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Faq's Follicular Unit Grafting |
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What are Follicular Units |
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What is Follicular Unit Transplantation |
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The Reason for Using Only Follicular Units |
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The Importance of Keeping Recepient Sites Small |
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How is Follicular Unit Transplantation Different from
Mini-Micro grafting? |
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Differences between Follicular Unit Transplantation
(FUT) and Mini-Micro grafting |
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| What are Follicular
Units? |
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| Human hair grows in
tiny bundles called follicular units. Although this fact had
been recognized for some time by histologists (doctors who study
human tissue), the existence of follicular units has been largely
ignored by physicians performing hair restoration surgery. The
follicular unit of the adult human scalp consists of 1-4 terminal
(full thickness) hair follicles. In areas of the scalp affected
by genetic balding, the healthy terminal hairs are gradually
replaced by hairs of smaller diameter and length called "miniaturized"
hairs. In addition to the full terminal hairs, the follicular
unit contains 1-2 fine vellus hairs, sebaceous (oil) glands,
a small muscle, tiny nerves and blood vessels, and a fine band
of collagen that surrounds the unit (the perifolliculum). The
follicular unit is thus the hair bearing structure of the skin
and should be kept intact to insure maximum growth. The follicular
unit is seen on the surface of the scalp as a tiny group of
hairs that appear to be growing together. They are best viewed
under a microscope where they are seen as well-formed structures
in the skin. |
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| What is Follicular
Unit Transplantation? |
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Follicular Unit Transplantation is a technique,
pioneered by the physicians at the New Hair Institute, in
which hair is transplanted from the permanent zone in the
back of the scalp into areas affected by genetic balding
(and some other types of hair loss), using only the naturally
occurring, individual follicular units. In order to remove
follicular units from the back of the scalp without damaging
them, the donor tissue must be removed in one piece. This
technique, "single strip harvesting," is an essential
component of follicular unit transplantation as it not only
preserves the follicular units, but also prevents damage
(transection) to the individual hair follicles. It differs
dramatically from the minigrafting and micrografting technique
of using a multi-bladed knife that breaks up follicular
units and causes unacceptable levels of transection of hair
follicles.
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| Another essential component
of Follicular Unit Transplantation is "stereomicroscopic
dissection." In this technique all of the follicular units
are removed from the donor tissue under total microscopic control
to avoid damage. Complete stereomicroscopic dissection has been
shown to produce an increased yield (as much as 30%) of both
the absolute number of follicular units, as well as the total
amount of hair. (This procedure differs from minigrafting and
micrografting in which grafts are cut using minimal or no magnification.)
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A major advantage of
follicular unit transplantation (besides preserving follicular
units and maximizing growth) is that it allows the surgeon to
use small recipient sites. Grafts
comprised of individual follicular units are small because follicular
units are small, and because the surrounding non-hair bearing
tissue is removed under the microscope is not trans-
planted. Follicular unit grafts can be inserted into tiny needle-
sized sites in the recipient area, that heal in just a few days,
without leaving any marks. |
| When performed by a
skilled surgical team, Follicular Unit Transplantation can produce
totally natural-looking hair transplants that maximize the yield
from the patient's donor supply to give the best possible cosmetic
results. Because the tiny follicular unit grafts (and the very
small wounds they are placed in) allow large number of grafts
to be safely transplanted in one procedure, the total restoration
can be completed in the fewest possible sessions. |
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| The reason for using
only Follicular Units |
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| The fact that scalp
hair grows in follicular units, rather than individually, is
most easily observed by densitometry, a simple technique whereby
scalp hair is clipped short in a very small area and then observed
via magnification in a 10mm2 field. What is very obvious when
one examines the scalp by this method, is that follicular units
are relatively compact, but are surrounded by substantial amounts
of non-hair bearing skin. The actual proportion of non-hair
bearing skin is probably on the order of 50%, so that its inclusion
in the dissection (or, conversely, its removal) will have a
substantial effect upon the outcome of the surgery. When multiple
follicular units are used (as in minigrafting and micrografting)
the additional skin that is included will adversely affect the
outcome of the surgery, by necessitating larger wounds, making
the healing slower and often causing irregularities of the skin
surface. |
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| A great advantage of
using individual follicular units is that the wound size can
be kept to a minimum, while at the same time maximizing the
amount of hair that can be placed into it. Having the flexibility
to place up to 4 hairs in a tiny recipient site has important
implications for the design and overall cosmetic impact of the
surgery. This is one major advantage that follicular unit transplantation
has over extensive micrografting. Follicular Unit Transplantation
can minimize or eliminate the "see through" look that
is so characteristic of micrografting. |
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| The main reason for
transplanting only individual follicular units is to duplicate
the way hair naturally grows. By mimicking the way hair grows
in nature, the doctor can insure that the transplant will look
totally natural. Any grouping larger than the naturally occurring
follicular unit will run the risk of a pluggy, tufted look.
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| The Importance of Keeping
Recipient Sites Small |
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| Using only follicular
units enables the recipient sites to be kept very small. In
fact, in Follicular Unit Transplantation, the sites are so small
that they are made with specialized instruments that are the
size of 18-20 gauge needles. This is about the size that is
used in routine blood tests. |
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| The importance of minimizing
the wound size in any surgical procedure cannot be over emphasized.
This, of course, includes hair transplantation as well. The
effects of recipient wounding impact many aspects of the surgery.
Larger wounds tend to injure larger blood vessels and although
the blood supply of the scalp is extensive, the damage to these
vessels can have a deleterious impact on blood flow to the tissues.
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| Especially when transplanting
large numbers of grafts per session, it is important to keep
the recipient wounds as small as possible so that growth will
be maximized. The compact follicular unit is the ideal way to
permit the use of the smallest possible recipient site, and
has made the transplantation of large numbers of grafts technically
feasible. Another important advantage of the small wound is
a factor that can be referred to as the "snug fit."
A follicular unit graft is so small that it can always fit into
a tiny wound without having to remove tissue. Unlike the punch,
which destroys recipient collagen and elastic tissue, a small
incision, made with a needle, retains the basic elasticity (recoil)
of the recipient site. When a properly fitted graft is inserted,
the recipient site will then hold it snugly in place. This "snug
fit" has several advantages. During surgery, it minimizes
popping and the need for the sometimes traumatic re-insertion
or re-positioning of grafts. After the procedure, it ensures
maximum contact of the graft with the surrounding tissue, so
that oxygenation can be quickly re-established. In addition,
by eliminating empty space around the graft, microscopic clots
are minimized and wound healing is facilitated. |
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| It is important to note
that when trying to place larger grafts (either round or linear),
into a small site (kept small to minimize tissue injury) compression
of the grafts is an undesirable consequence, and may result
in a tufted appearance. In contrast, when transplanting follicular
units, there are no adverse cosmetic effects of compression,
since follicular units are already tightly compacted structures.
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| Finally, large wounds
cause a host of other cosmetic problems including dimpling,
pigmentary alteration, depression or elevation of the grafts,
or a thinned, atrophic look. The key to a natural appearing
hair transplant is to have the hair emerge from perfectly normal
skin. The only way to ensure this is to keep the recipient wounds
small. |
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| How is Follicular Unit
Transplantation Different from Mini-Micrografting? |
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| This is one of the most
commonly asked questions and it is a very important one for
those deciding which hair restoration procedure to choose. In
contrast to Follicular Unit Transplantation, where the graft
sizes are determined by nature, in mini-micrografting (the combination
of minigrafts and micrografts as defined in Chapter 6) the graft
sizes are arbitrarily determined by the doctor who cuts the
donor tissue into the size pieces that he wants. Another name
for this technique is mini-micrografts "cut to size." |
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| In mini-micrografting,
neither preserving follicular units, nor even keeping hair follicles
intact, are felt to be that important. Rather, the speed and
economics of the procedure are the deciding factors. Mini-micrografters
use a multi-bladed knife to quickly generate thin strips of
tissue and then use direct visualization (rather than microscopic
control) to cut the tissue. The resulting grafts are generally
larger than follicular units and since the excess skin is not
trimmed away the donor sites (wounds) are also larger. |
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| It should be apparent
from the comparison shown on the next page that Follicular Unit
Transplantation is superior in producing a natural, undetectable
result, in maximizing healing, and preserving precious donor
hair. Mini-micrografting, however, requires a smaller staff
and each procedure is cheaper and shorter (although in the end
it takes more procedures and therefore may cost just as much
for this technique). |
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| For more detailed information
on Follicular Unit Transplantation, please see the reference
section in the back of the book. |
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| The following
table summarizes the major differences between Follicular Unit
Transplantation (FUT) and Mini-Micrografting |
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THE GRAFTS |
FUT |
Mini-Micrografting |
Follicular Units used exclusively
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Yes |
No |
Graft size |
Uniformly small |
Larger |
Number of hairs per graft |
1-4 |
1-6 (or more) |
Follicular transaction |
No |
Yes |
Maximizes donor supply |
Yes |
No |
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THE TECHNIQUE
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Harvesting type |
Single-Strip |
Multi-bladed knife |
Microscopes required |
Yes |
No |
Follicular Units Preserved |
Yes |
No |
Hair/skin ratio in graft |
High |
Average |
Extra skin transplanted |
No |
Yes |
Wound size |
Uniformly small |
Variable |
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THE RESULTS |
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Healing time |
Fast |
Slower |
Skin surface change |
No |
Yes |
Maximum fullness |
Yes |
No |
Undetectable |
Yes |
No |
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COST & CONVENIENCE
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Staff requirements |
Moderate |
Small |
Duration of individual procedure |
Long |
Short |
Time for complete restoration |
Short |
Long |
Cost per procedure |
More |
Less |
| Total cost for restoration |
Similar |
Similar |
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