Restoring a full head of hair has been a long-time obsession of modern man, ever since the beginning of civilization. A long head of hair in both genders has always been a strong human indicator of virility and fertility, and the natural “replacement” that comes with the aging process has been the fuel for trillions of dollars spent on medical and commercial hair loss solutions, ranging from the ludicrous to the promising, with side effects that can at times be life-threatening. One of the earliest hair restoration procedures available, and to this day one of the most effective, is Follicular Unit Transplantation (FUT). Often referred to as the “strip method”, it is one of the first surgical procedures that has been around in some form for the better part of four decades, and has served as a reliable and often permanent fix for hair loss for millions of people suffering from pattern baldness (Androgenetic Alopecia) and other medical conditions leading to hair loss.
That said, it is easy to get lost in the dizzying developments and new hair transplant techniques that have arisen over the past several years. Between mini-FUTs, micro FUTs, mega-grafts, direct-to-plate, bladeless tractions, secret enhancers, multitouch technology, DHI, and frankly, a lot of proprietary terms that are very similar, hair transplants are a fast-moving field that can feel overwhelming and hard to navigate. An FUT procedure is only one of several different hair transplant types offered to patients, but it is one of the most essential, a surgical procedure that has garnered the highest number of happy, healthy patients in the history of hair loss solutions, and for good reason. The Follicular Unit Transplant is the only permanent procedure that has been around for so long and continues to be actively practiced and updated. When it comes to density, consistency, and highest-yield results possible, nothing quite outpaces an FUT session in the hands of an experienced, qualified surgeon. Whether you are a beginner or have been considering hair restoration for a long time, getting acquainted with Follicular Unit Transplant will serve as a good reference point from which to compare and contrast other options available.
Basic Hair Transplant Theory
The concept behind hair transplantation is actually fairly simple: because of unique hair growth patterns, certain areas of the scalp are genetically “immunized” from hair loss due to a condition known as androgenetic alopecia, or pattern baldness. The specific regions that have this attribute are the “donor zones”, the back and the sides of the scalp. Hair transplant procedures are made up of two basic steps: removing individual follicles from the donor zone, and implanting them into balding or thinning areas, known as the “recipient areas” of the scalp.
The FUT procedure is unique in that it is a means of extracting large quantities of undamaged hair follicles from the donor area as a single tissue strip. A major advantage of this method is that it offers the most efficient and highest yielding process to collect hair grafts. The length and shape of the strip, which is harvested under local anesthesia, is dependent on a few factors including the size of the patient’s donor supply and the number of grafts requested by the patient. A highly important aspect of the FUT process is the skill of the surgeon in making the linear cut parallel to the direction of the follicular orientation. By making a precise incision that follows the natural anatomy of the hair follicles, the surgeon will be able to preserve the maximum number of grafts and most importantly, minimize the angulation of the harvested hair grafts.
Once the tissue strip is removed, a group of highly trained technicians dissect the strip under high-powered microscopes, with the goal of separating the strip into “follicular units” that contain 1 to 4 hairs each, in their natural groupings. The harvested follicular units are then counted and prepared for implantation back into the scalp.
FUT’s biggest advantage as a surgical technique is the sheer number of viable grafts that can be removed at one time. When you get down to it, nothing offers a better overall ratio of quantity and quality when it comes to graft extraction in a single session than a strip procedure. With a single FUT surgery, it is not uncommon to harvest between 3,000 and upwards of 8,000 grafts. The end result of being able to provide that many grafts in one sitting can make the difference between needing 2-3 separate surgeries to achieve the same result, especially for men with advanced balding as per the Norwood scale. By gathering large strips of tissue at a time, the surgeon is also able to reduce the overall trauma of follicle manipulation, an important factor when it comes to survival of each graft post extraction.
The FUT scar
The downside of such an efficient procedure is, predictably, the resultant scar it leaves behind on the back of the head. This linear scar down the back of the head is actually a trade-off for having so many grafts removed in one go. As a result of such large tissue extraction, the closure of the donor wound is a critical step in determining the cosmetic outcome of the scar, which has in the past been a frequent point of concern for FUT patients.
Innovations in the manner in which the scalp is sutured back together have come a long way in the past few decades, with modern “trichophytic” closures being able to improve cosmetic scar outcome significantly. In this method, the surgeon sutures the wound by overlapping the edge of the scalp that still has hair follicles in it, so that when the grafts grow back in, they will grow through the scar itself as well. With this type of surgical scar closure, and in the hands of an experienced surgeon, this linear scar can be rendered virtually invisible for 90% of patients (especially for ethnic patients with darker hair), even with shorter hairstyles like buzzcuts.
FUT’s final outcome is ultimately judged by the quality and the naturalness of the results. As a hair transplant technique that has been around for so long, the benefits of utilizing the FUT are significant. The most important advantage of using naturally occurring follicular units is the fact that the surgeon is able to design a hairline that is highly indiscernible from the rest of the scalp, with optimal overall hair growth in the recipient area that is randomly and evenly spaced.
FUT also ensures that the direction and angle of the implanted hair grafts is at the surgeon’s complete discretion and is specifically adapted to match the patient’s own hair growth in that area. Finally, the key benefit of Follicular Unit Transplantation is the longevity of the results. Because the grafts are removed from areas of the scalp that are not affected by pattern baldness, the FUT grafted hair is genetically resistant to DHT (Dihydrotestosterone, the hormone responsible for pattern baldness) and thus will continue to grow in perpetuity. Ultimately, because of the genetic makeup of the follicles, the transplanted hair will be 100% resistant to receding and will last a lifetime.
FUT vs. FUE – The Biggest Comparison
When it comes to hair transplant procedures, it is safe to say that the biggest comparison is almost always between FUT vs. FUE. Follicular Unit Extraction is another hair transplant technique that involves directly extracting individual follicular units from the donor zone using a small punch tool or similar device. The primary difference between the FUT and FUE method is the type of scarring they will leave behind in the donor area. FUE produces tiny dot-like scars that are scattered throughout the donor area in a seemingly random pattern, while FUT produces a single linear scar at the back of the head.
The question of whether one should do FUT or FUE is one of the most common and often most complicated decisions in the process. At the end of the day, it is less about choosing a better procedure and more about matching the right tool to the right patient. Follicular Unit Transplantation is the preferred hair transplant technique for a patient who wants the absolute maximum number of grafts removed in a single session, has the looser scalp laxity (allowing for easy removal and closure), and is not planning on keeping their hair very short where the linear scar would be exposed. It is also a faster procedure to do in the OR when large sessions are involved, which can also potentially make the overall cost of FUT (graft by graft) lower than FUE in some cases.
The Post-Operative Care for Your Hair Transplant
The end of your FUT procedure is not quite the end of the journey with your hair transplant, with a significant recovery period also required to secure the results you have paid for. In the days immediately following your hair transplant, you can expect to have some degree of soreness and swelling in both the donor and recipient areas, as well as numbness as the anesthesia wears off. These symptoms will typically subside after a week. The hair that you have received in your new hair transplant will begin to fall out in the following 2-3 weeks, as part of the natural cycle, and will subsequently enter a dormant period in which you will notice little to no new hair growth. You can expect new hair growth to begin to become apparent in as soon as 3-4 months, with the full results not appearing for up to a year or more, as the hair continues to thicken and mature.
Post-operative care is an important aspect of the process, as the FUT transplant hair is very sensitive during the initial stages of recovery, and proper aftercare (in terms of gentle washing and avoidance of strenuous activity) will be instrumental in not only securing the best possible result from your hair transplant, but also in healing the donor scar, the other crucial endpoint for a successful FUT surgery.
In conclusion, the Follicular Unit Transplant is certainly not a dying procedure. It is a complex and highly-refined surgical procedure that has and will continue to serve as an important, if not the most important weapon in a hair transplant surgeon’s arsenal. By gathering large strips of tissue at a time, the surgeon is also able to reduce the overall trauma of follicle manipulation, an important factor when it comes to survival of each graft post extraction. It is a highly effective, reliable procedure that has the highest number of happy, healthy patients in the history of hair restoration surgery, and is anything but a thing of the past. As long as it is discussed with a reputable and qualified hair restoration surgeon who can help you assess your specific donor supply, scalp laxity and head shape, and help you understand your aesthetic expectations, an FUT hair transplant can be the life-changing procedure that gives you back not just your hair, but your self-confidence.
