Follicular Unit Transplant (FUT)

Fullicular Unit Transplant (FUT)

Follicular unit extraction (FUT) is long considered to be the gold standard of hair transplantation, and was the first method developed that utilized individual hair grafts over multi-bundled grafts. This technique was developed in response to the early days of hair restoration that involved procedures such as scalp reduction or the infamous hair plugs of the 70s and 80s. Instead of transplanting multiple hair bundles into a single site (i.e. “plug”) the FUT method pioneered the use of naturally occurring bundles and arranged them in a way that approximated natural hair growth patterns. This makes sure that the transplanted hair moves and flows just as natural hair would.

Known colloquially as the “strip method,” this technique gained that moniker from how the donor hair is harvested for the transplantation process. A “strip” of hair is removed from the occipital ridge along the back of the scalp, and the skin edges are sutured together with multilayer closure technique to ensure minimal scarring. This transplantation method is often chosen by patients who do not wish to shave the back of their heads for the follicular unit extraction (FUE) method. All of the surrounding hair that is not extracted will remain its same length, and it is because of this post-operative concealment that FUT is often chosen by female patients who wish to keep their hair long.

The Hair Growth Cycle

Hair typically grows one centimeter per month, resulting in approximately 6 inches of hair growth per year. Hair growth occurs in three distinct phases: the anagen, catagen, and telogen phases.

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Anagen Phase

The Anagen phase is the part of the cycle where hair actively grows. During this phase, the cells that make up the hair’s root will divide and grow. As the new hair forms, it will push up from the base of the follicle and emerge above the skin. This active growth phase will last somewhere between two to six years and is different for each person. Some people are not able to grow their hair beyond a specific length, and this means that they have a relatively short Anagen phase. Other people might be able to grow their hair very long and quickly, which would mean that they have a relatively long Anagen phase.

 

Hairs on different parts of the body also have different lengths of the Anagen phase. Eyebrows and beard hair are normally known to have shorter Anagen phases than scalp hair, meaning they are unable to grow as long.

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Catagen Phase

The Catagen phase is the part of the cycle where hair growth stops. The shaft of the hair shrinks and separates from the bottom of the hair follicle, yet it remains in place. This phase typically lasts around ten days, and is the shortest phase of the hair growth cycle.

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Telogen Phase

The Telogen phase is the part of the cycle where the hair sheds, and is known as the ‘resting’ phase. This is where the follicle is at rest in the scalp and is prepared to be shed. This phase should last around a hundred days, and between twenty-five and one hundred Telogen hairs are typically shed per day. A white bulb is formed at the base of the hair shaft, and you may see these at the root of the telogen hair once they have been shed.

How is an FUT performed?

The anagen phase is the part of the cycle where hair actively grows. During this phase, the cells that make up the hair’s root will divide and grow. As the new hair forms, it will push up from the base of the follicle and emerge above the skin. This active growth phase will last somewhere between two to six years and is different for each person. Some people are not able to grow their hair beyond a specific length, and this means that they have a relatively short anagen phase. Other people might be able to grow their hair very long and quickly, which would mean that they have a relatively long anagen phase.

Hairs on different parts of the body also have different lengths of the anagen phase. Eyebrows and beard hair are normally known to have shorter anagen phases than scalp hair, meaning they are unable to grow as long.

How is an FUT performed?

The FUT procedure is performed with the patient either sitting upright or facedown in a surgical chair. A small section of hair will be shaved along the back of the scalp in order to be prepared for the extraction process.

Local anesthesia is used to numb the donor section, and no intravenous or general anesthesia will be required: the patient is awake and alert for the entire duration of the procedure. Once the small donor area is completely numb, the surgeon will extract the “strip” of tissue using sterilized surgical equipment and subsequently join the skin edges with a multilayer closure technique.

The sutures used are dissolvable and will be absorbed by the surrounding skin over the next 2-3 weeks. The hair above and below the suture will remain its original length, meaning that as long as the patient’s hair is at least 2 inches long, the suture will be completely covered by the surrounding hair.

The extraction process normally takes no longer than 10-20 minutes, and for the remaining duration of the procedure, the patient will sit upright in the surgical chair. From there, a hairline will be designed according to the patient’s desires and the scalp will be numbed in preparation for the actual transplantation of hair bundles.

If a beard or eyebrow transplant is being performed, the areas selected for transplantation will be outlined and anesthetized according to their need. A television with streaming services will be available for the patient to watch as the surgical team transplant the hairs into the necessary areas, and breaks will be provided at the patient’s discretion. All in all, most of the day will be spent watching television and/or relaxing in the chair as each hair is carefully transplanted into the desired location.

Signs and Symptoms

In some men the first signs of hair thinning may be seen around the temples. Others may see hair thinning start in the crown. Abundant shedding is a common sign of hair loss as well, and lost hair follicles may be seen in the shower or on a pillow. The stages of thinning may progress to where small empty spots are seen along the hairline and scalp, indicating that telogen hairs have not grown to replace the shedded hairs.

Norwood Scale

The norwood scale is a tool used to measure the extent of hair loss in men and the patterns of loss typically seen in patients. The position of the scale may be a helpful indicator of how many hair grafts are needed in transplant cases.

Excellence in the Art of Hair Transplantation

Hair transplantation is a hair restoration surgery that works by moving hair from the back and sides of your head to the thinning or balding areas on the top of your scalp. Dr. Koher and the surgeons of Koher Medical are particularly experienced with this procedure, having over 35 years of experience and having performed over 15,000 hair transplants nationally and internationally.

If you’re looking for a solution to your hair loss, you can trust the surgeons and staff of Koher Medical to deliver a world class experience and state of the art cosmetic results. No matter what your hair loss situation, Koher Medical is ready and willing to offer our expertise and years of experience.