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Follicular Unit Extraction

Follicular Unit Extraction: F.U.E.

Hair transplantation has become a minimally invasive surgical procedure that moves individual hair follicles from one part of the body that is called the donor site to a bald or balding part of the body that is known as the recipient site. This procedure is commonly used to treat male pattern baldness. The Follicular Unit Extraction involves the taking of grafts that contain hair follicles that are genetically resistant to balding. The donor area is often the rear or sides of the head and these grafts are then transplanted to the bald recipient part of the scalp. This amazing procedure can also used to restore eyelashes, eyebrows, beard hair, chest hair, pubic hair and to fill in scars that were caused by accidents or surgery such as face lifts and previous hair transplants. Follicular Unit Extraction and transplantation differs from skin grafting in that the grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.

Hair grows naturally on the human head in groupings of 1 to 4 hairs, the most advanced modern techniques harvest and transplant these naturally occurring 1–4 hair follicular units in their natural groupings. Therefore, modern hair transplantation can achieve a very natural appearance by copying nature itself. This type of hair transplant procedure is called Follicular Unit Transplantation (FUT). Donor hair can be harvested in two different ways.

Strip harvesting for transplantation

A very thin strip of scalp tissue is removed under a local anesthetic, the wound is then sutured back together and this piece of scalp tissue is cut in to small pieces of tissue called grafts which are then transplanted into small recipient sites prepared by the surgeon in the thinning area of the patients scalp. This method will leave an extremely thin linear scar in the donor area of the head, which is typically covered by the patients hair even at rather short lengths. The recovery period for this procedure is around 2 weeks and will require the stitches or staples to be removed by a medical practitioner or sub cuticular suturing can be done.

Follicular Unit Extraction for transplantation

Follicular Unit Extraction, otherwise referred to as FUE Harvesting is when the hair transplant surgeon removes individual follicular units containing 1 to 4 hairs, under local anesthesia, from the donor area. This procedure often makes use of very small punches of between 0.6mm and 1.0mm in diameter. Each follicle is then inserted into a tiny recipient hole made by the surgeon using a special tool. Because individual follicles are removed, only small, puncture scars remain and any pain experienced after the surgery is minimized. As no suture removal is required, the recovery from Follicular Unit Extraction is well within 7 days. Some surgeons have commented that Follicular Unit Extraction can lead to a lower ratio of successfully transplanted follicles as compared to strip harvesting. Some have even suggested that should a patient need more than one transplant, it would be quite difficult to find a good strip to work with after a Follicular Unit Extraction.

History of hair transplantation

The practice of hair transplantation dates back to the 19th century. It is believed that modern transplant techniques began in Japan around the 1930s, where surgeons used small grafts, possibly even follicular unit grafts to replace damaged areas of eyebrows or eyelashes, but not to treat baldness. Maybe this was a cultural influence as baldness, natural or otherwise, was very common in the Samurai class. The early hair transplant surgeons efforts did not receive global attention at the time, and it wouldn't be until the 1950s, that the hair transplantation procedure pioneered in Japan, became available to a wider audience.

When the practice of hair transplantation first arrived on western shores, there was a general belief that transplanted hair would not last. It was considered to be a temporary and limited fix to a problem that had cursed humanity for many years. In general, surgeons thought that once the donor hair had been transplanted to the recipient part of the head, it would slowly die off and suffer the same fate as the original hair that had once occupied the now bald or balding area. Fortunately this was not the case.

It is now accepted that transplanted hair will only grow in its new site for as long as it would have in its original one. This rule continues to serve as the fundamental foundation for hair follicle harvesting, whether it be by strip method or Follicular Unit Extraction.

Varying levels of success in the hair reansplantation field were achieved over the next couple of decades. Some surgeons worked on transplanting smaller grafts, but the results were only slightly successful, with 2–4 mm plugs that resulted in a scalp that resembled a dolls head. Other surgeons started using large numbers of small grafts in the 1980s, while American surgeons began using thousands of micrografts in a single session. In the late 1980s, an eminent surgeon introduced the use of a stereo microscope to dissect a single donor strip into small micrografts.

The follicular unit hair transplant procedure has continued to evolve, becoming more refined and only slightly invasive as the size of the graft incisions have become quite minute. These smaller and less invasive incisions enable the surgeons to place a larger number of follicular unit grafts into a given area. The new refined follicular unit hair transplantation procedure can place over 50 grafts into a square centimeter.

With the latest improvements to the surgical technique and in particular, the Follicular Unit Extraction procedure, the recovery time is instantaneous and the pain virtually zero. There is no need for any bed rest or hospitalisation after the hair transplant has been completed.

The Follicular Unit Extraction procedure

There will be an initial consultation where the surgeon will analyze the patients scalp, discusses the patients expectations, and advises them as to whether they would need single or multiple sessions and what results might be expected.

It is advised that, for several days prior to surgery, the patient should refrain from using any medicines which might result in intraoperative bleeding and resultant poor take of the grafts, such as aspirin. Alcohol and smoking can also contribute to poor graft survival. After the procedure, antibiotics are commonly prescribed to prevent wound or graft infections.

The Follicular Unit Extraction surgery

Hair transplant operations are generally carried out on an outpatient basis. As an option, the patient may request mild sedation prior to an injected local anesthesia, which usually lasts for around six hours. The scalp is shampooed and then treated with an antibacterial agent prior to the donor parts of the scalp being harvested.

In the usual follicular unit procedure, the hair transplant surgeon harvests a strip of skin from the posterior scalp, in an area that has good hair growth. The strip is about 1 – 1.5 x 15 – 30 cm in size. While the surgeon is closing the resulting wound, medical assistants start to dissect individual follicular unit grafts from the harvested strip. Working with binocular stereo microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for eventual grafting. The latest method of closure is called Trichophytic closure which results in much finer scars to the area where the units have been harvested from.

Follicular Unit Extraction harvesting does away with the need for large areas of scalp tissue to be harvested and can give very natural results with virtually no visible scarring.

The surgeon will then use a very small micro blade or a fine needle to puncture the sites that will receive the grafts, placing them in a predetermined density and pattern. The surgeon can also angle the wounds in a consistent manner to promote a more realistic hair pattern. The technicians that assist the surgeon will generally do the final part of the procedure, inserting the individual hair grafts in place.

Care following the Follicular Unit Extraction procedure

Advances in wound care permit the use of a semi permeable dressing, that allows seepage of blood and tissue fluid. These can be applied and changed on a daily basis. The now tender recipient area must be protected from the harmful rays of the sun, but gentle shampooing can be started two days after the surgery. Shampooing is considered to be quite important in order to prevent scabs from occurring around the hair shaft. Scabs stick to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first week or so after the Follicular Unit Extraction procedure.

It is expected that at some time during the first ten days, virtually all of the transplanted hairs will fall out, this is known as shock loss. After two or three months new hair will begin to grow from the moved follicles. The patients hair will then grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients choose to use medications to slow or block this loss, while others opt for further transplant procedures as a way of tackling the issue.

Modern techniques for hair transplantation

There are several different techniques available to the surgeon for the harvesting of hair follicles, each technique has its own advantages and disadvantages. Regardless of which donor harvesting technique is employed, the correct and effective extraction of the hair follicle is paramount to ensure the viability of the transplanted hair and avoid transection, the cutting of the hair shaft from the hair follicle. Hair follicles grow at a slight angle to the skins surface, which means that regardless of technique, transplant tissue must be removed with a corresponding angle and not perpendicular to the surface.

There are two main ways in which donor grafts are extracted in surgical procedures today. There is the strip excision harvesting and follicular unit extraction.

Strip harvesting is the most commonly used technique for removing hair and follicles from a donor site, which is usually the area at the back and sides of the scalp. A surgical scalpel is used to remove strips of hair bearing tissue from the donor site. Each incision is planned so that hair follicles are removed intact, and once removed, the strip is dissected into follicular units, which are very small and naturally formed groups of hair follicles.

Follicular Unit Extraction can be conducted in a single session over several hours or by multiple sessions of shorter time duration. Follicular Unit Extraction is considered to be more time consuming, depending on the surgeons skill. The advantages of this technique over the conventional strip harvest are that it doesn't leave a linear scar, and the surgery produces little or no postoperative pain and discomfort. There are some disadvantages such as increased surgical times and higher cost to the patient.

Side effects

The "shock loss" hair thinning, is a very common side effect, but this is usually only temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day.

Other side effects can include some swelling of areas such as the scalp and forehead. If this becomes uncomfortable, anti inflammatory medication may ease the swelling and an over the counter pain killer may be taken to ease the discomfort. Sometime the scalp starts itching and scratching will make it feel and look worse as it will cause scabs to form on the scalp. A moisturizer or massage shampoo may be used in order to relieve the itching.

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