What is FUT (Follicular Unit Transplantation)?
Follicular Unit Transplantation (FUT) is a surgical procedure where hair is transplanted from the permanent zone, the area in the back and sides of the scalp where hair is more resistant to balding, to the bald or balding areas of the scalp. This is accomplished using naturally-occurring groups of 1, 2, 3, or 4 hairs, called follicular units. After the patient’s scalp is anesthetized, the doctor removes a strip of tissue from the donor area, an area within the permanent zone, and, once extracted, the donor strip is cut into many individual follicular units using microscopic dissection techniques. As these follicular unit grafts are being prepared, the doctor makes tiny holes in the scalp, called recipient sites, where the grafts are placed.
The arrangement and positioning of these follicular unit grafts determine the aesthetic qualities of a hair transplant, and so this arrangement must be decided on a case-by-case basis, depending on the patients’ history of hair loss and the likelihood of future hair loss. Since follicular unit transplants mimic the way hair grows in nature, the results, in expert hands, will look completely natural and be indistinguishable from one’s original hair. See some of these results in our Before & After Photos galleries.
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The FUT Hair Transplant Procedure
All procedures performed at Bernstein Medical – Center for Hair Restoration are based on Dr. Bernstein’s pioneering Follicular Unit Transplantation (FUT) techniques. The essence of these procedures is that the hair is transplanted into the balding area as individual follicular units (naturally occurring groups of 1-4 hairs), so that it will look totally natural and be undetectable as a hair transplant.Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) differ in the way the hair is harvested (removed) from the donor area in the back of the scalp. In FUT Follicular Unit Transplantation
In Follicular Unit Transplantation (FUT) a thin strip of hair is taken from the back and/or sides of the scalp and the area where the strip was taken from is sewn closed. The hair from above the incision covers the area so that it is not visible. The donor strip is placed under a series of special dissecting microscopes where the individual follicular units, of one to four hairs each, are carefully dissected into tiny grafts. These grafts are stored in a special holding solution and refrigerated while awaiting placement.
The recipient sites (tiny incisions) are made in the bald or thinning areas of the scalp using a fine-needle size instrument. Once the recipient sites are made, the follicular unit grafts are carefully inserted into the scalp. The 1-hair grafts are placed at the hairline, the 2’s immediately behind them and the larger 3- and 4-hair units are placed in the central, forelock area. The recipient site sizes are matched to the different size follicular unit grafts to facilitate healing and maximize the growth of the transplanted follicles., the hair is removed in a single, thin strip and then dissected into in individual follicular units using microscopes. In FUE Follicular Unit Extraction.
In Follicular Unit Extraction (FUE) a relatively large area in the back and sides of the scalp is shaved to approximately 1-mm in length. Instead of removing a single strip, as in FUT, a tiny circular incision is made around each follicular unit. The follicular units are then extracted, one-by-one, directly from the scalp. These grafts are stored in a special holding solution and refrigerated while awaiting placement in the bald or thinning scalp (the recipient area). The tiny wounds are left open to heal on their own.
As in FUT, recipient sites (tiny incisions) are made in the bald or thinning areas of the scalp using a fine-needle size instrument. The follicular unit grafts are then placed into these sites. The follicular units are removed directly from the back and sides of the scalp using a robotic device (see Robotic FUE).
All of our hair restoration procedures are performed under local anesthesia. Hair transplant sessions that use thousands of follicular unit grafts may take a whole day; however, the time goes by quickly. During the procedure, patients rest comfortably and can watch TV or a movie, take a nap, or chat with the staff.
The misconception that most people have of hair transplantation is associated with the out-dated “plug” techniques in which patients leave the office with their head wrapped in bandages and enduring significant bleeding and pain. In modern follicular unit hair transplants, patients leave the office with only a hat and headband and are able to shower and shampoo their hair the day after the hair restoration surgery.
Follicular Unit Transplantation – Follicular Units
For years it was thought that scalp hair grew as individual strands, but scalp hair actually grows in tiny little groups of 1-4 hairs each. These groups are called “follicular units.” Surprisingly, even after doctors learned about the existence of these groups, they didn’t think to use them in a hair transplant.
The term “follicular unit” was introduced into medical literature by Dr. Robert Bernstein in his 1995 publication “Follicular Transplantation.”
Follicular Unit Transplantation Graft Dissection
One of the most important aspects of FUT hair transplant surgery is stereo-microscopic dissection. This allows follicular units to be isolated from the donor strip without being broken up or damaged. During graft dissection, it is critical that the whole follicular unit is kept intact as this will maximize its growth. Intact follicular units will also give the most fullness to the hair restoration, as they contain the full, natural complement of 1-4 hairs.
Follicular Unit Transplantation Holding Solution
There are a variety of solutions in which grafts can be stored during surgery in order to maintain their viability and ensure maximum growth. Our understanding of the ideal holding solution continues to evolve. In our practice, we are currently using HypoThermosol.
Follicular Unit Transplantation Recipient Sites
Recipient sites are the tiny slits or holes that the surgeon makes in the patient’s scalp, where the follicular unit grafts are placed during a hair restoration procedure. At Bernstein Medical, recipient sites are made using lateral slits (also called coronal or horizontal slits). Lateral slits have the advantage of orienting the hair within the follicular unit to match the way it grows in nature. This gives the surgeon the highest degree of control over the direction and angle in which the transplanted hairs will ultimately grow.
Follicular Unit Transplantation Donor Area
The donor area is the area of the scalp (generally the back and sides) where hair-bearing skin is removed during a surgical hair restoration procedure. For a transplant to be effective, the hair in this area must be permanent (i.e. not subject to the effects of DHT).
Minimizing the scar from the donor incision is a critical part of a successful procedure. A fine donor scar allows a person to keep his/her hair relatively short after the hair restoration (if one wants to do so) and increases the amount of hair that can be harvested (removed) in subsequent procedures.
Follicular Unit Transplantation Graft Numbers
Determining how many follicular unit grafts will be transplanted is an important aspect of planning and designing a hair transplant for the maximum possible aesthetic effect. The graft numbers page gives general guidelines for the number of follicular unit grafts needed in a patient’s first procedure and for subsequent procedures, if more than one session is indicated.
FUT Hair Transplant Lecture
Dr. Bernstein’s lecture on Follicular Unit Transplantation includes an historical review of hair restoration techniques, from the out-dated “plugs” and “cornrows” to the current, refined FUT hair transplant procedure.
Brief History of Follicular Unit Transplantation
FUT was a major advance over the, now obsolete, “mini-micrografting” procedures that preceded it. In mini-micrografting, the graft sizes were arbitrarily determined by the hair restoration doctor, who would cut the donor tissue into different size pieces. These larger grafts, commonly known as “hair plugs,” might have contained up to 12 or more hairs, were bulky, and could produce a tufted appearance. They could also result in a dimpling of the underlying skin.
The major advance brought by FUT hair transplant procedures is that the use of special stereo-microscopes enables surgeons to meticulously dissect the hair grafts. This helps preserve the integrity of the follicular units and enables the surgeon to keep all of the growth elements of the hair follicle intact. The survival of the grafts is maximized and, as a result, both the hair and the underlying skin will look completely natural when the transplant matures. With FUT hair transplants, thousands of grafts can safely be transplanted in one session, allowing the patient to complete the hair restoration as quickly as possible.