FUT (FOLLICULAR UNIT TRANSPLANT)

March 28, 2019

Pronunciation: eff-eu-t

Also called FUSS (Follicular unit strip surgery)

Why this technique is called follicular unit transplant?

While follicular units are used in all types of hair transplant (whether it is FUE or BHT), perhaps FUT was the first time in the history of hair transplant where surgeons used individual follicular unit as transplant unit.
Perhaps it was the excitement and love for follicular unit to the surgeons, it was named follicular unit transplant.
Before FUT process other units like mini-golf, micrograft or plugs were used.
For practical purpose, FUT is also known as strip surgery. A linear strip of skin with hair is removed from back and side of the head. A gap is created on the head owing to removal of the strip. The gap created because of strip removal is sutured in two layers with or without trichophytic closure. This whole strip is then cut into individual tiny follicular units under stereomicroscopic vision. These follicular units are then transplanted to the bald area.

Process

Anesthesia
Local anaesthesia is used in all hair transplant procedure. Local anaesthesia means absence of sensation in specific parts of the body (such as a small part of the skin or tooth). During a hair transplant, anaesthesia is injected on an area of graft extraction, i.e. back of the head and area where grafts need to be transplanted (front part of the forehead). The first step is injections of local anaesthesia.

Strip removal
A linear strip is taken from permanent zone or safe zone (from back and side of head) by a surgeon. It is usually cut from ear to ear. The length and width of the strip are decided by the surgeon based on various considerations like the number of grafts required, laxity of skin, density on donor area, number of grafts required etc.

Suturing
Suturing is carried out to close the gap created due to removal of the strip. It is done in two layers to reduce the tension. The reduced tension decreases the scar formation. The inner layer is sutured with absorbable suture while the external layer is sutured with non-absorbable suture. Some doctors prefer to staple instead of suture.

Trichophytic closure (Tricho)
It is used for further reduction of scar (See details of trichophtic closure)

Graft dissection
One of the most important aspect for success of FUT is stereo-microscopic dissection. This allows complete follicular units to be separated from the donor strip (without being damaged as these healthy and complete units will have a greater chance of survival, regrowth and fullness to the hair restoration). It has two parts:
Slivering, The strip is approximately 10 to 20 cm in length usually. It is a time consuming and exhaustive process to separate FUs (follicular units) from such a long strip. Therefore, this long linear strip is divided into smaller sections of approximately 2 to 2.5 mm width. This creation of small sections of 2 to 2.5 mm width is called slivering. This technique generates smaller pieces of hair bearing tissue without breaking up follicular units, and without transecting (cutting) hair follicles (by passing the cutting blade around follicular units and not just straight away cutting the strip into small pieces).
Creating individual follicular units Individual follicular units are isolated from slivered sections by trimming extra fat and tissue around the follicles.

Graft storage
Individual follicular units or grafts are preserved in optimized hypothermic (low temperature) preservation medium. The different clinic uses a different medium. During the procedure, the follicle tissues experience multiple forms of stress, hence it becomes very crucial to take care of this procedure. The grafts should be preserved in the proper medium.

Hair line marking
This is more of an art form in the otherwise science of hair transplant. The creation of the good hair line alone decides the outcome of hair transplant. Hair line depends on several factors like face profile, number of grafts available, patients age or pattern of hair loss.

Recipient area preparation
It is done by slit making (creating holes in recipient area) as per the hair line marking of the area to transplant.

Implantation
This is the final step of the transplant. Implantation is done by inserting the grafts inside the slit. A lot of expertise is required to successfully execute this process.

Are you a good candidate for FUT?
If you have any of these conditions, you are not a good candidate for FUT hair transplant. Patient with a greater risk of donor scarring like:

Younger patients
Very muscular
Athletic patients
Those with very tight or very loose scalps
Those with a history of keloid scarring or poor healing

How to choose clinic for FUT?

A very well experienced team of doctor and technicians are required as post the strip removal, slivering and individual graft making is done by the technician. If they are inexperienced, the graft yield will be poor in quality and number. If the doctor is inexperienced, he/she may not guide the technician with the standard procedure to perform.
Make sure that the clinic is well equipped with a stereo microscope as graft dissection with the naked eye can damage number of grafts.
Make sure that the doctor knows, understands and performs trichophytic closure, because the scar on donor area will be very thin and even untraceable by trichophytic closure. Enquire with the clinic about graft preservation method and graft handling system. This factor alone can improve the result many times.
Make sure that everything is done under the supervision of doctors as sometimes the technician and new doctors just throw your valuable graft in the dustbin. Hair transplant is a very tough job to perform where every single graft is valuable! Sometimes it becomes so tiring that these newbie doctors or technician never mind taking such steps.
Make sure that doctors understands the flexibility of your scalp. If they attempt for more graft in one session by taking out bigger strip, It may cause delay in wound healing or bigger scar. Also, due to scalp shock, poor result is eminent. Graft placement by no touch technique is the best. Make sure that they use the best implantation technique for best result.

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