Follicular Unit Extraction
Follicular Unit Grafting
“Trichophytic” Donor Closure Technique
Follicular unit extraction or FUE is an alternative procedure for performing follicular unit hair transplantation. However, unlike the predominant follicular unit transplant procedure, in which a strip of donor tissue is removed and dissected under magnification, the FUE procedure uses a small punch to extract each follicular unit one by one.
Both the strip excision and FUE procedures create 1, 2, 3, and 4 hair follicular unit grafts that are then transplanted into the balding area in the same manner. The primary difference between these two procedures is the technique used to harvest the follicular unit grafts.
Scalp hair grows in naturally occurring groups called Follicular Units. Each follicular unit contains from 1 to 4 hairs. In Follicular Unit Transplantation, a single strip of skin is harvested from the scalp in the back of the head and then, using special microscopes, the strip is dissected into individual, naturally occurring follicular groups of 1-4 hairs. This technique, performed exclusively at Virginia Surgical has many advantages. They include completely natural results, no scarring in the recipient area, fast healing, and the ability to perform large sessions so that the restoration can be completed in a short time span. The disadvantage of this technique is that it produces a linear scar in the donor area, although the scar is generally very fine.
At Virginia Surgical, we only perform procedures on patients who we can expect to have full yield and growth from the extraction technique. This procedure can be done at any of our three locations in Virginia.
A Follicular Unit Extraction Test can identify those individuals with the optimal hair and scalp characteristics to get maximum benefit from the procedure. In the test, follicular unit extraction is performed in a sample area in the back of the scalp. It is performed under local anesthesia and takes about 15 minutes. Patients who pass the test will be good candidates for Follicular Unit Extraction. If the test is negative, conventional strip removal with microscopic dissection is the best option.
- Patients with limited hair loss or those who require small sessions
- The treatment of small cosmetic areas, such as eyebrow restoration
- Those who wear their hair very short
- Patients with very low donor supply, a scarred donor area or very tight scalps
- Selected repair procedures
- The camouflage of traumatic scars or donor scars
- Athletes who must resume full activity soon after the procedure
- Patients who tend to heal with wide scars
In recent years great change has occurred in the way our surgeons perform hair grafting. Our clinic has adapted the use of the dissecting microscope to create hair grafts of the smallest possible size that still retain the natural characteristics of hair growth.
By natural characteristics of hair growth, we mean the pattern of hair follicles as they grow out from the skin. If one looks at the scalp with 5-10 powers of magnification, one can see that hair grows out of the skin in units of one, two, three, or four hairs. The human scalp averages one follicular unit per 1 mm and each unit averages 2.2 hairs. Therefore a strip of scalp 1 cm in height and 10 cm in length could yield 1000 follicular unit grafts (2200 hairs). This is the way nature grows hair. We move hair in these follicular units, cutting away the non-hair bearing skin between them, and then transplant them into tiny slits on the top of the head. By keeping hair grafts as small as possible, yet keeping the follicular units intact, one can create a totally natural appearance.
Only one or two graft sessions are necessary to give complete results and, if the goals are limited, one session will work. Because male-female pattern baldness is progressive, it is best to distribute the hair grafts so that coverage creates a natural and undetectable look.
When performing large sessions of hair grafts, it is necessary to have a team of physicians, nurses, and technicians who can do the labor-intensive task of cutting the donor hair under microscopes into hundreds (or even thousands) of these small grafts and then insert them into the micro-slits that the surgeon makes into the scalp. In our clinic, we have up to five assistants working on a case. The skill and experience of these assistants is crucial to efficient and successful modern-day hair grafting.
We perform these procedures under local anesthesia only. This allows the patient to be fully alert through the procedure and able to drive himself or herself home afterwards. The operation is painless once the scalp is anesthetized.
We do not use a post-operative dressing; However, we encourage each patient twenty four hours after the procedure, to use a saline spray on the scalp every 2-3 hours. This technique seems to lessen the amount of crusting and sometimes causes the hair to grow a bit more rapidly.
Every patient returns to the clinic the day after for a gentle scalp cleansing and, if they have sufficient hair to comb over, can style it. The second day after surgery, we gently shampoo again and, on the third day, you may use your usual hair styling methods. The stitches used for closure in the back of the head are removed in ten days.
A minor problem can occur following a hair grafting procedure. Swelling of the forehead is possible, which can occur within the first two days of surgery. The swelling, if it occurs, goes away spontaneously. We can employ certain measures during surgery that lessen the incidence of swelling. We see this phenomenon in perhaps one out of ten cases. In your follow-up shampoo treatment, we can spot early detection of swelling and address it immediately. A common occurrence after large sessions of grafts is the hairs will fall out along with the little crusts that form around the grafts. The hair will go through a premature phase of hair growth cycle where the hair falls out and then re-grows.
In the “old days” hair grafting was done with larger grafts which have essentially been abandoned for the smaller grafts described in this writing. These older style grafts, often referred to as “plugs,” frequently resulted in a “corn row” or “doll’s hair” look. This was due to large grafts standing out by themselves. By dividing the donor tissue into smaller grafts, we spread the hair around more diffusely and, therefore, get a natural look. We strive for a totally natural undetectable look. We can also correct the old “plug” procedures and obtain the same natural result.
Judgment, experience, and a sense of artistry are required by the surgeon in order to achieve optimal results with each patient. There are a great variety of balding patterns, hair textures, densities, colors, and scalp laxity–all of which are factors that require modification to get an optimal result. We always emphasize that hair transplantation is not, in our opinion, an assembly line type of procedure where one can recommend the same technique for all patients. We feel it is our responsibility to personally educate each patient and devise a plan based on our knowledge and experience.
The new “Trichophytic Donor Closure” technique allows for improved camouflage of a linear donor scar. Before the trichophytic (aka “tricho”) closures, a patient could expect their donor scar to be 0-2mm in width. Normally, the surrounding hair would easily cover the scar. For some patients with very short hairstyles or buzzcuts, the resulting donor scar could sometimes be visible. The trichophytic closure is a type of ‘overlapping’ technique which results in hair growing directly through the donor scar. This can dramatically improve coverage of the donor scar in those with short hair.
Our surgeons use the trichophytic donor closure technique as a routine part of all of his linear donor harvests. For patients with short hair, this offers an acceptable alternative to FUE (Follicular Unit Extraction), which is typically a less efficient (and oftentimes more expensive) way to harvest hair from the donor. We believe that there is still a role for FUE, but that the benefits of a trichophytic closure make FUE a somewhat less attractive option for some patients.
The trichophytic donor closure can be used on patients who have had previous procedures and are looking for improvement in the camouflage of their donor scar, as well as patients who are undergoing hair transplantation for the first time
With Virginia Surgical Center Micro-Follicular Unit hair transplantation, all of the grafts are dissected using state of the art Mantis Microscopes, enabling minimal, if any, tissue waste. This results in a cleaner, more precise Follicular Unit and contributes to the best, most natural end result.
