Hair transplantation techniques

The Extraction Methods

Hair transplant surgery is a procedure in which hair is moved from the back/sides of the scalp, where the hair is permanent (donor area), to areas that are thinning or bald (recipient area). The most important feature of a successful hair transplant involves achieving a natural-looking hairline and the right hair density, without any signs of the treatment being noticeable. There are two techniques being used in hair transplantation surgery, FUT and FUE. The common feature of both techniques is the extraction of the smallest hair groups (1 - 4 hairs) which are called follicular units (FUs). Once transplanted, the hair will continue to grow for a person's lifetime. Hormones do not influence their growth, therefore they don't fall again.

The main difference between the two lies in the way the follicle units are extracted. In an FUT, the strip method is used, by which a strip of the scalp with hairs on it is taken from the back of the head, with its hair follicles subsequently being extracted. Using FUE, individual follicular units are extracted directly from the scalp. Furthermore, these two extraction techniques differ with regard to the scarring left in the donor area.

Choosing the right extraction method is one of the most important and decisive factors in any hair transplant. In both techniques, FUE and FUT, the focus is on selecting high quality hair roots in order to make sure that the grafts take root. Technical progress and improvements over the last decades have contributed greatly towards achieving complete naturalness. Through increasingly smaller grafts, a greater amount of hairs can now be extracted and transplanted. Moreover, the incision techniques have greatly been enhanced. The incisions in the recipient area, into which the extracted and prepared grafts are implanted, play a major role in any hair transplantation. The right incisions also help the grafts to quickly connect up to blood vessels and nerves, having a major influence on their survival rate and making the transplant look natural.

The FUE Method (Follicular Unit Extraction)

Using FUE, individual follicular units (follicles) are extracted directly from the scalp. Instead of using scalpels, this method is dependent on extracting the follicular units with special needles. The size of these punch needles plays a decisive role; choosing the right size minimizes damage to the donor area. In short, the finer the punch needle used, the less damage is caused to the skin in the donor area and the less visible the extraction is. In FUE method, which is performed under local anesthesia, the hair follicles are transplanted one by one to the hairless area. FUE is the most appropriate method when hair transplant surgery has to be done with the help of BHT technique. Body Hair Transplant (BHT) is derived from the FUE technique, and basically involves extending the donor area to the whole body. So, they are in principle the same technique. BHT is discussed in more detail in a separate section further on.

FUE is a state-of-the-art method. To successfully perform a transplantation using this technique, there are many factors which play a decisive role. The key success factors include the accurate use of the smallest possible punch needles, ideal FU quality and expert knowledge of transplantation techniques. That being said, it should be reminded that the success of any FUE or FUT transplant is to a great extent dependent on who perform it. Therefore, irrespective of which operation technique is used, any FUE or FUT transplant should always be performed by an experienced specialist.

The FUT Method (Follicular Unit Transplantation)

In FUT technique, also known as ‘strip method‘, tiny bundles of 1 to 4 hairs each are harvested from the donor area by removing a single, thin strip that is further dissected into individual follicular unit grafts with the aid of special microscopes. Though both extraction techniques basically allow the same number of hairs to be extracted, there is one major difference. In an FUT, under good working conditions, 4000 - 5000 FUs can be extracted in one operation session (the corresponding figure for FUE is 3000 - 3500 FUs). So when using the FUE technique, a second operation is generally needed to achieve the same number of FUs. This can only take place some 6 months later.

Special closure techniques such as trichophytic closure are beneficial for obtaining minimum scarring after FUT strip extraction. Trichophytic closure (or tricho) implies overlapping the edges of the wound when stapling them. Although one effect of the local anesthesia when using FUT is a feeling of tension on the scalp, it is generally only minor and will disappear after a few days. However, healing after FUT treatment is slower than FUE. A temporary numb feeling, which could last for several months in case of FUT, does not occur in an FUE.

The BHT Technique

Body Hair Transplant (BHT) is considered as a variation of FUE method, because it uses the same principles of extraction as FUE. It is used when patients do not have enough hair on their heads to achieve the desired result. Just as hair follicles can be transferred from scalp to scalp, the hair follicles can also be transferred from body to scalp. In this case, the hair, which is taken from the breast and other hair coated parts of the body, is transferred to the hairless area on the scalp.

As a technique, body hair transplantation is still in its early stage of development. It has not yet been the subject of as much research as has been done into the FUE and FUT methods. It should be reminded that hair follicles on the scalp, however, anatomically differ from the hair follicles from other parts of the body. So these follicles may behave differently, meaning that the yield can be unpredictable. Due to these facts, BHT should be seen as the last-resort method for improving an existing situation. BHT offers hope for patients who are in need of an alternative and additional source of hair. For certain patients, body hair becomes the source of several thousand grafts. A Body Hair Transplant is considered after a thorough consultation and a lab test which confirms the feasibility of a BHT, meaning that candidates for a BHT must meet certain physiological requirements.

Pros and Cons of FUE & FUT

Both FUE and FUT have very good success chances. So when it comes to selecting between them, you cannot simply say which one is the best method. Although some may have the luxury of making a decision based on their own personal preferences, it is generally up to a hair surgeon to decide which option is the most practical based on the patient’s physiological circumstances. Still, there are advantages and drawbacks to both of these methods operational wise. That having said, it should be reminded that the extraction of hair follicles is just one of many aspects that need to be taken into account in any successful hair transplant. Should little or no attention be paid to other aspects such as expertise of the surgeon and the techniques used in incisions, there is a high risk that the result does not meet up to expectations. The following is a summary of benefits and shortcomings of FUE and FUT.

FUE:

There are apparently many advantages to FUE method. The first one is that in FUE treatment hair follicles are extracted without leaving scars. Although there would be left many small non-pigmented dots around the back of the head, they are not permanent and will be healed very soon. FUE is generally recommended for young people (who may change their mind about their hair style in the future) and individuals who have a short hair style. Both of these groups want to avoid a linear scar at all costs. Besides, younger patients usually require only minor treatment, as it is always the case when a corrective or reconstructive hair surgery is involved. In addition, FUE is the right choice when there is little hair in the donor area, and hence body hair has to be used for hair transplantation. Moreover, based on experiences, FUE is less painful and its healing process is quicker.

FUE treatment, may result, however, in less quality hair. It is mainly due to two factors. Firstly, the way in which FUE works is by extracting and harvesting hair from all over the head, including the upper and lower regions as well. It’s believed that any hair situated in such places is not as permanent as hair that can be found in the middle portion of the head. Secondly, the rate of follicular transection in FUE is greater. It means that the risk of damage to grafts is more higher compared to FUT, because the grafts are more fragile and subject to trauma during placement. The other disadvantage of FUE is the amount of FUs that can be extracted in one operation session. It is about 1000 grafts less than when using FUT technique. Therefore, a second operation is generally needed to achieve the same number of FUs. This can only take place some 6 months later.

FUT:

The main benefit in an FUT is the quality of the hair that is being transplanted. It is usually of a much better standard than when it is extracted and harvested with FUE. In addition, the amount of follicles that can be extracted in one operation session is much more in FUT. Under normal working conditions, 4000 - 5000 FUs can be extracted.

To mention the drawbacks, the scarring is the main problem associated with FUT. Anybody who undergoes FUT will unfortunately be left with a large scar on the head. However, thanks to the new advancements in hair extraction methods, now it is possible to make the scars caused by the removal of the strip of skin practically invisible. This is down by utilizing 'trichophytic closure' technique. Another disadvantage of FUT is the recovery time. It is much longer than FUE. This also correlates with the pain threshold; the pain left after FUT operation is much more.

The Conclusion

Hair loss is one of the most important aesthetic problems of our time, because unexplained and excessive hair loss can be worrying and scary. It can happen to anybody; man, woman, young or old. Hair loss causes both psychological discomfort and loss of confidence. As we know, there are a few medical, social and psychological factors responsible for hair loss conditions in humans. Yet, some accept that “it is their fate to be bald”, and unhappily live their life this way. The good news is that there is always a way to treat hair loss, one way or another.

The hair transplant surgery can be performed by two techniques, FUE and FUT. In the first approach, the grafts are removed, one by one, directly from the donor scalp. In FUT, a strip of the scalp with hairs on it is taken from the back of the head. Once harvested through either of the two techniques, thousands of these tiny grafts are placed, in a single session, into needle-sized holes (called recipient sites) which the physician makes in the balding area. The transplanted follicles will begin producing new hair in 2-3 months and the hair transplant will be fully grown-in, or mature, after about one year. The hair density needing to be achieved (30 - 90 FUs per cm²) is possible with both techniques, meaning that the selected extraction method has no appreciable influence on the end result density wise. However, the amount of FUs that can be extracted in one operation session is about 1000 grafts more in FUT than FUE.

Both FUE and FUT have good success capabilities and there really is no right or wrong answer to ‘which one is best’. Each method has its own pros and cons. Briefly, FUE is the good option for young patients and those who might consider a shorter hair style in the future. FUT on the other hand is recommended to those who have a long hairstyle. Our specialist decides which method is appropriate for which patient, and how many hair follicles/grafts are needed. Although both extraction techniques require extensive know-how and experience, the FUE extraction technique is much more demanding. The success of the operation in both methods is largely dependent on the experience and expertise of the doctor. A hair surgeon must be in a position to assess future natural hair loss, the quality and density of existing hair, and in particular the hair structure.

Hair transplantation is a serious operation. There are a few other factors involved in the process that need to be taken into consideration as well. The choices of technical equipment and a well-organized team are very important too. Put it in a nutshell, irrespective of which operation technique is used, any FUE or FUT transplant should always be performed by an experienced specialist. Here at the Dr. Aslan Hair Clinic, this operation is performed safely and in accordance with the laws in force by our plastic surgeon and neither by aestheticians nor by dermatologists. We offer only the tested and the least risky solutions to our patients. For the health of our patients and a safe operation, complete blood count, hemorrhage time, coagulation time, hepatitis and HIV tests are realized within our clinic before the transplantation. The costs of these analyses are included in our hair transplantation prices. Our clinic employs a fair and reasonable pricing policy.