Advantage Follicular Unit Transplant

As I discussed in my last blog, the scalp hair is arranged in distinct anatomical and physiologic units called Follicular units. The knowledge of existence of follicular units have revolutionised the field of hair transplant, so that modern day transplant looks absolutely natural.

These are the advantages of Follicular architecture that we use in modern hair transplant;

Maximizing  growth

The follicular unit is a family. some have only one member while some have more. These members (hairs) of a follicular unit share vital support system. If we remove hair from them, then neither of them grow well. This results in sub optimal growth and inferior result.

 Natural Appearance


Since Follicular unit is a natural phenomenon, transplant done using follicular units looks natural and easily mixes with existing hair. The unnatural clumpy appearance of mini and micrografting is avoided. Since the follicular units are small in size an even density can be provided, mimicking the nature.

Dense Packing

Follicular units are generally prepared under the microscope and therefore it is possible to create trim grafts by removing excess of fat/skin tissue. This trimmed graft takes lesser space as compared to a traditional graft, and so, more grafts can be placed in same area.

Wound Healing and Recovery

Again, since graft size is small we need to make smaller cuts in scalp (to place them). These heal faster than the bigger cuts required for traditional grafting. It also means less pain and lesser chances of nerve damage.

Correction Hair Transplant

This method can be used to correct and improve the hairline and pluggy appearance of a punch or mini/micrograft transplant.

What is a Follicular Unit?

Follicular unit is a natural grouping of one or more hairs in the scalp. Follicular units also contain sebaceous (oil) glands, arrector pili muscle, and nerves and blood vessels. This can be likened to a family of hair. If you separate a person from his/her family, he may survive but will not be happy. These Follicular units terminal (and occasionally a velus) hair are so close together that it is not feasible to separate them, without compromising the growth.

This is how a follicular unit looks like.

On the left is a two hair unit and on the right is a single hair unit.

So, what is advantage of this follicular architecture?? How does this affect your hair transplant?
I shall discuss this in my next blog.

FUE or Strip: Which is Better?

The two most commonly performed procedures for hair transplant currently are Strip method (FUT - Follicular unit transplant) and FUE (Follicular unit extraction). Although FUT is currently most performed procedure, world over, FUE is fast emerging as a method of 1st choice especially when cost is not a constraint. I offer both procedures to almost all my patients who have good donor area and even now, most patients opt for strip method since it is cheaper.

The only difference between FUT & FUE is in harvesting the hair from the donor areas. The method of placement and the final outcome is similar in both methods..

Why FUE?

1. STITCH:

Strip method will always use stitch / staples in the donor area.

Some patients, in spite of the best techniques and educated judgment by the surgeons across the world will encounter problems due to stitches such as foreign body reaction, delayed absorption, suture spitting, stitch abscess etc solely due to presence of stitches. Such complication can then give rise to wide scars. Non Absorbable stitches and staples both need to be removed by 7 to 14 days and patient needs to visit the doctor for that that may add to their expenses and time out of work

FUE does not have stitches and therefore avoids all stitch related complications

2. SCAR:

Strip method will always leave a permanent linear scar in the donor area. This scar, how so ever fine is always visible in a short hair cut and therefore does not allow patient to wear a short hairstyle. Even trichophytic closure can have its own set of problems such as misdirected and ingrown hair.  After multiple sessions, patient will usually have “tram line” scars, tightness of scalp and low hair density leading to “show” of the unsightly scar.

FUE: Although it is known that FUE does leave marks and cumulative scarring is more than that of strip scar for equal number of follicles, it is the position of scar(s) that makes all the difference. I like to call it the stars and the Moon phenomenon. If you combine the brightness of all the stars in the sky the total brightness will be more than a full Moon. But still, you will more often notice a full moon in the sky first. The multiple pin point scars when combined are more than strip but they are so scattered as to be less visible to the eye.

3. PAIN:
 Strip method is painful and patient usually require pain killers for 3-5 days. Some patients cal develop long duration pain or painful scars. . Painful scarring, long term parasthesia or reduced sensation above the linear mark is always more in strip method.

 FUE patients usually have pain free recovery. Some patients may occasionally require painkillers for a day or two. Very rarely, some FUE patient may have hypersensitivity of the donor area but it always involves smaller area as compared to strip method and lasts for a shorter duration.

4. PREVIOUS SURGERIES

Strip method is not suitable for patients having tight scalp due to previous strip procedures or scalp reductions. In such cases, there is always some difficulty in closing the wound after strip removal and there is a high chance that the scar may widen with time.

 FUE does not require donor site closure and is therefore eminently suitable for such cases. In fact, many surgeons including me prefer to do second and third sessions with FUE, especially if the first one was FUT.

 5. SHOCK LOSS
Difficult to assess at this stage. Evidence is missing. FUT is more invasive so, it may cause more shock loss. FUE involves larger area so it may cause more shock loss.

6. SHAVING

Strip method is almost always done without shaving of the entire donor area. The existing hair in the donor area can usually hide the stitch line well.

 FUE requires shaving of the donor area. Theoretically, if small no. of hair are required, one may shave a strip of hair, harvest from it and use existing hair to cover the donor area. This is usually not the case. Shaving is the price, I feel, one should be ready to pay for all other donor site advantages.

7. BODY HAIR TRANSPLANT:

Strip method can not be used for BHT. Total hair supply is restricted to 5000 to 7000 grafts. In patients with advanced stages of baldness (Norwood VI/ VII) where more hair is required, it actually delivers less.

FUE can extend the donor area to body hair. In doing so, a large pool of DHT resistant beard, chest and other hairs become accessible and therefore practically inexhaustible hair supply is available.

8. FOLLICULAR TRANSECTION RATE

Strip method probably has lower transection rate compared to FUE since it is done under vision. However, slivering and cutting which involves major part of procedure is done by trained technicians of different skills and it is not possible for surgeon to inspect and assess each graft prepared by the staff.

FUE harvest is almost always done by surgeon (hence the cost). He can maintain control on the quality of graft. In strip surgery 80% job is done by assistants and 20% by surgeon whereas in case of FUE it is vice versa.

9. HAIR QUALITY:

Strip method has no control over the quality of harvested hair. At a given time 5-15% of hairs on the head are in telogen /  exogen phase. In strip technique, what ever is harvested is grafted, whether it is a good anagen follicle or a poor telogen graft. Moreover, the exact no. of hair harvested is difficult to tell beforehand, and sometimes the surgeon may harvest more or less than the requisite number.

In FUE only good anagen hair are harvested, because every hair is chosen by transplant surgeon. These hair have more chance of robust growth in post operative phase as compared to poor telogen/ exogen hair. Also, the number of hair harvested is exactly the same as no. of hair required.

10. COST AND TIME:

Strip method is relatively faster and cheaper.

FUE usually requires more time. An average surgeon will do 1000-1500 FUEs per day depending upont the expertise of the team. However a single session can go on for 2-3 days or more, depending upon patient requirement.

The cost is usually 2-3 times more than strip method because 1.disposable items ie; FUE punches are costlier, 2. Majority of work is done by highly skilled cosmetic surgeon, 3. Only a limited no. of grafts can be transplanted in a day so operation theatre charges & maintenance cost goes up.

Hair Transplant Basics: Who is the Right Candidate?

Did you know that by the time you start noticing hair loss, approximately 50% of the hair are already gone. So, as soon as you notice hair loss, you should consult a doctor. Remember that consulting a doctor is not same as going for transplant. In early stages of baldness, medicines can help you retain your hair and may postpone the need of transplant. However, medicines can not bring back the lost hair and to grow new hair in a bald area, transplant is the only option..

You should plan a transplant if,

      You have Androgenetic alopecia stage III to stage VII.

      Your hairline is not appropriate for age or you wish to achieve younger looking hair line

      You have burn alopecia or traction alopecia.

      You have eyebrow, eyelash or facial hair loss.

You should wait if,

You are in your teens or early twenties with unstable hair line.

If you have rare genetic conditions like DUPA, extensive alopecia areata etc.

If you are medically unfit for surgery (uncontrolled blood pressure, uncontrolled diabetes, heart failure etc)

Even in these conditions, it is best to consult a qualified plastic and cosmetic surgeon; because he can help you chalk out a plan for future and may offer you alternative therapies. An honest expert advice can save you lot of grief and money.

Hair Transplant Basics: What is Follicular Unit hair transplant?

Baldness and thinning of scalp hair are conditions that affect almost one-third of all men in their thirties and, fifty percent by their fifties.  Infrequently, some women also experience noticeable hair loss. There are many causes for temporary hair loss including systemic diseases, severe infection, anemia, thyroid disease, protein, vitamin and mineral deficiency, certain drugs, cancer treatments, childbirth and birth control pills. In this type of hair fall the root of hair is not destroyed. Therefore hair loss is temporary and corrects after the offending agent is withdrawn.

However, when hair root is destroyed, the loss of hair is permanent. The causes include direct trauma such as accidents, burns, operations and inflammatory or infectious diseases of the scalp. But, the most common type of permanent hair loss is Androgenetic alopecia, the exact cause of which is not known. However a hormonal byproduct called DHT has a significant role to play. It is postulated that people who have hair roots with increased genetic susceptibility to DHT suffer more severe hair loss. Since DHT is present in very small quantities in women, they do not generally suffer this type of hair loss.In Androgenetic alopecia, hair loss occurs typically from front and top portions of head, while sides and back hair are retained. 

Artificial coverage of bald area can be done with hairpieces and fibers, but many people find them unnatural looking or difficult to maintain. There are some medicines and oils in the market that claim to restore hair growth with limited success. Although medicines like Finasteride (Propecia) and Minoxidil (Rogaine) may stop hairfall to an extent, no amount of medicines can bring lost hair back. Follicular unit hair transplant is the only predictable, natural and permanent solution for those who are bald or have thinning hair. Hair transplants or grafting is a procedure which produces natural growing hair in bald areas.