Follicular Unit Transplantation
Follicular Unit Transplantation (FUT) also known as ‘strip’ is a 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 final aesthetic result will be determined by the strategic placement of these grafts, this is a highly skilled task that can only be achieved from experienced transplant surgeons who not only have the skill to complete the process but who also have the aesthetic artistry to get a truly pleasing natural result. This is really where selecting a transplant surgeon comes down to the small details as it is the actual final result that is what you are looking for that counts. Dr Feller and Dr Bloxham have an incredible skill level in both transplantation and artistry to get the best possible result for that individual.
Dissection of follicular units
Once the donor area strip has been harvested the strip is then taken to a specialized team of staff who begin dissecting the strip into their individual units of 1,2,3, and 4 hair units. These are done under very high powered microscopes within the facility.
“Trichophytic” donor closure technique (“tricho”) provides improved camouflage of a linear donor scar in Follicular Unit Transplantation (FUT). Normally, in FUT, the surrounding hair easily covers the scar. For some patients with very short hairstyles, the resulting donor scar may be visible. With the trichophytic closure technique one of the wound edges is effectively trimmed to create a slight beveled edge this allows the edges to overlap each other and the hair to grow directly through the donor scar. This can significantly improve the appearance of the donor area in patients who wear their hair very short.
The trichophytic donor closure can be used on patients who have had previous hair transplant procedures and are looking for improvement in the camouflage of their donor scar. It is also used in patients in their first hair restoration procedure. It is particularly useful in repair or corrective work.
Follicular Unit Extraction (FUE)
Dr. Feller has been on the very leading edge of this procedure and has been performing FUE since its introduction into North America in 2002. He has invented and patented new tools specifically for FUE and his techniques and protocols have been written about in the leading text on surgical hair restoration.
All of that was the upside of FUE, the downside is that this new procedure is much more labor intensive and time consuming; meaning it costs more to perform and far fewer grafts can be obtained in a single session when compared to traditional strip harvesting. Another downside is that not all patients are candidates for the procedure. Most are, but some are not. You will need to speak with Dr. Feller and Dr. Bloxham to learn more about your potential as an FUE candidate.
Follicular Unit Extraction, or FUE, has established itself as an important aspect of the modern hair transplant industry. We at Feller and Bloxham Medical, PC have been practicing and studying this method in detail since 2002 and have determined that FUE is, in fact, a viable adjunct or even alternative to standard strip surgery in certain patients.
Rather than removing a strip from the donor area to obtain hair grafts, very fine holes are made in the back and side of the scalp that don’t exceed 1.0 mm in diameter. While this method will produce far more scarring than the standard strip technique, this additional scarring is LESS VISIBLE and non-linear, and is therefore more attractive to many patients who chose to buzz cut their hair very short.
FUE can be used solely as a means to recreate hairlines and cover bald skin, or it can be used in conjunction with the standard strip procedures. FUE may also be used as a means to repair scarring from older obsolete hair transplant surgeries.
Modified FUE (mFUE)
While traditional FUE is a useful technique for certain patients, it is not without its downfalls. Specifically, lower growth yields and greater donor damage when compared to the FUT or strip procedure (which remains the hair transplant industry “gold standard”). Despite the advantages of the FUT procedure compared to FUE, some patients are averse to undergoing the strip harvesting process or have concerns about the thin, linear strip scar. Many of these patients seek FUE as an alternative, but it may not be the right procedure for them.
To help these patients, Dr Feller, Dr Bloxham, and Dr Lindsey invented a new alternative procedure: modified FUE (mFUE). During an mFUE procedure, a small (millimeters) punch tool is used to score (cut around) a grouping of follicles in the donor region of the scalp. This grouping of follicles is gently lifted with forceps (tweezers) and carefully removed with a small blade or scissors.
The grouping is then dissected into perfect follicular units under a microscope by our “super technicians” just like a strip (FUT) procedure. While the technicians are preparing the grafts, Dr Feller or Dr Bloxham place a single stitch or staple into the small hole left by the mFUE punch (this is different than an FUE procedure, where the punch holes are left open to heal into round scars). This creates a small “dash” in the donor region that is difficult to visualize, even with shorter hair. Because the mFUE punch is larger than an FUE punch each cut in the donor removes dozens of grafts each time. This means patients are left with a small number of little “dash” scars spread throughout the donor opposed to hundreds or thousands of circular FUE scars.
By removing the follicular units in small groups and closing each cut with a stitch or staple, mFUE avoids the damage that causes poor growth in FUE but still creates minimal (and non-linear) scarring in the donor – allowing patients to wear shorter hair styles because there is no “line” strip scar. In other words, mFUE provides patients with the benefits of the “gold standard” strip procedure, but without the linear scar.
mFUE is ideally suited for patients seeking strip results without the linear scar. It is particularly useful in highly visible regions of the scalp like the hairline, where lower FUE growth yields can create significant differences in the final result. mFUE can be used in any scenario where FUT or FUE may be utilized.