4103 FUT

1 Hair 691            691
2 Hair 2108       4216
3 Hair 1025       3075
4 Hair 279          1116
Total: 4103       9098

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5063 FUT

5063 FUT

1 Hair 397 397
2 Hair 2329 4658
3 Hair 1654 4962
4 Hair 683 2732

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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

Open Donor

A hair transplant relies greatly on the capacity of the donor area to supply enough hair to cover the surface area of hair loss; the more times the donor is entered or harvested the quality of the area will be impaired

Donor management is vital to a successful hair transplant; older techniques such as punch grafting would leave large cylindrical scarring across the donor area and greatly reduce the amount of hair and density that can be safely harvested and leave obviously visible scarring

Planning is critical, both from the donor and recipient, to prioritise on what supply is available to what the demand is in the recipient area; as the number of follicular units available is a finite resource they need to be distributed in optimum approach

When dealing with a depleted donor it is important to prioritise how the hair that can be harvested can then be used in the recipient area; very often a depleted donor also means a less than successful recipient hair result and this will require planning to get the most from the donor to give a cosmetically pleasing result in the recipient

Known as an “open donor”, the area has been depleted of hair, either due to excessive scarring by previous operations or the donor hair quality not being adequate to be used, either miniaturised or simply a low density, possibly signs of DUPA

In cases where the donor is open with punch scarring, and assuming the skin laxity still allows it can be possible to excise the scarring using the FUT technique, or strip method; this allows for the strip to be taken and then sutured leaving a single line, opposed to multiple punch scarring

A depleted donor can also occur prior to any hair transplant being performed; if the area has a high % of miniaturised hair, or a low density or hair count. If the case a hair transplant is very possibly not the answer, short or long term it is unlikely a successful result can be achieved

Research is important, having the donor area checked and examined, especially with repair hair transplant surgery so a master plan can be made and both the candidate and doctor understand the goals, priorities and limitations

Sustainable Hair Retention

It is important to understand as we age our hair characteristics will also change naturally; when younger, later teens generally our hair is at its strongest and not uncommon to change slightly as we enter our early 20´s as men

MPB is generally relatively slow to manifest itself and deciding at what stage to treat hair loss is critical to your long term happiness; with the first signs of thinning if this is something an individual wishes to treat hair loss retention treatments should be the first option

Surgical hair restoration is not necessarily the best option in the initial stages of hair loss and is not a cure; until the hair loss pattern can be better established or the hair loss stabilises a hair transplant should not be considered

Especially at a younger age it is prudent not to panic if some thinning or miniaturising of hair is seen in the temples or generally along the hair line; almost every man will experience this over their lifetime even if MPB does not take an aggressive path

As to whether this will continue into advanced Male Pattern Baldness is a prediction to a great extent, genetically family history can be a guide but only that as the MPB gene can skip generations

The on-set of hair loss normally starts with the temporal regions of the hair line, causing the hair line to become more acute and exposing the temples to give the impression the forehead is larger; the V shaped hair line

The earlier treatment is started the greater chance of maintaining the growth you have; another option is to allow nature to progress and monitor the hair loss and then make a decision as to how best to treat over time

Although there are only 3 FDA approved hair loss treatments and results will vary from person to person it is the logical initial path to take; trying to maintain the hair line and potentially improve upon the weaker hair that is still growing can allow to keep the hair line or at least slow down the pattern of hair loss

The initial use of medications can sustain the growth of your hair for many years without the need for a surgical procedure; when deciding to start a treatment programme is specific to the individual and how severe they see their hair loss

Making The Numbers Reach

A hair transplant relies on being able to meet the demand for hair by the recipient surface area to cover; the hair that can be removed safely to ensure the donor area is kept in good condition and not depleted to the extent no further work can be carried out

The density of hair is measured per follicular unit, each follicular unit can range in size from on average 1 to 4 hairs per grouping, with an average of around 2.2 hairs per follicular unit and the calculation measured per cm²

Donor management is vital to the long term result a candidate can achieve; if too much hair is removed to treat a relatively small area as hair loss progresses the demand surpass what the donor can supply

The donor hair density will alter dependent on the area of the scalp, around the back a higher density of follicular units compared to the sides; also the average number of hairs per FU will drop around the sides compared to the back

The donor area covers the back and each side of the head and ranges in size dependent on the technique utilised, FUT or FUE

The FUT technique relies on removing a hair bearing strip from around the sides and back; although the hair has been removed the overall density is hardly changed; FUE relies on the removal of follicular units from the surface area, so the density of FU´s will actually decrease

With planning it is possible even with high Norwood scale hair loss sufferers to give close or total restoration from hair line to crown, may be requiring a lower crown density being placed, but achieving a natural coverage

The hair line placement has to take into consideration potential hair loss and the ability to sustain a balanced coverage from the donor hair available

If the starting donor hair density is too low surgical hair restoration may not be a viable option; it may be able to treat minor hair loss but as hair loss progresses the demand for hair will out way what the donor can provide

The donor hair density can be easily assessed at a hair consultation under magnification; it can make an estimate of the density per square cm, the approximate average of hairs per grouping and any miniaturisation present; from this a Master Plan can be made how, when and where to start the restoration

Donor and Recipient Follicular Units

Grafts or follicular unit density applies to the donor and recipient areas; donor hair density has a large part to play with the suitability of a hair transplant candidate. Recipient density reflects on how natural the result will look

With a hair transplant the result works by illusion of density, blocking the light reflection off the head, the more the reflection can be blocked the greater the look of thickness is achieved

Hairs grow in natural groupings called follicular units; there are generally one to four hairs per follicular unit and dependent on the area to be treated will be strategically placed in the recipient area to give the best cosmetic impact

Hair density in the donor and recipient areas is generally measured per cm²; the density around the sides and back varies, with a slightly lower hair density around the sides and a higher density around the back

Average donor hair density is considered around 75 FUcm², it can rise to over 100 FUcm² and can drop to as low as below 50 FUcm². Donor hair density can also be linked to the hair characteristics and ethnicity of the individual

Aspects such as hair colour, hair calibre, curly or straight hair can all impact on the density of hair around the donor area safe zone

Hair density placement is a vital component to a successful hair transplant, it is important that whatever the area is that needs to be treated it is completed in one pass with the required density; it is not ideal to have to go back into the same area

The exception to this is when rebuilding a higher Norwood scale hair loss sufferer and total restoration in one procedure is not possible. Then the density placed will drop going back over the head to not leave a flat hard line

Single hair follicular units (FU´s) require a greater number to be placed to create this illusion of thickness, dependent on the hair characteristics possibly from 40-70 FU´s per cm². Hair line work requires the use of single hair follicular units directly on the hair line to give a soft, natural look, not a hard wall of hair

Behind the hair line the multiple hair units are placed to help gain the fullness of the result. Hair characteristics play an important role in the number of grafts required to be placed per cm²; fine, wispy hair gives little coverage whereas coarse wavy hair gives a much greater illusion of thickness

Multiple hair units can reduce the density placed due to more hairs per follicular unit; the density placed could be 30% less but actually give more hairs in the area, allowing for greater distribution of the follicular units, meaning more coverage being achieved

Placing a high density is a skill, creating the slits for the graft to be placed in such a small area needs precision tools; at Hattingen Hair use custom-made blades, to alter the size of the slit dependent on the graft size placed

Being able to vary the slit size also allows for a greater density and speedier healing at high density; a skill required on small or large procedures, but especially larger procedures having to cover a wider surface area

The density required has many variables and needs to be discussed with the doctor to ensure an understanding is there as to why a certain density is required; this will help to understand why a certain number of grafts are required and what coverage can be achieved