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Follicular Unit Transplantation : In depth

Follicular Unit Transplantation is a hair restoration technique where a patients hair is transplanted in naturally occurring groups of 1 to 4 hairs, these are called follicular units. Follicular units also contain sebaceous glands, nerves, a small muscle, and occasional fine vellus hairs. In Follicular Unit Transplantation these small units allow the surgeon to safely transplant thousands of grafts in a single session, which maximizes the chances of the procedure being a success and looking good from an early stage too.

Follicular Unit Transplantation is considered by many to be an improvement over older hair transplantation procedures that used larger grafts and often produced a pluggy, unnatural look for the scalp of the patient. In a correctly performed follicular unit transplant, the results will tend to replicate the way hair grows naturally and will be undetectable as a hair transplant.

Maximizing hair transplant growth

Since the follicular unit is a distinct anatomic and physiologic entity, preserving it intact during the graft dissection is felt to maximize growth. In Follicular Unit Transplantation, after hair is removed from the back of the scalp in a single strip, stereo microscopic dissection allows the individual follicular units to be removed from this strip without suffering any damage.

In the older mini micrografting techniques, hair was harvested in multiple strips with the follicular units in each strip edge exhibiting damage from the harvesting blades. The strips were then cut into smaller pieces, a process that would break up follicular units and risk additional damage to the follicles.

Follicular Unit Transplantation: Ensuring the naturalness of hair transplant

Follicular Unit Transplantation allows the hair transplant to look natural both at the individual follicular unit level and in regards to the overall graft distribution. Scalp hair usually grows in follicular units of 1 to 4 hairs, the exclusive use of these naturally occurring units in Follicular Unit Transplantation ensures that each graft will be identical to the surrounding follicular units. When the transplanted follicular units grow hair after a transplant, the overall results of the transplant will appear far more natural.

Also, by using individual follicular units, rather than larger grafts, the surgeon has a greater total number of grafts with which to work. This allows the surgeon to distribute the grafts more evenly over the scalp for a more natural overall distribution of hair.

Ease of surgical planning

The density of naturally occurring follicular units in a normal scalp is relatively constant, measured at approximately 1 unit per mm2. This helps in the planning of a hair transplant in two ways:

  • The hair transplant surgeon can accurately estimate the number of follicular grafts that can be obtained from dissecting a donor strip of a particular size.
  • The same number of follicular units can be used to cover a specific size balding area regardless of the patients actual hair density.

In patients with a high hair density, there are usually a sufficient number of follicular units in the donor area to accomplish the patients goals. However, in the patient with low hair density, a compromise must be made and this is guided by the follicular unit constant. By transplanting a patient with low hair density using the same number and spacing of follicular units as in a patient with high density, the transplant surgeon will produce a thinner look, but will allow proper conservation of donor hair for future procedures.

Follicular Unit Transplantation: Keeping trauma to the scalp to a minimum

The key to a natural looking hair transplant is to have the hair emerge from perfectly normal skin, so minimizing trauma to the scalp is an important aspect of follicular unit transplantation. This can be achieved by trimming away the excess tissue around the follicular units and then inserting them into small recipient sites on the patients scalp.

Follicular units are relatively compact structures, but are surrounded by substantial amounts of non hair bearing skin. This extra tissue can be removed without injuring the follicles, using stereo microscopic dissection. These small, trimmed, follicular unit grafts can then be placed into tiny incisions in the patients scalp; thereby minimizing damage to the scalps connective tissue and blood supply. In contrast; the larger wounds produced by mini micrografting and plug transplants caused cosmetic problems that included dimpling and pigment changes in the skin; depression or elevation of the grafts; and a thinned, shiny look to the scalp. These problems can be avoided using very small grafts and very small recipient wounds.

A further advantage of making small recipient wounds is the ability to create a much better fit for the follicular unit grafts. Unlike the old and outdated punch grafts and some mini grafting techniques; each of which removes a small bit of tissue in the recipient area; the trimmed follicular unit grafts used in Follicular Unit Transplantation fit into small incisions that are made with needles without any need for removing tissue. This preserves the elasticity of the scalp and holds the tiny grafts in place tightly. After surgery, the perfect fit facilitates wound healing and helps to ensure that the grafts will get enough oxygen from the surrounding tissue in order to maximize their survival.

Follicular Unit Transplantation gives the surgeon the ability to perform large hair transplant sessions

There are four reasons why the follicular unit transplantation procedure allows a hair transplant surgeon to transplant large numbers of grafts in each session:

  • The hair restoration can be completed quickly so that the patient has very little interference with their lifestyle,
  • A larger number of grafts can compensate for the shedding that frequently accompanies a hair transplant, called telogen effluvium,
  • Using large numbers of grafts in each session preserves the donor supply by reducing the number of times incisions are made in the donor area,
  • Extracting large numbers of grafts provides sufficient 1 and 2 hair grafts to create a soft frontal hairline and enough 3 and 4 hair grafts to give the patient the fullest possible look.

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Further Information

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