Follicular Unit
Transplantation &
Extraction
Follicular unit
transplantation(FUT)
and follicular unit
extraction(FUE) are
recent and widely
discussed surgical
procedures for hair
restoration.
Follicular unit
extraction(FUE) is a
procedure for
obtaining follicular
graft units from
donor areas on the
scalp. Follicular
unit
transplantation(FUT)
is the surgical
procedure for
transplanting
follicular unit into
the scalp. The
Follicular Unit(FU)
is identified
anatomically as a
small bundle
consisting of 1 to 4
hair follicles,
full-thickness as
well as fine hairs,
and the oil glands,
muscles and
connecting tissue
that accompany and
support hair
follicles.
Follicular Units,
ready for insertion
If you look closely
at the
closely-clipped
scalp from above as
you would look at a
wheat field from an
airplane, you can
see that scalp hair
does not grow in
even distribution
like wheat in a
field but rather in
little groups of
hairs that seems to
be clumped together.
These little
groupings of hairs
are called
follicular unit(FU).
When the scalp is
examined under a
magnifying glass or
microscope, these
FUs look like
islands.
Follicular Unit(FU)
on the scalp
The “islands” are
rooted at a level
beneath the skin
surface, called the
mid-dermis.
Identifying an
individual FU can be
difficult when
follicles grow at
angles under the
skin and “surface”
in the midst of
neighboring FU. The
identification of FU
is done by the hair
restoration
specialist using a
microscope. The
identification,
harvesting and
transplanting of FUs
requires the
training and skill
of a hair
restoration
specialist.
A recent development
in surgical hair
transplant surgery
is to specifically
use the FUs for
transplantation. The
FUs are removed from
the donor site
(usually on the nape
of the neck) by
using a harvesting
technique that
preserves the FU
intact. One such
technique is called
single-strip
harvesting and is
done with a
scalpel-like blade.
Single strip
harvested from Donor
area
Another method is
called
follicular-unit
extraction(FUE). FUE
is performed by
using a punch-like
“circular scalpel”
to score the skin
and mid-dermis to a
level of about 2
millimeters around a
follicular unit,
then gently
extracting the FU
from within the
scored circle. The
extracted FU may be
used intact, or may
be divided into
smaller units for
transplantation.
Single follicular
units are often used
to fill in a
hairline, multiple
FUs to provide
greater density in
the center of the
scalp. The FUs are
transplanted into
the scalp by
inserting them into
small slits incised
into the skin and
underlying tissue
with a small blade
or needle.
small slits in
recipient area
Insertion of a FU
There has been
debate regarding the
scarring left at the
donor site by
harvest of FUs.
Single-strip harvest
leaves a single,
fine incision that
usually heals in a
few days. Follicular
unit extraction (FUE)
leaves small holes 1
to 2 millimeters in
diameter at the site
of FU extraction.
These holes are not
stitched but are
rather left to heal
on their own.
Proponents of the
FUE procedure claim
decreased or
complete lack of
scarring but others
have cautioned that
in some patients
these extraction
sites may leave
dimpled white spots
similar to a golf
ball.The choice of
harvesting
techniques should be
made after
discussion between
patient and
physician.
Follicular unit
transplantation is a
newer surgical
technique that
continues the modern
emphasis on
achieving a
“natural” look from
hair transplants. It
is a technique that,
like micrografting,
uses 1 to 4 units to
achieve an even
distribution of hair
coverage over the
scalp and avoid the
“row of corn”
appearance that was
common many years
ago. An additional
advantage claimed
for follicular unit
transplantation is
that FUs are the
natural hair-bearing
structure in the
scalp, and
transplanting them
as units increases
the likelihood of
natural growth after
transplantation.
The availability of
FU transplantation
expands the number
of options a patient
may consider for
surgical hair
restoration. Whether
it is the best
option for an
individual patient
depends upon the
individual patient
characteristics,
including cause of
hair loss, type of
hair loss,
likelihood of hair
loss progression
over future years,
cost of procedures
the patient may
consider, and the
patient’s wishes for
the “look” that he
or she wishes to
achieve from hair
restoration. |
