Surgical Information

Follicular Unit Hair Transplantation

What is Follicular Unit Hair Transplantation?

We treat the donor area with the same care as the recipient area; the donor hair is meticulously dissected from the donor area in the back of the head. We remove the donor material at the same angle that hair emerges from the skin to minimize follicle transection. We preserve blood vessels and nerves by carefully dissecting around them. We do not use cautery (burning) to stop bleeding as bleeding is minimal and controlled by gentle wound closure. We never use staples. In our view, staples are only a time saver for physicians, they leaves tracks and unsightly results, and are uncomfortable for the patient. Much is written about trichophytic closures and it has its place. A trichophytic closure (dissecting a small strip of skin from the wound edge) is only performed if realignment of follicles cannot be accomplished adequately.

Once the donor area is removed under magnification we meticulously prepare the grafts so that the integrity of follicular units are preserved. We maintain the support structure around each unit to ensure maximum survival. Follicular Unit Hair Transplantation allows us to place these tiny grafts into very small recipient sites. The small recipient sites cause minimal damage to the tissue, allowing us to safely transplant thousands of grafts in a single session and to complete the hair restoration procedure as quickly as possible. The recipient sites are created at an angle that mirrors what occurs naturally. The grafts are placed elevated slightly so that the epidermis (that contains Keratin) will turn into a small scab and fall off. After placing of the grafts we never cleanse the scalp with hydrogen peroxide (a heavy oxidizer that causes cell death). Your scalp will have some blood specks present at the end of the procedure which will be gone after your first scalp cleansing 1 day after the procedure. The tiny recipient sites heal in just a few days leaving no sign that the newly growing hair was ever transplanted.

Follicular Unit Transplantation was a major advancement over the mini/micro grafting hair transplant procedure that had preceded it. It is leaps ahead of the round plugs of the not so distant past. Follicular Unit Transplantation combined with the skill and artistic abilities of Dr. Goertz, give results so natural it is impossible to distinguish transplanted hairs from naturally grown hairs.

Follicular Unit Extraction

What is Follicular Unit Extraction?
Follicular Unit Extraction (FUE) is a method of obtaining donor hair for Follicular Unit Transplantation (FUT). Naturally occurring follicular units can be obtained in one of two ways; either through single strip harvesting and microscopic dissection, or through individual Follicular Unit Extraction (FUE). With FUE, individual follicular units are harvested directly from the donor area without the need for a linear incision. Follicles are removed in a 3 step process developed by Dr. Jim Harris; a 1-mm punch instrument is used to make a small circular incision in the skin around the upper part of the follicular unit, the follicular unit is then extracted directly from the scalp.

Follicular Unit Transplantation and Follicular Unit Extraction are usually viewed as being two different procedures. However, FUE is in fact a type FUT, the difference is in the method of harvesting the donor hair. So, comparisons made between FUT and FUE are really comparisons in the way the follicular grafts are obtained (i.e. strip harvesting and dissection vs. direct extraction).

When considering a harvesting method for a procedure one needs to consider the number of grafts per session, transection or damage rate, the potential for ingrown hairs in the donor area, and post-operative healing and recovery.

FUE vs FUT/Strip Method
FUE's main limitation (compared to FUT) is inefficiency of harvesting from the strongest donor area in the middle of the permanent zone. In FUE the follicular units are extracted individually and other follicular units between the extracted follicular units must remain to provide coverage in the donor area. This significantly limits the amount of hair that can be removed from the permanent zone. In FUT, the strip is taken from the central part of the donor region with the edges being sewn back together, so all the hair in this area can be removed and transplanted.

With FUE the entire donor area hair must be shaved to 1 millimeter to facilitate FUE extraction. This leaves the patient with a large shaved area that takes time to grow back to the normal length. With FUT, only the donor area of the strip that is being removed is shaved, leaving the adjacent hairs their original length so that area is concealed when sewn together.

In Follicular Unit Extraction the wounds are left open to heal, leaving small punctuate scars. These scars distort adjacent follicular units and makes future FUE procedures more difficult. With FUT after the strip is removed, the follicles are realigned and wound edges are sewn together leaving a fine linear scar.

Another major problem with FUE is that grafts obtained by extraction generally lack the protective tissue that surrounds the bottom of the follicles - tissue that is carefully preserved during the microscopic dissection of FUT. This tissue serves to protect the grafts during the hair transplant procedure and increase survivability.

The new techniques and instruments significantly decrease the amount of transection and damage during FUE however, the incidence of transection is still significantly greater than microscopically controlled dissection used in FUT.

These reasons, combined with the inability to fully access the mid-portion of the permanent zone in FUE, and the risk of poorer graft survival, significantly limits the total amount of hair that can be transplanted in a single session. This leaves us with a procedure that is less optimal for most people with significant balding.