - Follicular Unit Transplantation
Follicular Unit Transplantation (FUT) is a technique where hair is transplanted from a permanent zone in the back of the scalp into areas affected by genetic balding. This uses only the naturally occurring individual follicular units. In order to remove follicular units from the back of the scalp without damaging them, the donor tissue is removed in one piece. This technique is called “Single Strip Harvesting” and is an essential component of follicular unit transplantation as it not only preserves the follicular units, but prevents damage (transaction) to the individual hair follicles. It differs dramatically from the “Mini-Micrografting” technique of using a multi-bladed knife that breaks up follicular units and causes unacceptable levels of transaction of hair follicles. The other harvesting technique, Follicular Unit Extraction (FUE), allows the surgeon to remove individual follicular units without a linear donor incision. The most essential component of FUT is “Stereo-Microscopic Dissection”. In this technique all the follicular units are removed from the donor tissue under microscopic control to avoid damage. Complete Stereo-Microscopic dissection has been shown to produce an increased yield of both the absolute number of follicular units, as well as to total amount of hair, (upwards of 25%). (This process differs from mini-micrografting in which the grafts are cut with no microscopical magnification.) A major advantage of follicular unit transplantation, (besides providing follicular units and maximizing growth) is the ability to use small recipient sites. Grafts comprising individual follicular units are small because follicular units are themselves small, but also because the surrounding non-hair bearing tissue is removed under the microscope and doesn’t need to be transplanted. Follicular unit grafts can be inserted into tiny needle-sized sites in the recipient area, which heal in just a few days without leaving any marks. When performed by a skilled surgical team, FUT can provide totally natural looking hair transplants that make full use of the patient’s donor supply to give the best possible cosmetic results in the fewest possible sessions. How is FUT different from Mini-micrografting? This is one of the most commonly asked questions and it is a very important one for those deciding which hair restoration procedure to choose. FUT has graft sizes determined by nature. Mini-Micrografting has graft sizes arbitrarily determined by the surgical team who cut the donor tissue into the size of pieces that they need. Basically Mini-Micrografting means “cut to size”. In Mini-Micrografting neither preserving follicular units nor even keeping hair follicles intact are felt to be that important. The deciding factors are the speed and economics of the procedure. Mini-Micrografting uses a multi-bladed knife or a single bladed knife to quickly generate thin strips or one strip of tissue and then uses direct visualization or backlighting (rather than microscopic control) to cut the tissue. The resulting grafts are generally larger than follicular units and since the excess skin is not trimmed away, the donor sites (wounds) are also larger. The follicular units may be trimmed under backlighting bulb the hair shafts or the hair bulb are transected due to poor visualization and therefore the final results are poor. It should be already apparent from the comparison above that FUT is superior in producing a natural, undetectable result, in maximising healing, and preserving precious donor hair. Your Procedure When you arrive for your hair transplant, the surgical team will begin by discussing the activities of the procedure with you. Your surgeon will review the goals that have been established and will answer any last minute questions that you may have. He will take the time to ensure that there are no outstanding issues, areas of confusion or concerns. The surgical consent form is signed and then followed by taking pre-surgical photographs. Mild medication is given to relax you and make you comfortable. We also give routine antibiotics before and after the procedure. Length of the Procedure Your FUT may require many hours of work by a team of professionals. Some of the longest procedures (between 2000-2500+ grafts) may take hours of surgery and during that time, many highly trained nurses will participate in the process. The work must be organised efficiently so that the total length of the procedure for the patient will be minimised. On average, a procedure of 1000 grafts would last about 6 hours. The Surgical Experience The procedure may be long, but time goes by quickly. You are lightly sedated so that you can sleep if you desire. Most patients choose to watch TV or movies for at least part of the time. We try to make your experience enjoyable so that the actual time the surgery takes is transparent. Some patients may choose to be fully awake the entire procedure. Usually the patient sleeps for a few hours, watches a movie or two, chats with the surgeon and nurses doing the work. You can take a few breaks, visit the bathroom, eat lunch or just stretch and move around. The whole procedure should be a pleasurable experience. Some of our patients even report that they watched all of our team working on them and compared it to watching an orchestra playing beautiful music, while having people catering for their every need! Local Anaesthetic After preparatory medication is given orally, the actual anaesthesia begins. We use a combination of Lidocaine (Xylocaine) which you have probably been given by your dentist, and a longer acting local anaesthetic called Marcaine. Injections are made around the perimeter of your scalp (called a ring block) which will make the entire area of your scalp numb. With this technique, there is no need to use anaesthesia directly in the area that is being transplanted. Once anaesthetization is complete, there is generally no pain or discomfort during the remainder of the procedure. If you do require more, it will be given before the first wears off. The Surgical Team The procedure can be long, and during the initial period when the donor hair is removed, the surgical team must work without stopping. The team must prepare the grafts according to the surgeon’s exacting specifications. The preparation of 2,000 or more grafts and placing them into the recipient area may take a team of hours of intensive, concentrated work. Care must be taken to keep the surgical team free from stress. Just as a patient needs a break, so do the team members. At the clinic we focus on the needs of our staff as well as the patient to ensure that the best-trained staff in the world are always operating at peak performance. Donor Scalp After a strip of donor scalp is removed, it is temporarily placed into a container with chilled Lactated Ringers – a solution that mimics the body’s own natural fluids. The area from where the donor strip is removed is sutured closed. This usually leaves a very fine scar that heals in a week or two with the sutures being removed in that time frame. Ideally, the scar may heal well enough that it is almost undetectable even when the hair is combed back by a barber or hairdresser. After the tissue has been harvested, the individual follicular units (each containing from 1 to 4 hairs) are meticulously dissected out in their naturally occurring groups under strict stereo-microscopic control. The grafts are trimmed of extraneous fatty tissue and the bald intervening skin between the groups is discarded. The isolation of the individual, naturally occurring follicular units, that were obtained from the donor area as a single strip, and then carefully dissected under microscopic control, is an essential part of Follicular Unit Transplantation. If this step is not done correctly the follicles can be injured and growth impaired. It is important that these steps be carried out only by a highly experienced surgical team. Length of Time the Grafts are Away From Their Blood Supply A number of hours may pass between the time the donor grafts are removed from the back of the scalp to the time they are placed into the recipient area. Care must be taken to preserve the viability of the grafts during this process. The procedure starts with the removal of a strip of scalp from the donor area. Once the strip is removed, it is immediately immersed into a cold bath of Lactated Ringer’s saline to lower its temperature. Once the individual follicular unit grafts are prepared, they are cooled to 3.8-4.0ºC and kept at this temperature while awaiting placement. Bleeding Many people have the impression that hair transplantation is a “bloody procedure”. In our hands it is not. At our clinic we have developed surgical techniques that greatly minimise the amount of bleeding in all aspects of the procedure.
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