Abstract
The roots of modern day hair transplantation firstly evolved in Japan in the year 1930s. In the year 1939, the Japanese dermatologist Dr Okuda described the procedure of surgical hair restoration intended for burnt victims in detail. Later in the year 1943, the other Japanese dermatologist popularly known as Dr Tamura refined the work of Dr Okuda and explained that each follicular unit consists of more than one hair roots which ranges between 1-4 follicular units and applied the elliptical incision to extract the donor’s tissue and then dissected each individual graft.
Later, in the year 1952 a New York dermatologist named, Dr Norman Oreintreich performed the very first hair transplantation in the US on a man suffering from male pattern baldness. It was the time of re-inventing and re-defining the procedure of hair transplantation. And now it is the best option for a patient, who is suffering from the male pattern baldness and similarly applies in the case of female pattern baldness as well.
In FUT, the grafts are harvested via the strip of the skin, usually taken from the back and sides of the scalp termed as the ‘safe donor zone’ and transferred to the recipient zone to achieve the aesthetic goal of the procedure.
Keyword: FUT hair transplant, Hair grafting, Hair transplant Surgery
INTRODUCTION
The hair transplant procedure finds its root in 1952 with the revision restoration procedure of Dr Norman Oreintreich that introduces the process of punching for extraction with 4mm punches. The same later got transformed into the procedure of Micrografting and minigrafting. And thenceforth, later in the year 1990, the most compatible technique of harvesting the grafts has came to the picture which involves the strip of the skin that contains the follicular units. In the technique of FUE hair transplant, the extraction involves the use of punching machine which leaves to the process of extracting the grafts, one-by-one from the scalp and if needed used to target the unsafe zone too for extracting the hair roots. As the deviation in the punching that can occur due to the random motion of the punching which automatically put the limitation for extracting the roots from the scalp. Since there is a need of keeping the aesthetic distance to take the grafts. The extraction of graft in the FUE hair transplant leaves a small open hole which heals with a small white mark.
In the procedure of FUT, an acronym of follicular unit transplant involves the shifting of follicular units that usually pairs in the number of 1-4 from the donor portion to the recipient one via the excision of the strip of the skin. In the procedure of FUT, the patient’s scalp is numbed to excise the strip and make an incision to take the strip and the portion is closed by the advanced Trichophytic closure to avoid the chances of scars. If well executed, the results of FUT will look completely natural and will be undetectable.
This article presents a review of different aspects of FUT such as the prerequisites of doing FUT hair transplant, indications, and myths & facts, steps, limitations and the budget cost perspective of FUT procedure.
PRINCIPLE OF FOLLICULAR UNIT TRANSPLANTATION
In the procedure of FUT, the strip of the skin harvested from the donor area (back & sides of the scalp), the donor strip is then separated into the individual follicular units using precise stereo-microscopic dissection techniques. After dissection of the follicular units, the further step is followed by making the hairline design on the scalp to place the grafts. The incision portion of the scalp is closed by the advanced Trichophytic closure that avoids the chances of scars and makes the procedure devoid of scars.
(here put the image of donor area during the excision of strip)
NOTE: use the real patient photo rather than the drafted one!
The main advantage of FUT hair transplant is that it is suitable for covering the higher grade of Norwood class baldness as the technique provides the greatest number of follicular units via the strip. As the follicular units in the FUT hair transplant harvested from the safe donor portion are permanent in nature since these roots are resistant to the effects of DHT. It is only possible to implant the higher number of the follicular units via the FUT hair transplant and no other alternatives are being practiced in the field of hair transplantation if there is need of higher number of grafts to cover the greater degree of baldness.
PREREQUISITES FOR DOING FOLLICULAR UNIT TRANSPLANTATION
There are some prerequisites for doing FUT as jotted down below:
- Adequate skill, experience and knowledge for a Surgeon
- Ultra refined tools for making the incisions
- Adequate magnification of at least 20x for the surgeon and technician
- An advanced closure technique of Trichophytic closure to avoid the scars
- A highly trained team of technicians to dissect the grafts
- Use of optimized hypothermic (low temperature) preservation (holding solution) to keep the grafts outside that extends the life of the cells outside the body
- Use of digital sensor machine to maintain the temperature of the holding solution at a constant level to avoid the damage of grafts
Trichophytic Closure Technique
It is important to note in the FUT procedure to make the incision scarless after harvesting the strip from the donor portion. The technique which makes the scar almost invisible is the advanced Trichophytic closure. It is a different closing technique which is far better than the general technique as the closing done in this process with a zig-zag fashion along with trimming and closing the edge of the incision area in such a manner that they overlap with each other and present the invisible scar after the closing. In Trichophytic closure, the hair grows naturally and the sutures get absorbed after the one or two weeks and there is no need to remove it out. The hair growing through the scar can provide a strip devoid of by FUT procedure and it’s very hard for anyone, even a doctor, to notice the scar after the procedure is complete. In Trichophytic closure, doctor trims one of the most incisive edges and allow them to overlap each other so that the hair grows directly through the donor scars.
Safe Donor Area
The goal of the hair transplant is to use only those hairs which are destined to remain permanent. The hair follicles that are resistant to DHT (di-hydro Testosterone) are permanent and for lifelong. The Surgeon only targets those permanent hair roots from the scalp so that he achieves the aim of the hair transplant. Now; we must consider this fact which is the safest one in terms of containing the DHT resistant hair roots and the answer is usually the back and sides of the scalp. The hair within these areas are immune to the effect of the di-hydro Testosterone, that presents the hair loss problem due to the sensitivity with the Androgen hormone. The motto is to fully utilize the donor portion hair to achieve long lasting hair roots for the hair transplant.
In the view of full utilization of donor portion hair, the surgeon gives the FUT technique in most of the hair transplant cases in order to achieve long lasting hair roots. FUE is given only in those cases when there is a need of body hair transplants, eyebrow transplant or a moustache transplant.
(here put the pic of safe donor area)
Unsafe Donor Area
The hair roots of the front portion, crown, and mid-scalp are sensitive to Androgen hormone and tending to fall out presents the male pattern or female pattern hair loss. The unsafe area of the scalp is never counted as the safe zone to harvest the hair roots as these areas consist the DHT sensitive hair roots which causes the hair loss. The FUT hair transplant seriously applies the rule of safe donor strip excision to harvest the sustainable hair roots that is free from the effect of the DHT (di-hydro Testosterone). In the FUE hair transplant technique due to the random punching by the surgeon compel to target the unsafe area also resulting in the less sustainable hair roots which are prone to fall out.
(here put the pic of unsafe area)
Why is FUT the best Technique for Hair Transplant
A grade of higher NW class Baldness
When a patient is suffering from a higher grade of Norwood class of baldness, it’s only a FUT technique that can provide the greatest number of grafts to cover the bald portion as according to the desired number of grafts. When the patient grade ranges between the grade III to grade VII, the FUT technique is recommended by an expert surgeon.
A Desired (High) Density can be Achieved
It is the FUT technique that offers the huge number of grafts via the strip of the skin fulfilling the desired density on the scalp so that to achieve the aesthetic results of the hair transplant.
The high density hair transplant is the latest type of hair transplant in the hair transplant world. Density is the total number of hair follicular units in a square centimeter. Normally, the natural hair density in an average male is 90 to 110 follicular units in a square cm. The high density transplant basically for those patients, who have a lower grade of baldness like grade a II or III or maybe for those patients, who require really a very high density hair transplant for their special purposes in the view point of their hairstyle need and demand. Giving high density hair transplant requires a long experienced surgeon because it needs highly précise surgical skills and expertise.
To achieve the Long lasting Hair roots
To achieve long lasting hair roots, it’s greatly assured with the FUT hair transplant technique. As the strip are excised from the safe donor portion that is resistant to DHT hormone in the usually back and sides of the head. The DHT resistant hair roots don’t present the effect of hair loss problems and are destined to be permanent in nature.
Why FUT is better than FUE?
1. Extraction via the strip offers the greatest number of grafts
2. Most sustainable hair roots are harvested
3. Most permanent results with the possibility of multiple sittings
4. High density hair transplantation with densely-packed hairs
5. A Lesser rate of transection
6. Higher covering of the area
7. Scar less if Trichophytic closure
8. Maximum grafts yielding results
9. Maximum possibility of harvesting all the hair roots from the donor portion
10. Shorter procedure, whereas in FUE it takes longer to extract the roots one by one which causes the longer time process to complete the task
11. Affordable and cost effective as compared to FUE
12. Less time consuming with utmost results
Myths & Facts of FUT Hair Transplant
It is a painful process: (Fact: Nowadays it is a 100% painless procedure, subjected to the local anesthesia, And if it is being done at the right clinic and by the right doctor)
FUT leaves Scars: (Fact: FUT doesn’t leave any scars if the Trichophytic closure has been done)
FUT Hair Transplant may damage nerves of the brain: (Fact: Hair Transplant is performed on the top layer of scalp far above the brain)
After FUT Hair transplant, one needs to take medicines throughout life: (Fact: No medication or maintenance is required for the transplanted hair, as these are not prone to the activities of DHT hormones which trigger hair fall)
Procedure of FUT Hair Transplant
Excision of the Strip
In the FUT hair transplant, the strip of the skin from the safe donor area is excised from the depth of the strip of about 4 mm. The strip involves the clinches of grafts of all the units that fulfil the needed number of grafts as according to the grade of baldness and desired density.
Dissection of Grafts
After removal of the strip the dissection process is performed. The dissection process allows follicular units to be detached from the donor strip without being broken. The grafts are divided under the correct vision of the microscope (20 X). If there are a proper magnification and experienced person to divide the follicular units, the damage rate will automatically be reduced during the dissection of grafts. To make the reduction of grafts less than 1 % is the most advantageous part of the FUT hair transplant. As we harvest a strip we can harvest also a number of hair follicles as per the sitting in an average of around 8000 hair follicles per sitting from SAFE DONOR ZONE and can reduce the damage rate by using a 20x microscope under the correct vision and magnification by seeing the each hair root very clearly with the aid of video-assisted microscope that help in the dissection of hair roots easily and clearly. Magnifications by which we can get the higher yielding results of above 95%, i.e., around 7600 hair roots of 8000 hair follicles per sitting that gives an excellent opportunity to cover a higher area of baldness or to give a high density even in a smaller area of baldness.
Closing the Incision Area with Advanced Trichophytic Closure
We close the incision area with an advanced Trichophytic closure to avoid the scars. The Trichophytic closure is a modern technique tomake the suture on the wounded part of the strip excision in such a manner that the edge of the incision overlap each other and the hair grows through it and there won’t be any scar visible at donor portion.
(Here put the image of Trichophytic closure)
Implantation of the Grafts/Follicular Units
This is the final step of hair transplant procedure in which surgeon artistically puts the grafts on the bald portion as according to the hairline design. There is much importance of the role of implantation way more than the extraction or harvesting to get the best natural results. Nowadays, when we surf on the internet and talk commercially about the transplant we talk about the procedures that explain what particular clinic or surgeon does, especially the FUT or an FUE, but, nobody talks about the designing of the implantation which is more important in the hair transplant procedure. The implantation of grafts needs an aesthetic sense from the surgeon side as it is the most important aspect of the hair transplant procedure. Surgeon’s artistic skills can be seen through their hairline designing as well as the placement of grafts in a zig-zag fashion to achieve the great aesthetic touch of the hair restoration procedure.
(Here put the image of FUT hair transplant)
Advantages of FUT Hair Transplant
- It offers permanent and longlasting hair roots as the harvesting is done through the strip that is taken from the safe donor portion
- It is a best option for higher grades of NW class of baldness when there is a need of a number of grafts
- A surgeon can achieve the maximum number of viable hair roots as there is no chance of unwanted damage like FUE where the randomly punches are required to extract the grafts
- Shaving of the head is not required before the procedure and the possibility of covering larger areas of baldness
- The cost of the procedure comes under the budget that is suitable to all economic classes of people
Limitations of FUT Hair Transplant
Only Limited to the Expert Surgeon
The FUT hair transplant involves the excision of strips and closing it back needs great care and attention as well as the experience and expertise to do the procedure with great efficacy in order to avoid the risk of scars and pain. Only an expert surgeon with full aesthetic and surgical skills could perform the FUT hair transplant procedure.
Possibility of scars on the incision area if it doesn’t close by the Trichophytic closure
It is important to close the incision area with the advanced Trichophytic closure to avoid the chances of scars. If the Trichophytic closure has been done with greater precision and skills, there won’t be any scars left on the strip harvesting zone in the donor area.
Limited to the Availability of good Donor Portion
The FUT technique is only possible if you have a good donor portion. In some peculiar cases, if the person doesn’t possess a good donor area due to their anatomical or physiological stratum, the FUT procedure can’t be possible and in this case the FUE procedure is performed. Even if your donor area is very poor and contains the least follicular units, the expert surgeon can do the FUT hair transplant with the efficient utilization of the donor portion follicular units by their skills and expertise.
Why FUT Hair Transplant is a Budget Cost Option
The FUT hair transplant technique is one of the advanced and worthy ways to harvest the hair follicles via the strip of the skin from the safe donor portion resulting in longlasting hair roots. The cost of the FUT procedure is less as compared to the FUE technique because in the case of FUE technique, the hair roots are extracted by the use of punching that requires the maximum time as well as a special set of skills since the graft harvesting is all based on the speculation and forecasting that may be wrong causing the damage of hair roots. The FUE procedure is a tedious job to perform because each and every punching needs an aesthetic distance for the next punching that automatically reduces the possibility of getting a number of grafts to cover the particular bald area. The FUT procedure offers the longest lasting and permanent hair roots which is sufficient to get over the problem of baldness forever, whereas in FUE technique, there are the chances of scheduling the next sitting for the procedure as the hair roots are taken from the unsafe area also and that is not for permanent.
Conclusions
Summing it up, we can say that the FUT hair transplant procedure is one of the basic methods of hair restoration technique that primarily focuses on the results that is all aesthetic in terms of densely-packed hairs as well as covering the higher grade of baldness. It is the FUT that can assure you about the maximum number of viable hair roots which is used in the implantation to achieve the aesthetic goal of the hair transplant, whereas in FUE, it is not possible to cover the higher Norwood class of baldness as the technique involves the randomly punching process that offers the lesser number of hair follicles and the chances of damage are also very possible during the extraction.
