Hair Transplant Technique: FUT, FUE or Both?

When deciding on the technique to best use; remember:

The harvesting method is not a matter of taste but a matter of necessity. Every patient has different characteristics and these should be taken into account when deciding on the best technique that should be employed

To gain the best long term result it must be thought about from the first session, then the optimum and maximum utilisation can be made of the donor area as it is untouched and has the greatest potential. Prior to surgery the donor and recipient area will have their best properties; the donor having the best density, laxity, no scarring and the recipient has also never been touched or impaired

Achieving high numbers is not only about the characteristics of the patient. The Doctor´s & Medical Team must be able to work together efficiently and with high skill to ensure graft survival and patient care is the priority

The hair loss pattern will determine the number of grafts required to cover the surface area. Each technique has pros and cons and before deciding on the technique to first use it is important to access the long term donor management.

If hair loss has progressed to an advanced state the need for grafts is high to cover the surface area. The larger the surface area the harder it is to treat the entire area in one procedure with either technique

The options is to treat the area over multiple procedures, starting with the hair line and working back over the frontal third and mid-section and later to treat the crown; this will require maybe 2-5 procedures dependent on technique and the quality of the donor resources

There are 2 recognised hair transplant techniques in use today, the FUT and FUE techniques. They differ mainly in the donor management and the manner the follicular units are removed from the scalp

Utilising the benefits of both FUT and FUE and combine the techniques to maximise the graft numbers in a single procedure; allowing for the potential to reach total coverage and possibly a “home run” result

By combining the two there is the potential to reach in excess of 8000 grafts on a good candidate; on an average candidate that would maybe only achieve 4000 grafts increase the number to 6000

Combining the techniques can also be of great benefit to repair hair transplant candidates; when the donor area has been impaired by improper previous surgery. Being able to remove a strip and widen the extraction zone at the same time can provide the maximum graft numbers to correct the pattern of hair growth over the recipient area

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Hair Line Density

The hair line is considered to give the largest impact when restoring a head of hair; the hair line frames the face and generally the first aspect that people see; drawing the eye back to the centre of the face, the eye rather than the forehead

The hair line is progressive from one side along the frontal to the other side beyond the temporal recession; there will be slight irregularities from side to side as the face is not symmetrical

As the hair lines moves round the angles and density placed needs to change to create a natural “smooth” hair line that does not draw attention; not a thick wall of hair that is too symmetrical

There is no such thing as a designer hair line as each individual will be different and must be taken into account when designing and placing the grafts; it is advised to not try and create a hair line pattern that you did not have before

Hair Line Position And Design By Hattingen Hair Transplantation

Hair Line Position And Design By Hattingen Hair Transplantation

The best hair line is the one that fits your facial features the best, not necessarily the thickest or lowest but the most natural that does not draw attention as it looks perfectly natural. Because of this hair line placement is often a compromise between the candidate and doctor; and a great deal of medical proficiency and artistic ability is required

Density placed is the amount of follicular units per cm² and along the hair line this is usually single hair FU´s and the density is governed by the hair characteristics to ensure a natural result is achieved

Dense packing is the term used to describe a high density of follicular units placed within an area; placing each graft close together to mimic nature. Fine hair requires a higher density, coarse hair has other concerns as it can look pluggy when transplanted; curly hair has advantages as the curl helps to create the illusion of fullness

As the hair line reaches the temporal recession point the density needs to be reduced slightly as well as the angle of the hair exiting the scalp as the bone structure moves down the side of the face

As the hair moves further down to the side-burn the angles have to change further, more acute to the skin to allow the grafted hair to be blended with the original side-burn

As the hair line requires a large number of grafts in a relatively small area the distribution is vital to maximise the coverage and density achieved with as low number of grafts as possible; allowing for greater distribution of hair further back

The design must take into consideration future potential hair loss, if a hair line is placed too low and hair loss progresses aggressively the design may look out of place and unnatural in the future

Dense packing allows for a result to be realised in one pass, it ensures a smooth progression from single hairs to 2 hair FU´s behind to rebuild the density and thickness, but maintain a soft appearance to the immediate hair line opposed to a thick wall of hair that can look unnatural

Great importance is made of the hair line density but it can differ greatly between individuals so to give an estimate of graft numbers required is not practical or realistic and must be judged on a personal basis, can range between 400 to 1000 grafts, taking into consideration the design and the natural characteristics of the hair

 

 

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Hair Meds Or Hair Transplant?

Dependent on whether you use medications will have an influence on how the doctor plans your hair restoration, along with your age and hair loss pattern now and potential in the future

Before deciding on what approach for either hair retention or hair restoration it is vital to always research well and choose the best option for you at that time but with your long term well-being in mind.

The decision should not just be based on what you would like most as a result but what result is sustainable over time. Much will depend on the age of the individual and the hair loss pattern they have

Timing is very important when considering a hair transplant, treating minor hair loss at a young age can lead to problems in the future if the hair loss progresses aggressively and you cannot sustain a balance natural restoration

A Mature Hair Line Or The Start Of Male Pattern Baldness

A Mature Hair Line Or The Start Of Male Pattern Baldness

It is important to understand that surgical hair replacement without medical therapy may not provide a suitable result, dependent on your hair loss stage and future loss. Planning is important before deciding on a hair transplant, whether you intend to use hair loss medications or not, and having an open and honest dialogue with your doctor.

There are three FDA approved medicated treatments and therapies for treatment of hair loss, although FDA approved it must be understood there is no miracle cure and results can vary from person to person, and always consult a specialist before using

Combining medications and surgical hair restoration is an option; this can have the benefit of potentially reducing the size of the operation required and sustaining much of your natural hair growth

When consulting a hair loss or hair transplant doctor be clear whether the intention is to use a treatment programme long term after a hair transplant has been performed as this will have a bearing on the approach and master plan the doctor makes in your restoration

Dependent on the individual´s hair loss pattern some clinics may advise to wait before undergoing a hair transplant, either use medications or simply allow the hair loss pattern to mature a little more

This allows for the potential hair loss pattern to be easier identified and making long term planning easier; also allowing for the individual and doctor to agree on the goals and set out a plan, hair line design and coverage

Surgical hair restoration for the correct candidate can help restore hair permanently to areas that have suffered from hair loss; but it is not a miracle cure and will not prevent future hair loss of the native hair

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Costs Involved In A Hair Transplant

Surgical hair restoration is elective surgery and generally has to be paid for privately as it is not covered by private insurance or social medical services. Prices can vary greatly between Clinics and as important the cost is the decision should not be based on cost alone; be it cheaper is more economically beneficial or the more expensive must be better

The physical cost of the hair transplant is one factor but there are other costs involved, research, travel, accommodation, post operation care, time off work.

Follicular Units divided into the natural groups in a holding solution

Follicular Units divided into the natural groups in a holding solution

Most clinics charge per follicular unit (FU) with each FU containing between 1 to 4 hairs, and the charge is made per FU placed in the recipient area; generally the rate for FUE is higher than FUT. Always ask for the FU/Count when making your final payment so you can ensure you pay for what you receive

On an average size hair transplant procedure the hairs per follicular unit averages out to around 2.2 hairs per unit, for example a 4000 graft (FU) procedure there will be approximately 8800 hairs

This is an important consideration on two respects

A hair transplant result relies on the strategic distribution of natural follicular units to gain the coverage required and the appearance of natural density

If the hair count is considerably lower than the average then the overall cost will increase pro rata

A Hair Transplant can be a big investment and before deciding all due care should be taken; a benefit of a hair transplant is the grafted hair is permanent. As important as the cost is in the decision your decision should not be related to the cost, be it high or low; your decision should be based on the quality of the results of the clinic and reputation from previous patients

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The Best Use Of Surgical Hair Restoration Techniques

One of the aspects when researching a hair transplant procedure is which technique best suits your goals short and long term; as the FUT and FUE techniques differ mainly in the removal of the hair each method will give advantages and disadvantages

It is common for Clinics and individuals to favour one technique over the other, and this is not a problem as long as the chosen technique can deliver the results, coverage, density, high yield and good donor management for the candidate

A technique should not be chosen simply because it is in vogue, but for the results it can deliver short and long term; in some cases combining the techniques will reach the goals of the individual better than choosing between them

Educated donor management will allow for the efficient movement of grafts from the donor to the recipient; the minimum impact on the donor, the minimum amount of times the donor has to be entered to achieve the restoration goals of the individual

FUT and FUE Hair Transplant Techniques, one or the other or combine the two?

FUT and FUE Hair Transplant Techniques, one or the other or combine the two?

In the recipient this translates to using the minimum number of grafts to achieve the necessary coverage and natural looking density; not depleting the donor to the degree that little to no hair can be safely harvested and not reducing the density to an unsafe level

The goals will be different for each hair transplant candidate; those with an advanced pattern of hair loss can be less demanding on aspects such as low hair lines and prefer to concentrate on coverage and density from the hair line to the crown

Being able to achieve a balanced coverage in one procedure has many advantages; time efficient is the obvious advantage, financially less wear on the pocket and in respect of donor management only having to enter the area a single time

As the first procedure will set the tone for restoration in the future deciding on the correct technique is vital as the scalp is in the best condition. As with FUE the follicular unit extraction can be spread over a wider surface area compared to FUT if the harvesting protocol is in place very little density change can be measured

The higher the graft numbers an educated harvesting protocol becomes harder as less hair remains in the area and it is more likely to over harvest or increase miniaturisation due to a traumatic ripple effecting the surrounding follicular units left in the donor

Hair line and frontal third reconstruction can require around 2500-3000 grafts; assuming the donor hair density allows for the safe removal of the numbers without over harvesting FUE is a suitable technique: Even higher hair loss patterns can be treated as long as the donor hair density is not reduced to a level white dot scarring or hair less areas do not become overly apparent

Although FUT leaves a linear scar line it will allow for a more efficient form of harvesting and can safely with the right candidate achieve higher graft numbers in a single procedure; with an average candidate achieving 4000 grafts safely and a good candidate 6000 plus in one day

The technique is an important aspect to discuss when having a consultation with a doctor, try to consult various doctors and ideally those that perform both techniques as an objective appraisal can be given as to the correct technique

Remember that the hair and scalp physiology cannot be improved upon, it can only change the more sessions are performed; the numbers available can be calculated by measuring the donor area against the hair density: The conclusion can only be mathematical as each technique will have the limits as to how much can safely be removed

 

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Crown or Vertex Surgical Hair Restoration

Treating the crown or vertex can be a technically demanding aspect of surgical hair restoration, largely due to the changing angles and orientation of hairs to recreate the natural spiral that occurs. Furthermore, the surface area of the crown can be extensive, equalling the frontal and mid-section combined, dropping on the sides as well as the back of the head, making restoration demanding and sometime not practical.

It is common the crown is the last area to be treated, due to this the highest number of the safe donor has been used on the frontal and mid-sections, reducing the numbers available to maintain the same even density over the crown. With good hair characteristics this may be possible but the average candidate has to be content with coverage but at a slight lower hair density

Before and Grown Out Result. 4954 Grafts. Hattingen Hair, Switzerland 5. 4772 FUT TOP 4. Before & Grown Out Result. 4920 FUT. Hattingen Hair Transplantation, Switzerland

 

 

 

 

 

 

 

 

 

 

 

 

 

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Can Old Plug Grafts Be Removed?

 

Older style techniques for hair transplantation could leave an unnatural pattern of hair growth, commonly known a plug grafts and given derogatory names such as dolls hair and tooth brush look

The look was achieved because too many hairs were placed together in one large slit or recipient site; they could not be placed close enough together and stood out; if within existing hair they could be hidden but in the hair line there was no hiding

Hair Transplant repair Surgery Requires Technical Skills & Ability

Hair Transplant repair Surgery Requires Technical Skills & Ability

As hair loss progresses the pattern of hair growth becomes more extreme and unnatural; this also affects the donor hair supply as the plug method would waste a great deal of hair and leave large scarring in the donor making future hair transplant difficult

There can be a number of solutions to hiding the old plugs; some are dependent on the quality of the donor hair and as with any hair transplant repair priorities need to be made to achieve a successful natural looking resolution

Dependent on the position of the plugs it may be possible to camouflage them; by placing smaller follicular units in front of and around the plugs can soften the look but if the placement of the plugs is too low on a hair line or temporal area this solution will not be suitable

In some cases it may be better to remove the old offending plugs and design a new hair line; although this option may take two procedures to complete it can give a better and more natural solution

Dependent on the size of the plugs there are two options for excising, strip or FUE; either making a micro strip cut around the grafts and then suturing the strip, or using an FUE punch to encompass the graft and then extract with the wound healing over a short period of time

Either extraction method will need to properly heal before hair can be placed in or near the same area; if the plugs are below the new recipient area then restoration can be continued otherwise restoration will need to be continued in a second procedure

When removed it is common that some impairment to the skin will remain, small scarring or ridging to the skin surface; some treatments can reduce the visibility of this and some resurface the skin but can take time to show positive results

The extracted plug grafts are quite strong and durable due to their size and the amount of tissue surrounding them; dependent on how easy they were to extract and the trauma caused some can be saved and still used

The grafts needs to be examined under magnification, cleaned and divided into smaller hair grafts, probably one to three hairs, the damaged, transected hair follicles need to be disregarded as the possibility is they will not regrow when transplanted

Once the plug grafts have been divided and cleaned they can either be used back into the recipient area or in some occasions placed back into the donor area to help conceal any scarring that remains

Hair transplant repairs can be delicate procedures, psychologically as well as technically; the patient will have undergone a great deal of stress and sometimes depression and their trust has often been eroded

Technically full restoration is very unlikely and the goals should be to get back to as natural cosmetic situation as possible; goals and priorities need to be addressed and mutually agreed upon for the best well-being of the patient

 

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