Learn all you need to know about the Follicular Unit Transplantation technique.
Written by Dr. Konstantinos Anastassakis, MD, PhD.
Written by Dr. Konstantinos Anastassakis, MD, PhD.
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And wherever you read such an “assumption” be very careful, it is not a scientific article it is an advertisement!
On the other hand, the FUT Hair Transplant technique is the most complete and scientifically approved.
This assumption is the official fact of ISHRS, the International Society of Hair Restoration Surgery.
Fig. 1a-c: 12 months’ result of hair transplantation with the FUT technique (3150 FUs).
There is no “old” and new hair transplant technique, surgical techniques are always the result of the development of a previous technique. These techniques have “roots” in ancient times, especially when we are talking about General Surgery techniques.
The FUT hair transplantation technique is a breakthrough in the strip technique, first introduced in 1963, and the FUE technique, which some people present as the “new” hair transplantation technique, but is actually an evolution of the Punch Graft technique that was introduced in 1959!
As a result someone can easily say that the FUT hair transplantation technique has more “recent” roots in Surgical Science.
But this is less important because surgical techniques are not like laptops or TVs, the newest is better and more sophisticated!
The result is the most important in order to please the patient.
And as we will see below, the results of the FUT hair transplantation technique are still unsurpassed.
Even in the donor area, many patients are concerned about the scar. With modern hair transplantation, using the FUT technique at Anastassakis Hair Clinic, it doesn’t matter if your hairs are thin.
The excellent results of FUT Hair Transplantation have made it very popular since 1993, when it first appeared. The FUT Hair Transplantation technique managed to change the public’s negative perception of the abnormal effects of “prehistoric” Hair Transplantation Techniques (punch graft, scalp flaps, scalp reduction).
It is now a fact that a specialized surgeon and an experienced surgical team can offer, at one session, with modern FUT Hair Transplantation, both impressive density and 100% natural result. No one will know that the person had a Hair Transplantation and that the person once had Hair loss.
With the continuous micro-improvements that science and technology have allowed us to apply, FUT (Follicular Unit Transplantation) hair follicle results are now excellent and do not stand out from natural hair, neither in naturalness nor in density!
A surgeon with little experience in hair transplantation cannot perform an FUT hair transplantation surgery because its success is determined by high standards. A surgeon would have to manage, train and maintain a large group of assistants and invest thousands of euros in surgical equipment. FUT hair transplantation can be perfectly implemented by only few dedicated surgical teams with a high level of expertise, experience and education in order to have excellent results.
These surgical teams, using the modern FUT hair follicle transplantation technique, can conveniently implement Mega-sessions of hair transplantation of up to 4,000 hair follicles in one day. Their experience and expertise leads to a perfect exploitation of the donor area (that has zero graft losses and minimal injury to the area) and with the same coverage as the patient had before losing hair.
The primary target of the FUT technique is to preserve the natural, integral, independent hair follicle (FU) and the transplantation of only natural hair follicular units.
FUT hair transplantation may be the end of the development of Hair Transplantation surgeries with regard to the recipient area, specifically:
The Follicular Unit (FU) is the natural form in which hair grows on the human scalp.
The anatomist Headington discovered in 1984 that hair follicles in human hair do not grow one-by-one but as groups, forming Follicular Units (FUs) containing 1-5 hair follicles, having the same sebaceous gland, the same nerves and vessels and all that are enclosed in a common “tunic” of connective tissue.
From the roots to the epidermis, the hair follicles inside each hair follicle look like an upside-down bouquet of flowers, with the bulbs in random directions in the subcutaneous tissue, and the hair complements as they come to the surface of the skin. (Fig. 2, 3)
The average (m.o.) hair follicles in each hair follicle unit is 2.2 but there are individuals with m.o. 1.3 hairs per hair follicle unit (inappropriate candidates for Hair Transplantation) and people with p.o. 3.0 hairs per hair unit (ideal candidates for Hair Transplant).
The discovery that hair grows in nature as hair follicles units has led us to understand that each hair follicle unit is also an independent micro-organ!
And the most important element of the FUT hair follicle transplantation technique that the revolutionary hair loss surgery had, is the discovery that when we transplant each micro-organ whole (without dividing it into smaller fragments-hair follicles) and independent (without transplanting it into same slot with other micro-organs) the results are:
Fig. 2: Graphic representation of the microscopic image of a hair follicle unit as an independent micro-organ
Fig. 3: Trichoscopy image which clearly shows that almost all hair follicular units contain more than one hair, one close to the other on the skin surface, like small flower bundles.
In a first approach, the two techniques differ in how we remove the hair follicular units from the donor area.
With the FUT hair transplantation technique, we remove the hair follicles in a row while in the FUE hair transplantation technique the follicles are removed one by one.
From the removal of the hair follicles and then, in both techniques, the remaining steps are the same.
The FUT hair transplantation technique, however, is superior in the most important areas of hair transplantation because it offers:
The most important advantage is that with the FUT hair transplantation technique you are sure that the surgeon is an experienced surgeon.
The FUT hair transplantation technique requires a multi-year, more general surgical experience, knowledge and in particular, experience in order to handle the scalp, which is the surface with most vessels in the human body.
In contrast, in most clinics, the FUE hair transplantation technique is performed by young, inexperienced and unqualified doctors, or even non-doctors for a very low fee. This is because the FUE hair transplantation technique does not require any prior surgical experience and it is rare, even with major mistakes, from a doctor or non-doctor when performing a FUE hair transplantation to cause significant damage or risk to the patient.
The FUT hair transplantation technique is not applied by a doctor who does not have a long-term experience in surgeries, and non-doctor won’t dare to try it!
Personally, as a qualified and certified Hair Transplantation Surgeon, I think that this surgery must be performed by an experienced doctor.
The disadvantages of FUT hair transplantation are that it leaves a horizontal scar in the donor area and that there is a small chance of remaining numb in the donor area for 3-6 months if the session is too large in a number of hair follicles (Megasession, > 3000FUs)
Finally, the period of abstinence from very intense and heavy activities is 4-8 weeks. Compared to 10 days with the FUE Hair Transplant technique.
But let’s get a better understanding:
Personally, as a qualified and certified Hair Transplantation Surgeon, I find these disadvantages very small compared to the advantages of FUT hair transplantation technique.
Someone will be forced to shave his head in order not to have the sharp contrast of the empty, “upper” areas, which are sparse, with the dense side areas of the permanent hair growth area.
Nobody undergoes a Hair Transplantation surgery just to shave after his head, but instead he does it in order to enjoy his hair.
So, whenever you see a man with a shaved head and one or more scars on the back of the head, is someone who should never have had a Hair Transplantation. That’s because he was not a suitable candidate at first or his doctor did not do his job correctly.
Someone who has done a Hair Transplantation and shaved his head, had this happened: the result of Hair Transplantation was so unnatural, sparse or non-existent that he prefers to show the scar in the donor area rather than have a little longer hair that would hide his scar!
In fact, those with scarring and shaved heads have never been suitable candidates for Hair Transplantation (so they should never have been operated!) or their surgeon was careless and non-specialized in Hair Transplantation.
These bad results of Hair Transplantation on inappropriate patients or by inappropriate surgeons are very unpleasant. We can easily eliminate them with modern FUT, FUE and BHT Hair Transplantation Techniques.
Personally, as a qualified and certified Hair Transplantation Surgeon, I can guarantee that at Anastassakis Hair Clinic, using the FUT hair transplantation technique, it will never come across your mind to shave your head. That’s because you will be totally satisfied with the results and you will enjoy your hair in whatever length you like!
FUT Hair Transplantation involves taking the hair follicles from the donor area (on the back or the sides of the scalp) in a row. In these areas, hair follicles are genetically programmed to continue to grow throughout the person’s life without ever being affected by the androgens that initially caused hair loss. And this property is preserved forever, wherever we transplant them!
These follicular units, after preparing them under specific stereoscopy, are repositioned in the empty or diluted areas of the scalp.
In their new position, the transplanted hair follicles grow for the rest of the person’s life, they never fall, they produce normal hairs that grow and they can be combed and cut like the rest of the hair.
Fig. 4: According to the older techniques, the FUs were dissected either into micro-grafts or into minigrafts.
Fig. 5: In the modern FUT technique, small FUs are transplanted in the recipient area close to each other as natural hair occurs, for a more dense and natural result.
The result of Hair Transplantation is hair that behaves in the very same way as the hair you had before thinning and do not stand out.(Fig. 6, 7)
Fig. 6: In the hairline only the single-hair follicular units are placed in an irregular pattern, giving a natural result.
Fig. 7: The angle and the direction of the hair is the same as the existing hair, so that the transplanted hair does not stand out.
The procedure of the removal and the placement of the grafts by the FUT technique is this:
Fig. 8a-c: On the 10th-12th day after the operation, when suture is removed from the donor area, the linear scar is already invisible due to the trichophytic suture. The red marks are the spots where the suture was caught on. In the future, 5-6mm hair length will be enough to cover this trichophytic closure FUT seam.
Fig. 9: The hair follicular units are prepared under stereoscopic microscopes and categorized according to the number of hair containing; from 1 to 5 hair. The number of hair in a follicle determines the place which this follicle will be placed on the recipient area.
Fig. 10: Hair follicular units before placement in the recipient area. The hair follicles are prepared in a way to keep enough tissue around their base in order to prevent dehydration and injury during placement in the recipient area. They are also thin on top in order to ensure the highest density.
Fig. 11 The size of the follicular unit determines the tool that will be used to open the socket. The general rule is to use the smallest possible tool for every FU in order to have the smallest trauma in the area. The 18G needle has a 1.1mm diameter, the 19G needle has a 0.9mm diameter and the 21G needle has a 0.7mm diameter. If the doctor doesn’t use a needle, he may use micro-blades of different sizes (0.7-1.1mm), depending on the size of the FU.
Fig. 12a-c: Recipient area after the sockets are made. The sockets are painted temporarily with methylene blue to be more visible. Notice that on the frontline the sockets are smaller and closer to each other (for the single-hair FUs), the sockets following are a little bigger (for the two-hair FUs) and all the rest are gradually bigger (for the rest FUs).
Fig. 13: The doctor has to change the angle, the direction and the proximity of the sockets in the recipient area for a natural result.
Fig. 14: To implant each hair follicle unit we use either forceps or implanters. The choice of the technique and the tools depends on the surgeon’s preference and does not excel one another in the final result. In any case, grafts should be handled with extreme care so that they are not squeezed or “unnecessarily” damaged.
Fig. 15a-c: Hair transplantation with FUT. There were 2920 FUs transplanted which, in this case, are approximately 7600 hair (2.6 hair/FU). The pictures are (a) before, (b) immediately after and (c) 10 days after the operation.
From the day of the surgery, it takes about 4 months for your new hair to grow and then the growth is at a normal rate (usually 1 / month). So it takes at least 8 months after the surgery in order to get a significant amount of hair. In fact, your new hair continues to mature in color, mass and texture for up to 18 months after the surgery. (Fig. 16a-c)
Fig. 16a-c: The perfect candidate! Curly, thick, grey hair. A 12 months’ result where 2000 FUs were transplanted with the FUT technique.
Fig. 17a-f: Appearance of a common linear scar of the FUT technique on the 10th -12th day at Anastassakis Hair Clinic. Within the next 12 months, this microscopic scar will downsize to 40% -50% due to healing. It will also get white, same as the rest of the skin.
In FUT Hair Transplantation, we essentially remove a part of the hair follicles in a row from the back of the scalp and the area is stitched with tiny suture. The scar that remains is minimal, and usually does not exceed 1mm.
In the FUT Hair Transplantation technique, the grafts are not cut “on demand”, as there was in the older minigrafts and micrografts techniques, but they are separated according to their physical appearance in the scalp in independent hair follicles.
Using stereomicroscopes, natural hair follicle units are isolated in their native form and with limited skin tissue around them.
FUT Hair Transplantation minimizes trauma and scar tissue in the recipient area, optimizes healing and nourishment of the implants, a perfectly natural layout, a direction and an outgrowth angle are achieved, while sessions with more than 3500 hair follicles in one day are feasible.
In order to achieve these ideal results, the technical requirements on the part of the surgeon and in particular the assistant group are many and require teamwork, professionalism and the highest expertise that few teams can achieve.
Few surgeons are committed to be fully trained and are able to complete all stages of the FUT with perfection.
Therefore, if you want to have a perfect, natural and dense result in your Hair Transplantation, you should find the surgeon who is experienced, skilled and certified in order to offer you the perfect natural and dense result.