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FUT: FOLLICULAR UNIT TRANSPLANTATION OVERVIEW

In Follicular Unit Transplantation (FUT) procedures, hair is removed from the donor area in a single strip and divided into grafts under a high-powered microscope. These grafts are placed in tiny micro-incisions created in a pattern and distribution that mimic natural hair growth. Although FUT once described any procedure that created 1- to 3-hair grafts (follicular unit grafts), it now refers to a hair transplantation procedure using the strip harvesting method to obtain these grafts. When we refer to FUT in this section we are specifically referring to follicular unit “strip” surgery.

FUT has been the gold standard of hair transplantation for 25 years. It is the most reliable technique to achieve naturalness and maximum density in the recipient area. Most of the time, the linear scar left by the strip incision is very fine and not visible, even when the hair as short as is 1 cm in length. Many patients choose this technique because of its long track record of consistently producing a high number of grafts with excellent survivability.

Both FUE and FUT can produce excellent results. In some patient who may require a higher number of graft to achieve their goals , a combination of both FUT & FUE techniques are used to get more grafts than either technique can achieve alone.


FUT DETAILS

Meeting a patient’s expectations of both naturalness and density are the two most important goals in hair restoration surgery. The strip FUT procedure involves four main steps: donor harvesting, graft preparation, recipient site creation, and graft placement. Each step is an integral link in the chain that creates a successful hair transplant.

1. Donor Harvesting
2. Graft Preparation
3. Recipient Site Creation
4. Grafts Placement

STEP 1: DONOR HARVESTING

The first step in this procedure is the removal of the donor strip from the recipient site. It is important to do this in a way that ensures minimal damage to the donor hairs and minimal scaring to the donor area after the tissue is sutured together. First, the physician identifies the safe donor area, which is the portion of donor hair that is not susceptible to hair loss. Then the hair is wet and trimmed at the site where the strip will be removed. At SMG, we like to keep this hair longer for three reasons:

  1. It makes it easer to follow the angle of the hair when we make the incision.
  2. It makes it easier to handle the graft at the later placing stage.
  3. It gives a better preview of how the transplant is looking and makes it easier to do any fine tuning that is needed to create a perfect result.

Choosing Safe Donor Area

Wet Hair to Reveal Risk Area

Leave Donor Hair Long

Helps with Placing

Before removing the donor strip, the physician evaluates the donor area density so the correct amount of tissue can be removed and the correct amount of grafts created. At SMG, we use digital technology and specialized software to photograph and measure the donor density. We also test the laxity of the scalp in order to calculate the safe amount of tissue we can remove without causing tension or scarring. Each patient must do a scalp stretching exercises before their procedure to ensure the greatest laxity possible. We also use a medication called Vitrase that is injected into the donor area to increase laxity and decrease the chance of scarring.

Check Donor Laxity

1-2cm Depending on Laxity

Measure Donor Density

1cm Circle

We use 5.0 power surgical loops to magnify the area of tissue removal in order to better follow the exact angle of the hair and prevent damage. After the strip is removed, the donor area is sutured closed with a trichophytic closure. This technique helps limit any scar that develops in the donor area because it allows hair to grow through the scar and camouflage

DONOR STRIP REMOVED Follow angle of hair
DONOR SUTURED Trichophytic
DONOR SUTURED Incision hard to see

STEP 2: GRAFT PREPARATION

Once the strip is removed, it is dissected down into individual 1- to 4-hair follicular unit grafts.

Donor Strip is Cut into “Thin Slivers” with a Microscope

The first step in graft preparation is to sliver the donor tissue under a microscope into thin sections only 1 to 2 hairs wide. With the use of a high-powered microscope, the tissue can be converted into these thin slivers with almost no trauma or transection. Next, the slivers are cut down into the individual 1- to 4-hair follicular unit grafts and trimmed of as much excess tissue as safely possible. This trimming creates the smallest possible graft that enables the physician to use the smallest possible incision, resulting in less trauma and better graft survival. During this time, the grafts must remain hydrated and cooled. At SMG, we use a special holding solution called Hypothermasol that has antioxidants, buffers and nutrients to help maximize survival at cooler temperatures.


STEP 3: RECIPIENT SITE CREATION

While the grafts are being prepared, the physician will create the recipient sites by first planning the best pattern and distribution of grafts. This plan is created by evaluating the patient’s donor supply, balding area and expectations. The physician then makes thousands of tiny incisions in a way that will ensure maximum survival of the grafts, minimal trauma to pre-existing hair, and the proper exit angle and direction of the grafts. At SMG, a number of tools are used to accomplish this goal:

  1. Custom-cut blades that can be matched perfectly to the size of the graft.
  2. Separation of the 1- to 4-hair grafts so they can be selectively distributed to create more specific density, gradients and natural patterns. The 1-hair grafts are placed in the front for naturalness, and the 3-hair grafts in the center for density.
  3. True Surgical Loop Magnification to find the space between existing hairs.
  4. Following the natural angle and direction of hair to mimic natural patterns.
  5. Both coronal (lateral) or sagittal incisions, depending on the characteristics of each patient.
  6. Incision densities ranging from 25 to 50+.
  7. Sessions ranging from as small as 500 (e.g. eyebrows) to as large as 4,500.
Custom blades are matched to Graft Size
Incisions made in patter that mimics nature
Follow normal angle and direction of hair
Go in between existing hair to limit trauma

STEP 4: GRAFTS PLACEMENT

Poor placement can lead to trauma and poor graft survival. There are many ways to help with the placing process:

  • True surgical magnification to better see the sites.
  • Fingertip cups to hold the grafts during placing to ensure that they do not dehydrate.
  • Specialized forceps to place the grafts.
  • The art of the “gentle place” to ensure that each graft is inserted with as little trauma as possible.
Grafts are Placed Gently
Use Magnification

FUT ADVANTAGES & DISADVANTAGES

ADVANTAGES OF STRIP FUT

The main advantage of strip FUT is its 25-year history of producing the greatest degree of density and coverage on the most consistent basis. Strip FUT can harvest a greater number of grafts over the lifetime of the patient than the exclusive use of FUE. FUT grafts also have a slightly better survival than FUE grafts because they are typically chubbier with more protective tissue. However, new FUE techniques such as the Hybrid Blunt Punch and Oscillation System produce grafts that are now similar in size to FUT grafts.


DISADVANTAGES OF STRIP FUT

The main disadvantage of strip FUT is the potential for a wide linear scar and the longer healing time. Most FUT scars are very fine and difficult to see, even when the hair is 1 cm in length. However, shorter hair may result in a more visible scar.