Hair Transplant Technique

AAn Open Technique in Hair Transplantation

Hair Transplant Technique


A. Harvesting:

There are two techniques to remove the donor hair grafts from the permanent zone, which are located behind the ears. The standard practice is strip excision or FUT with microscopic dissection since 1992 that has produced excellent results for the past 15 years. FUT in good hands will result in a minimally visible linear scar, which can be covered even with short hairs in majority. FUE started in the late 1980’s and slowly progressed in technique in the last decade to address high transaction rates from blind cutting.

1. Traditional Strip FUT (Follicular Unit Transplantation) technique

This technique is still performed by majority (80%) of hair transplant surgeons worldwide.

The recipient area is measured first. The density is then counted at the donor area using a densitometer. The strip is marked and excised after the donor area is anesthetized with local anesthetic. We prefer the Open Technique than using the spreader technique since we can obtain lower transaction rates with less tissue damage. The incision is closed with Trichophytic closure (cutting approximately 1x1 mm tissue at the inferior rim), which allows hairs to grow inside the scar tissue. Transection is minimized with meticulous wound closure resulting in a very small to almost invisible scar in majority of patients.

Pictures of donor incision immediately after surgery and 1-year post-op

2. FUE (Follicular Unit Extraction) technique

Currently, FUE has become a hot topic and is advertised as painless and ‘scarless’ to attract the public who need hair transplantation. The scar from FUE are not linear but are scattered throughout the scalp area that was harvested. These circular 1mm scars may eventually heal and result to almost 2mm scars.

FUE has been resisted by majority of hair surgeons due to high transaction rates and with comparatively less satisfactory growth rate compared to that of the strip technique as has been reported in medical literature. However, with proper tools, technique and skills, FUE does have a role in hair transplantation especially among patients with tight scalp and those who prefer to wear their hair real short. The FUE technique is being continually refined and is producing better results than before.

There are many FUE devices available in the market today:

(1) Manual punch
(2) Motorized power punch
     (a) Dull punch
          i.e. SAFE system
     (b) Sharp punch
          i.e. CIT system, ERTIP FUE motorized hair transplant kit, etc.
(3) Neograft with a power punch and suction device to extract and insert grafts
(4) ARTAS Robotics using a robotic arm to extract grafts; grafts need to be manually extracted by the surgeon or assistant

At DHT clinic, we do both strip FUT and FUE and we utilize both dull and sharp FUE motorized power punches, having very good results.

Pictures of the donor with FUE scars immediately after surgery and at 4 months post-op

3. Combo (Combination FUT strip and FUE)

A combination of these two techniques can be performed when more grafts are needed after the strip technique has been completed and the yield was not enough or vice versa.

B. Slits creation:

After harvesting the grafts, we make very tiny incision [lateral slit] at the areas to be transplanted. These slits are oriented in the same direction and angle of your existing hair.

C. Insertion:

Follicular units may contain 1-4 hairs. Our team is very meticulous in handling and inserting the grafts into the created slits. The follicular grafts are first contained in special ring holders designed by our clinic to prevent desication. The holders also assist the transplanters to select the appropriate graft size for insertion. By selecting only skinny 1-hair grafts for the front, and coarse 2 to 3 hair grafts on the back, we can create very natural looking result. We insert the hair in a purposefully random fashion along the hairline to look natural.

Comparing Traditional Strip FUT and FUE

At the DHT clinic, we can perform either Strip FUT or FUE techniques of donor harvesting and even a combination of the two.
Both strip FUT and FUE techniques have advantages and disadvantages:


Technique

FUT (Strip technique)

FUE technique (extract follicular unit one by one)

Number of grafts

Can get a lot of grafts in 1 session (up to 5000 grafts depend on scalp laxity and donor density, recommend for mega-session) with good results

Majority of surgeons limit to 2,000 grafts per 1 session (recommend for small area), however, there are reports that more surgeons are able to harvest up to 4000 grafts per session.

Need to shave the hair for the procedure however unshaven FUE can also be done but more complicate and time consuming.

Scar

A single thin ( 1-2 mm ) straight line with trichophytic technique (hairs come through the scar)

The scars show if shave .

 

Numerous dispersed small white circular scar.

The scars show if shave .
 

Scar visibility

Can be covered if hair is worn at least 1cm long

Can be covered if hair is worn at least 1cm long

Time

Strip/ FUT  megasession 4,000 grafts more less can be complete in one pass.  

FUE may need 2 consecutive days to complete .

Quality of graft

The grafts are prepared under 10x microscopic dissection.

Less transection due to the ‘Open Technique.

Good quality of grafts, can dissect in to double or multi-unit grafts to add more volume.

The grafts are individually extracted after harvesting and are trimmed under the microscope

FUE is still a blind technique (may have greater risk for transaction, esp in curly hair)

Less fat around root à prone to trauma and dessication during insertion.

Growth rate

80- 90% growth rate as reported by majority of hair surgeons

About 75-85% growth rate

Pain

More pain at donor wound on the first day

Less pain at donor wound

Indication

For small or large area of baldness

For small area of baldness

Patient who wants to cut the hair very short (scattered scars may be less noticeable)

Tight scalp


Picture of a Strip FUT scar exposed when hairs combed up and concealed when combed done


Picture of FUE scars exposed when hair is worn short and concealed when hair is worn long


Picture of FUE scars exposed when hair is worn short and concealed when hair is worn long

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