Follicular Unit Transplantation (FUT), also known as the ‘strip’ procedure, is the world’s most popular hair transplant procedure and is considered to be THE gold standard of the different procedures available today.
The concept is simple:
Hair roots that exist in abundance in the back and sides of the head are painlessly removed and re-implanted into the thin and balding areas of the hairline and top of the scalp. After a few days the roots heal permanently into the skin and after a few months hair grows out of the new location. Once grown out the hair may be cut, styled, and washed just like the hair that used to be there. Thousands of grafts may be moved in a single session providing a major cosmetic improvement after just one visit.
How an FUT (Strip) procedure is done:
A follicular unit transplant must be performed by a licensed physician and a team of qualified medical technicians. This is not the type of procedure that is performed in a barbershop, hair salon, or shopping mall setting; but rather a physician’s office equipped with a dedicated hair transplant procedure room.
That said, the procedure is extremely safe, usually quite comfortable, and surprisingly pain-free after the local numbing medication kicks in.
The entire process begins with a visit to a physician for a consultation. During that visit the doctor evaluates the level of hair loss, predictable future hair loss,assess how many hair roots may be available to transplant, and takes a basic medical history. Thereafter a plan will be formulated and costs discussed. The patient is then encouraged to think about it for a couple of days. If they decide to book a procedure they call the front office to find an available date and leave a first payment.
Preparation before scheduled hair transplant procedure:
After the patient has reserved their surgical date they are directed to not drink alcohol, not take vitamins, and not workout strenuously starting 10 days before their procedure. This is because all of these tend to thin the blood which can make the performance of the hair transplant difficult and perhaps even impossible. Alcohol and vitamins (including those found in power drinks) chemically sabotage platelets which are necessary for clotting. Strenuous exercise like running causes physical damage to platelets. As blood circulates to the feet the stomping action of the foot increases the local pressure to such a degree that some of the platelets actually burst decreasing the ability to clot. So for these reasons we tell patients both verbally and in writing to avoid anything that undermines the blood’s ability to properly clot. Starting one week after the hair transplant the patient may resume heavy workouts.
If the patient takes any medication such as that for high blood pressure or diabetes they are usually instructed to take their medication as normal unless otherwise directed by the doctor.
Day of Hair Transplant:
Patients are directed to get a good night’s sleep prior to their procedure but most patients rarely do. They are usually very excited about the prospect of getting their hair back and are understandably a bit anxious- which tends to result in two or even three restless nights before their scheduled date. But that’s ok, most patients wind up catching up on that lost sleep during their procedure once they realize the procedure isn’t as complicated or frightening as they first imagined. As of this writing we have performed surgery on thousands of patients in our office over the past 23 years and never had a significant medical complication or problem occur, and this includes patients with delicate pre-existing medical conditions. This is the measure of how safe modern hair transplant procedures truly are.
Patients are asked to arrive 15 minutes early if possible and encouraged to wear comfortable clothing that they can dispose of when they get back home. This is because we use antiseptic sprays that can get onto clothing and stain them. So wearing nice clothing or a suit is really not a good idea.
Breakfast on the day of your hair transplant:
Before most medical procedures patients are required NOT to eat anything for hours or even a day prior to their visit. This is NOT the case for our hair transplant patients. We want you to have something in your stomach before visiting so a good breakfast is encouraged, but nothing heavy with a lot of grease. A muffin, bagel, or cereal are perfect choices. Three eggs with bacon probably isn’t. Our general rule is that patients should get some sugar into them in the morning prior to visiting. This is because the excitement from the prospect of getting a procedure can actually lower normal blood sugar levels. A good glass of juice or morning pastry are the perfect remedy. If you want to bring some snacks or your favorite food by all means feel free to do so. You may eat during your procedure.
To Drive or Not to Drive:
Patients may drive themselves to and from the office if they live within a 40 minute distance. This is because we do not use general anesthesia and rarely need sedatives. For patients who live further away we recommend they stay in a local hotel the night before so they don’t have to stress over getting to the office on time in the morning and then worry about dealing with heavy rush hour traffic in the afternoon. That said, we have had patients drive to our Long Island office from areas as far away as Philadelphia, get their procedure, and drive back the same day. We don’t recommend this but it can be, and has been, done. Again, this is another metric as to how easy on the patient a modern hair transplant can be. If you can get someone to drive you to and from the procedure that would be best. If that person wants to wait we have a comfortable waiting room, cable TV, and Wifi for their use. If they wish they can go shopping at the Miracle Mile nearby then return. They can also join the patient for lunch right in the procedure room.
There are two levels of free parking at Feller and Bloxham so park in any spot that doesn’t have a reserved sign right in front of it. Don’t worry, you’ll have your pick of parking spaces. After 23 years in the same building we have never seen the entire parking lot fill up. Take the elevator up to the second floor and make a right. The entire west side of the building is our office and you can’t miss the double doors at the end of the hall.
In the hair transplant office:
Once in the hair transplant office the patient will be greeted by the receptionist shortly after which the doctor will come out and invite the patient into a consultation room. The patient may come in alone or may bring along a family member or other supporting person. It’s completely up to the patient. The plan is then reviewed and discussed to make sure all questions are answered. The doctor will then take a sterile surgical marker out of it’s package and start to draw lines to demark the areas that will receive the grafts. Usually this includes the hairline, but doesn’t always have to. The patient is given a mirror so they can see for themselves where the new hair will be implanted. Photographs are then taken so that they may be used to compare to new photos that will be taken at 6 months after the procedure, then 12 months, then 18 months. There is no better way to gauge a result than to see how the patient looked at many different angles just prior to their procedure. Patients are also encouraged to take pictures with their own smartphones.
The patient is then escorted into the procedure room. There is a private bathroom in the suite just across from the procedure room so if the patient needs to visit it once or multiple times during the surgery it is not a problem. At almost no point in the procedure is the patient in a position where they can’t get up to stretch and use the bathroom if needed on a moments notice.
Preparing the skin for the procedure:
The patient is then sat up in the procedure chair. It looks a bit like a dental chair but larger and far more comfortable. Two experienced medical technicians will introduce themselves and begin cleaning the scalp with antiseptics. They will then comb the hair up in the back of the head and hold it in place with medical tape. A small strip of skin about half an inch wide will be shaved just under that swept up hair. This is known as the “donor” area. It is this strip that contains all the hair roots that will be moved that day.
Numbing the Skin:
Next, the doctor will come in and inspect the shaved strip. It will be disinfected a second time and then the doctor will lay the patient down on their back. The head will be turned to the side and a local anesthetic applied. It feels like a pinch and is rarely as painful as patients anticipate it might be. A tiny needle is used to numb up the entire donor strip and the medicine is given about 10 minutes to soak in. At no time do we need to use general anesthetic.
Removing the Donor Strip:
Afterward the patient is sat back up in the chair. The doctor will stand behind the patient and remove the strip a small section at a time. In the meantime the patient may watch TV, read the newspaper, or text on their phone. The patient has no idea what’s happening behind them and feels no pain. After the doctor has removed a small section of strip he immediately sews or surgically staples it closed before moving onto the next section. Once completed it will appear as if the doctor took one long strip out of the donor area in one shot and then sutured it closed, but in reality it was taken out small sections at a time.
It’s important to understand that the scalp, particularly the donor area, has more flexibility than it needs. So when the strip is removed the small gap that remains is instantly and easily closed by simply pulling the ends of the skin together. While there will be some pulling while the stitches or staples are in, it will abate back to normal after they are removed. It is a wonderful property of the scalp that hair transplant surgeons make the most of.
As each section of the strip was removed it gets handed over to the medical technicians for dissection. Using the most advanced stereo microscopes on the market each technician, usually numbering about 8 at Feller and Bloxham, will carefully start removing the hair roots from the strip.
The medical tape that was used to hold the hair up in the back of the head is then removed which allows that hair to come down and cover the entire donor area. At the end of the day a person standing behind the patient will not be able to tell that a strip of skin had been taken only hours before.
Making the Recipient Sites:
The patient is then given a stretch, a bite to eat, and a bathroom break if needed and is then laid back down in a comfortable semi-reclined position in the chair. The hairline and top of the scalp are then numbed in a similar fashion as the donor area. As the medication soaks in the doctor inspects the grafts being divided out of the donor strip and notes their varying sizes. He then custom cuts blades that will be used to make tiny slits in the scalp to receive those grafts. The usual size of these blades will very from .7mm for hairline up to 1.1mm for the top of the scalp. The depth of each slit is about 4mm which is about the length of a small grain of rice. Because all of these dimensions are tiny the doctor and staff wear magnifiers for the entire procedure.
After the blades are cut the doctor starts to make the recipient slits within the pattern drawn on the scalp in marker during the pre-op consultation. This usually takes at least an hour during which most patients fall into a restful sleep. After the doctor finishes making the thousands of slits patients are encouraged to take a stretch and use the bathroom if necessary.
Placing the new grafts
After sitting back in the chair three of the eight technicians will enter the room and stand behind and on both sides of the patient. These technicians will then begin to place hair roots into the slits. Patients usually sleep or watch a movie during this time and don’t feel any pain. The implantation process will usually take about 3-5 hours depending on the size of the procedure.
After the entire strip has been dissected into grafts (called Follicular Units) the technicians will work in shifts, in teams of three, until all the grafts are put back into the thinning and balding areas of scalp. This insures that staff do not become fatigued while performing this meticulous portion of the procedure. If needed the doctor will make more slits if there are more grafts available than anticipated or if he feels it is necessary to take more donor area.
Quality Control and accountability:
Quality control is at the core of this procedure. At any given time each technician is constantly monitoring the work of the others and working as a true professional team to insure the best possible results. The doctor is constantly monitoring all aspects of the procedure as well and even takes photographs and video that will be scrutinized as the procedure progresses. All these photos and video are available to the patient as well so they can see for themselves what was done during their visit. This represents a level of transparency and surgical accountability few hair transplant clinics in the world can claim. We are so sure that the work performed in our clinic is absolute top shelf that we are willing, with the patient’s permission, to post these photos and videos online for the world not only to see, but comment on publicly as well. This protocol was invented at Feller and Bloxham and only the very best clinics offer it.
Concealing the Procedure:
At the end of the day the once bald area looks like someone whose scalp was buzz-cut and received a sunburn. This will heal quickly. A hat is provided to conceal that a procedure had been performed and help protect the scalp and grafts for the ride home. The patient is given a post operative talk and instruction sheet which includes how to sleep and how to shower for the next few days. While patients may return to work the next day we usually recommend three days. Many patients who work from home simply work the next day.
Post operative care:
Patients may shower the next day and wash the scalp. They can even swim in the ocean within 3 days if they plan to take a vacation after their procedure as many patients tend to do.
The patient is then asked to return ten days later to remove the sutures or staples. If they are from out of town we can usually recommend a colleague in their area to do it at no cost. If none are available just about any doctor’s office or urgent care center can do it.
After three days the tiny scabs where the grafts were inserted will simply begin to slough off leaving short hair. The skin may remain red for 14 days or a bit longer but will eventually go back to it’s normal color. By 2 weeks the little hairs will begin to fall out. This is normal and expected. Not to worry, the hair roots are still well anchored into the skin and healing in stronger and stronger by the hour. Ultimately, all of the new hairs will fall out, this is called the “sleeping phase” but they will wake up and begin to regrow by about the 4th month. Usually by the sixth or seventh month the hairs will be long enough to start making a significant cosmetic difference. By 9 months it should be unmistakable. Most of these transformations seem almost miraculous.
In the 23 years our office has been open and offering hair transplants exclusively we have never had a failure of growth or any significant medical complication beyond the level of a pimple or ingrown hair. At no time have we ever had a single patient suffer a single significant medical problem related to, or as a result of, their hair transplant procedure. While this is not a guarantee that this will always be the case it accurately reflects the record of our clinic after performing various hair transplant procedures on literally thousands of patients over the years.
Follow up visit and photos:
After sutures are removed no follow up visits are required. However, we ask that all follicular unit transplant patients visit us at 6, 12, and 18 months anyway so that we may see the healing and the rate of growth. We also would like to take photos to document overall progress. If a patient can’t make it back to the office we ask that they take photos with their smartphones and email them to us. We will then couple them with the before photos to create a Before/After presentation. At Feller and Bloxham we are so sure that the results will be significant and stunning that we offer to hide the patient’s face digitally and post their before and after photos online for the world to see and evaluate openly. Very few hair transplant clinics in the United States offer this routinely. Perhaps no more than six in total and is an excellent metric by which to objectively critique and select the hair transplant doctor that is best for you.
After the hair grows it will just continue to grow and grow, so use your favorite barber to cut and style it as you always did. There is nothing else to do. The body does everything for you. No special medication, ointments, or shampoos needed. Just go about your life and enjoy your new hair and your new look.