Follicular Unit Transfer, FUT or Strip Surgery; out of the two accepted techniques used today is the older of the two; FUT removes a thin hair bearing strip from around the sides and back of the head approximately in the zone known as the occipital area
An advantage of strip is the follicular units are removed in the one strip making it able to harvest large numbers efficiently, along with a proficient and experienced team behind the doctor can then be divided in to the natural groups of follicular units
FUT surgery will leave strip scar around the area it was excised; the width and how noticeable the line will be is partly due to the proficiency the closure was performed, the skin healing characteristics and the post operation care of the patient
Once the strip is removed it is divided into smaller sections and then handed to the technicians who then divide into the individual follicular units, they are cleaned under magnification and kept in a holding solution
This process allows for only good quality grafts to be used and sustains a good yield or growth rate when the hair transplant matures; with FUT the grafts generally are a little larger with more fatty tissue surrounding them as they is the luxury of taking them directly from the tissue they naturally sat in
The process of extraction also allows for the overall procedure to run smoothly and efficiently; when the doctor has made the closure of the donor and the strip passed to the technicians the doctor can then start to make the recipient sites for the grafts to be placed in
This allows for a fluid movement of work and no down time, meaning that large numbers can be safely moved in a one day procedure; on the right candidate with good donor characteristics around 7000 grafts or FU´s
Like any surgical procedure there is always going to be a degree of scarring; when performed to a high standard the closure of the strip is easily hidden within the surrounding hair and even on close inspection hard to see
There are unfortunately exceptions to the rule and it is important that when researching you ask to see a decent number of results or examples of the doctor´s work and closures that have matured for at least 12 months post operation
As FUT relies on skin laxity for the removal this has to be considered when healing; not to create too much tension on the scalp, heavy exercise for example may create pressure on the area that can cause stretch back; so always take this into consideration when arranging your surgery and ensure you can adhere to the post-operative instructions you are given
With future FUT procedures and acceptable donor healing the old line can still be removed when extracting more grafts; the graft numbers will probably be lower than the initial procedure but still enough to complete restoration even on high Norwood cases most of the time
As the old line is removed you will still only be left with a single line closure, maintaining the integrity of the donor area as much as possible
With planning FUT can give the right high NW candidate an acceptable coverage from hair line to crown, albeit with a lower crown density, but if the individual is happy a result can be achieved in a single procedure
With any hair transplant technique scarring will occur; as said previously it is important to research the results of the clinic, not just recipient results but donor management to minimise any complications
Comments and questions made by those either looking to have a hair transplant or hair transplant veterans who have already undergone surgery, not necessarily by Hattingen Hair Transplantation
Hattingen Hair Patient Result Reviews
Comments and questions made by those either looking to have a hair transplant or hair transplant veterans who have already undergone surgery, not by Hattingen Hair Transplantation Patients
How Many Grafts Have I Got?
Hair loss is progressive and can continue for many years, starting generally from the hair line until it reaches the crown; the hair loss stages are categorised from minimal loss (NW2) to NW7 advanced hair loss. As hair loss over the top of the scalp progresses it can start to reduce the size of the donor area around the sides and back of the scalp as the sides and crown drop.
The donor area is a safe zone where the hair follicles are genetically programmed to not succumb to hair loss. But it is important as hair loss progresses that a conservative approach is taken to the size of the donor safe zone. Dependent on the technique used will determine how the follicular units are removed and how many FU´s can be harvested in one or multiple procedures.
An average donor hair density is around 75 FUcm² and can rise to over 100 FUcm² on a very good donor area. The hair density is an important factor in how many grafts you can use; obviously the higher density the more grafts available.
FUE extracts the follicular units one by one and over a wider surface area than FUT; the donor should be shaved and the safe zone assessed, checking for miniaturisation especially around the borders of the donor and recipient areas. As the FUE donor surface area has no signified boundary care needs to be taken not to stretch the boundary to try and reach high graft numbers and start to extract in a potential unsafe zone in later years.
FUT harvests the grafts from a single, relatively thin hair bearing strip where the follicles are at the highest density. The strip is then divided to remove the individual follicular units, 1, 2, 3 and 4 hair units. FUT relies much more on skin laxity rather than needing to harvest over a wide surface area; and because of the high concentration of FU´s in the area on an average candidate 4000 grafts can be removed in one procedure. On a good candidate anything from 6-7000 grafts can be harvested in one day with FUT. FUE generally in one procedure around 3000 can be achieved, partly due to the slow harvesting and to not over harvest.
It is possible to have more than one hair transplant procedure, either with FUE or FUT, generally the 2nd procedure will not yield the same amount as the first as the donor density has been reduced with FUE or laxity changed with FUT
Donor healing will play an important part after the first procedure how many grafts can be removed in the future.
With good laxity a 2nd procedure could yield a further 3000 grafts with FUT, FUE probably much lower because of the reduction in hair density from 100% prior to any surgery to around 70-75% after the 1st procedure. An average hair transplant candidate with FUT can reach around 7-8000 grafts over multiple procedures, over multiple procedures with FUE this figure will generally be lower, unless harvesting exceeds 50% of the donor hair.
Planning is vital from the very first procedure to ensure long term the donor is kept in the best cosmetic condition and the maximum number of grafts can be removed if/when hair loss progresses
Hair transplants have moved on greatly in the last decade and results can be undetectable from natural hair growth. Alas in the past and sometimes today poor surgery has been performed that needs to be repaired.
Repair surgery can be complicated and a drawn out procedure, requiring multiple future operations to get back to as normal situation as possible, patience is required and prioritising areas to repair first. Hair transplant repair can be either the recipient area or the donor area, or both. Poorly placed grafts in the recipient area and bad donor management can leave the scalp overtly scarred, miniaturised hair due to trauma.
Older methods used plugs or mini-grafts opposed to follicular units. These are larger bundles of hair maybe up to 20 hairs placed in an unnatural pattern of growth. When visible, especially along the hair line looks unnatural.
Poor slit placement can leave ridging and pitting on the skin; pitting is a crater effect where the hair enters the skin, ridging leaves a raised hump of hard skin on the surface of the head. Old pluggy grafts can often to hidden by placing around them to camouflage, if directly on the hair line it may be required to remove the graft or place directly in front to create a new hair line, design allowing.
The donor area, previous scarring can be englobed or removed with FUT to leave a smaller finer scar, laxity permitting. When the new strip is removed hair can also be harvested for use in the recipient. FUE can then harvest over a wider area if more grafts are required in the recipient, also if previous scarring has poor laxity grafts can be placed directly into the scar tissue to help camouflage the area.
With hair transplant repairs it is usual for a lower density to be placed to maximise the growth yield, especially if the hair is being placed in to scar tissue when the cardio-vascular is impaired. Also, due to the nature of a repair all areas are impaired, the remaining donor is reduced and damaged and priorities need to be made in where to place the hair in the recipient to give maximum benefit. It is important to research thoroughly before undergoing a repair, every hair counts
A hair transplant relies on the fact we can remove hair from the back and sides of the head and place them over the top of the scalp to give coverage and the illusion of high density to mimic nature.
Hairs are single shafts growing from a follicle embedded in the skin, the hairs grows, rests and falls out before it regrows again and goes through the same process time and time again. A follicular unit can be a single hair also, but a follicular unit can also be up to 4 hairs. An FU is a group of hairs that grow in tight bunches from 1 to 4 hairs normally.
The follicular units are spread around the scalp. There is a higher concentration of smaller FU´s around the sides of the head, with the larger follicular units, 3 and 4 hair units situated around the occipital bone, or the back of the head. So hairs to FU`s, you can have 5000 FU´s but the number of hairs could be anything from 5000 if all single hair units to 20,000 hairs if all 4 hair follicular units. This can make a huge difference to the quality of the hair transplant. Most hair transplant clinics use the phrase follicular units when saying how large the hair transplant procedure was. They will also give you the hair to FU count so you can compare the number of hairs; averaging to around 2.2 hairs per FU.
The definition of a graft is a piece of living tissue that is transplanted surgically. The term graft applies to the follicular unit in a hair transplant procedure. The term graft and follicular unit can imply the same. As the term graft technically only means a piece of tissue it is important to determine what the clinic refers to it as. Many clinics will say you have had “x” amount of grafts placed, and this can mean FU´s, but it important to understand the meaning prior to making your decision.
When quoted for a hair transplant it is common you are told you pay per graft placed, confirm this means pay for every intact FU placed and ask for the hair to FU count. As before there should be an approximate average hair count of 2.2 hair per FU/graft, if this is significantly lower it can impair the quality of the hair transplant and mean paying significantly more on average to the number of hairs.
Always research before making any decision on having a hair transplant