Follicular Unit Transplantation
Follicular unit transplantation (FUT) was first described by Dr. Limmer of San Antonio, Texas in the mid 1990’s. This new development in the field of surgical hair restoration represented the first technological improvements that allowed for completely natural results to be achieved on a consistent basis. The procedure called for the introduction of stereoscopic dissecting microscopes to replace the clumsy and primitive jeweler’s loupes that had been the previous standard with mini-micro grafting. By incorporating microscopes to dissect the donor strip of hair bearing tissue the technicians could more easily identify and harvest individual follicular units as they occur naturally on the safe donor zone. Follicular units, by definition, are the natural bundles of hair that grow on the scalp (or anywhere on the body) that contain groupings of one to five hairs. This meant that the grafts prepared for the purpose of surgical hair transplantation would be smaller than typical mini-micro grafts. The challenge was that there was a steep learning curve for not only technicians but also for physicians as this new technique required ever smaller incisions during recipient site creation. With surgical hair restoration, smaller is usually better, so the smaller incisions required of this new technique allowed for increased naturalness, less scarring in the recipient zone due to said smaller incisions, and an increase in first surgery densities also due to the reduced recipient site incision sizes.
The manner in which FUT is performed is fairly uniform from one clinic to the next with multitudes of small varying details subject to personal physician operational preferences. The general outline for a typical FUT is shared below.
The doctor confirms the patient’s candidacy prior to surgery. This includes discussions regarding the patient’s expectations but also a physical characteristic assessment including an assessment of the donor zone. This requires that the doctor gauge the donor laxity by pulling the scalp up and down in a vertical plane to ensure that this laxity is sufficient for accommodating the width of the strip expected to be removed. The doctor will then gauge the density of the donor zone which is the second component to determining the total graft estimate for the surgery. With FUT, donor laxity + donor density = total number of grafts.
The patient is prepped for the procedure with various medications given, both orally and via injections. These include, but are not limited to, antibiotics to protect the patient from infectious organisms introduced into any open wounds as well as anesthetics for pain management.
The patient is then asked to either sit down in a chair resembling a barber’s chair or to lay prone on a table. The doctor will usually shave a narrow strip of hair from the donor scalp to allow for visibility. Usually, this area that is pre-shaved will be slightly wider than the intended donor strip size to allow for better maneuverability and visibility. The goal is to avoid as much donor hair transection as possible.
“Tumescence” will then be applied through additional injections. This is performed so that the donor zone inflates, similar to a balloon. This forces the follicular units to spread apart from each other thereby allowing the scalpel to be pushed or pulled in between the follicular units which limits follicular transection to a minimum.