Hair transplant techniques – Hair Clinic
Introduction
Hair usually grows in groups of form one to four hairs, known as follicular units. Hair transplant procedures essentially involve the transplantation of these natural groupings, one by one, trying to imitate as closely as possible the natural way in which hair is distributed.
The transplantation of follicular units is the preferred method of all transplant surgeons, as natural aesthetic results are obtained and the difference between transplanted and non-transplanted hair is undetectable. The technique basically involves extracting (otherwise known as harvesting) follicular units (otherwise known as grafts) from the back of the scalp (donor site) and implanting them in the area that it is desired to cover (recipient site). Hair transplantation could be described as the reorganization and relocation of a person’s own hair to areas affected by baldness or thinning.
There are two basic hair transplant techniques that are presently in use: FUT and FUE. Below is a brief description of both techniques.
FUE hair transplantation
FUE is a hair transplantation technique that consists of individual extraction of the follicular units (hair grafts) from the back of the scalp of the patient and their subsequent implantation in the alopecia affected (bald or thinning) area.
FUE is a hair transplantation technique that consists of individual extraction of the follicular units (hair grafts) from the back of the scalp of the patient and their subsequent implantation in the alopecia affected (bald or thinning) area.
Development of the FUE technique began in the first decade of this century and has undergone various improvements over the intervening years.
In the FUE technique, the follicular units are extracted with 0.9-1.00 mm diameter circular punches. The affected donor site heals in just a few days without the need for sutures or stitches, and the wounds are virtually imperceptible even with very short hair.
The FUE procedure is indicated in both male and female patients with androgenetic alopecia (common baldness), as well as a large number of scarring alopecias especially those that are the result of injuries or burns.
The advantage of the FUE technique is that it allows patients to wear very close-cropped hair with virtually no visible evidence of the extractions performed in the donor site (minimal pin-type scarring). The drawbacks to FUE are that it is more laborious than the more traditional FUT technique and the donor site needs to be shaven to enable extraction of the follicular units.
Step-by-step description of the FUE technique:
- Shaving of the donor site:The donor site needs to be completely shaved to allow extraction of the follicular units. The donor site is in the occipital area of the scalp, as hair growth in this area is “permanent” and the hair maintains its longevity when transplanted to the alopecia affected area.
- Anaesthetization of the donor site: A local anesthetic is employed.
- Follicular extraction:Performed with a circular punch, either manually or with various types of device that rotate at a specified speed.
- Anaesthetization of the recipient (balding or thinning) area:The same type of anesthetic is used as for the donor site.
- Implantation in the recipient site:Graft implantation is performed one by one in the same session. The grafts should not remain more than 6 hours outside the body of the patient and are kept in saline solution until the moment of their implantation.
Implantation is performed with micro tweezers or specially designed implanter pens. Precision loupes are used to insert the grafts in the incisions made in the recipient site.
- End of the procedure:After all the grafts have been implanted, the patient can go home with a small dressing to cover and protect the donor site. This dressing can be removed the following day. No dressing is required for the recipient site.
FUT hair transplantation
FUT (Follicular Unit Transplantation) is the most traditional hair transplant technique. It was developed during the 1990s and consists of harvesting a strip of skin from the back of the scalp, using stereo-microscopic dissection to remove the follicular units (hair grafts) from this strip, and finally implanting the grafts in the alopecia affected area.
FUT is also known as strip harvesting.
FUT is indicated in both male and female patients androgenetic alopecia (common baldness), as well as a large number of scarring alopecias especially those that are the result of injuries or burns.
The advantage of FUT over FUE is that there is no need to shave the donor site to obtain the grafts, The drawback is that it leaves a linear scarring in the donor site which, although thin, can be seen if the patient shaves their head or wears the hair very short (less than half a centimeter long).
Step-by-step description of the FUT technique:
- Anaesthetization of the donor site: A local anesthetic is employed.
- Harvesting of the donor strip with the follicles:The strip is harvested from the “permanent” donor site at the back of the scalp. The strip is usually 1 cm wide and can be as long as desired depending on the number of follicular units to be implanted. Once the strip has been harvested, the wound is closed with sutures or staples, which are left for some 10-12 days before removal.
- Stereomicroscopic dissection of the follicular units:After the strip has been harvested, it is then cut into thin slices and each slice is microscopically dissected to obtain the follicular units. Each follicular unit can have between 1 and 4 follicles (hairs). These follicular units are placed in a saline solution until the moment of their implantation.
- Anaesthetization of the recipient (balding or thinning) area:The same type of anesthetic is used as for the donor site.
- Implantation in the recipient site:Graft implantation is performed the same day as their harvesting and the grafts should not remain more than 6 hours outside the body of the patient.
Implantation is performed with micro tweezers or specially designed implanter pens. Precision loupes are used to insert the grafts in the incisions made in the recipient site.
- End of the procedure:After all the grafts have been implanted, the patient can go home with a small dressing to cover and protect the donor site. This dressing can be removed the following day. No dressing is required for the recipient site.
Complications
A hair transplant is an intervention with very few complications. It is estimated that around 80-90% of the transplanted hair grows, though in some people the graft survival rate may be below 80%. See ‘Other complications’ in the Commonly Asked Questions section.
Number of interventions generally performed
Depending on the extent of the thinning/baldness, one or more sessions can be required with an interval of around one year between sessions. Hundreds or thousands of follicular units can be implanted in each session, depending on the recipient area that needs to be covered and on the donor area density.
When is a hair transplant not possible
Patients who have a very low donor area density are not good candidates (the higher the density and the thicker the hair in the donor area, the better the result will be).
A hair transplant should not be performed (with either the FUT or the FUE technique) in cases of inflammatory scarring alopecia, including frontal fibrosing alopecia and lichen planopilaris, nor in cases of alopecia areata.
Post-op period
- Washing the head:This can be done the day after the intervention. Usually, we will perform the first wash in our clinic.
- Healing of the donor area:The healing process takes just a few days. In the case of an FUT intervention, an antibiotic cream is applied in the area of the stitches until their removal. With FUE, an antibiotic cream is applied to the area where the harvesting took place, there are no stitches to be removed and the wounds heal in 3-4 days.
- Patients can return to their work activity within 3-4 days of the transplant. At this point, only some small white scabs will be visible in the recipient area. These scabs will fall off naturally in 7-10 days.
Visible results
The transplanted hair will start to grow from around the 3rd to 4th month after the intervention, with the definitive result perceptible between 8 and 12 months after the transplant. The transplanted hair is indistinguishable from the native hair, and as such will grow and can be cut like any other hair.