Follicular Unit Trasnplantation – FUT
Preface: The field of hair restoration has a chequered history. From days of punch grafting to the present day technique of follicular unit hair transplantation, the field has seen a new number of advances.
History Speaks – Milestones in Follicular Unit Transplantation: Hair loss due to disease, scarring and in particular androgenetic alopecia, seems to have troubled members of the human race since the dawn of the history.
Modern cosmetic hair transplant surgery dates from the work of New York Dermatologist Norman Orentreich in early 1950s. By 1970, the technique know as “punch grafting” was being performed by small number of dedicated practitioners in many countries of the world. Orentreich’s 4.0mm punch graft method remained basic procedure until 1975, although some surgeons used smaller grafts at times.
Hair Restoration Techniques: From the 1960s into the mid 1990s, transplanted hair appeared unnatural because surgeons used unnaturally large appearing hair grafts consisting of 10-25 hairs each. That era is over. Hair naturally grows in 1-4 hair follicular groupings/units.
Follicular Unit Transplantation is the redistribution of naturally occurring follicular groupings from the posterior scalp (donor region) into the region of thinning hair and in the mid frontal scalp (recipient sites). The groupings are removed from the donor area by an elliptical excision and are carefully dissected using appropriate lighting and magnification. The donor tissue is separated into follicular units, which are then re-implanted into recipient sites created by some specific slit making instruments.
Follicular unit transplantation is also used to correct unnatural -appearing plug like transplants, repair eyebrows, and redistribute hair in people with inactive scarring alopecia.
Key factor to consider in candidate selection include
Donor density in the posterior scalp
Caliber of hair
Extent and rate of hair loss, and realistic expectations
Extent and rate of hair loss: In an era in which male and female pattern hair loss can be halted with minoxidil and / or finasteride (for men), transplantation should be performed in patients who have enough space between thinning existing hair.
The net perceived density of a hair transplant is equal to the number of hair follicles transplanted minus ongoing hair loss. All patients must understand that the hair loss will affect the perceived density of the transplant.
Comparison of FUT Strip Method and FUE
|Pain after the procedure||Minor||None|
|Percent of time the doctor operates on the patient||10-30%||80-90%|
|Extensive bleeding during or after the procedure||May Occur||No|
|Wearing hair style short in the donor area||Not Possible||Possible|
|Nerve damage, numbness||Possibly||No|
|Healing time: donor area||2-3 weeks||Approx 4-5 days|
|Healing time: recipient area||Approx 10 days||Approx 10 days|
|Recovery time needed before exercise is possible||2-3 weeks||1-2 weeks|
|Amount of time after which patient may return to work||The day after||Usually the day after|
|Visible scarring with short hair at back||May be present||Microscopic|
|Reaction to suture materials||Seen Rarely||Never a problem|
|Shaving of head||not needed||needed|
Hair loss is one of the most frustrating experience for people. The most common type of hair loss is known as Androgenetic Alopecia or a male pattern baldness, despite the fact women suffer from it as well. Despite of advancement in the medical management for the same, the patients are often helpless and remain bald. Since 2000 , the techniques for harvesting donor tissue, preparing grafts and improving hair survival of follicular units have improved dramatically.
The factors imperative for transplant are precise calculation of donor’s hair, accurate separation of follicular units, prudent design of the transplant area to create an immediate cosmetic effect.