FUT Hair Transplantation

A Follicular Unit Transplant (FUT) is a hair restoration procedure that involves harvesting hair follicles from strip incised from donor area. From the strip grafts are separated and transplanted into areas of the scalp with thinning or no hair.

Among various hair transplant techniques, Follicular Unit Transplant (FUT) is one of the widely used and reliable methods to restore natural looking hair. FUT is the first and foremost technique accepted by doctors for surgically restoring hair. FUT is also known as strip technique and is considered one of the effective methods for hair restoration.

Follicular Unit Extraction (FUE) Procedure in Detail

Here, we discuss the step-by-step process of FUT hair transplant procedure .

1. Initial Consultation and Evaluation

The first step toward FUT begins with a consultation with a qualified hair restoration surgeon. The patients' specific needs, expectations and medical history are discussed during this consultation. The surgeon evaluates the scalp, availability of donor hair, character and the extent of hair loss is determined.

2. Planning

Once the consultation is done and the patient appears to be a suitable candidate for FUT, the customized plan is prepared. Planning includes:-

• The design of the hairline.
• Estimation of the number of grafts required.
• Booking of time-date for the procedure.

A well-thought-out plan is important to achieve natural and aesthetically pleasing results.

3. Preparation for the Procedure

Preparation is one of the most important steps before the procedure. Here the internal team with the doctor is introduced to the requirements of the patient. Each and everything is well organized so that no unpleasant surprises or huddles appear during the procedure. A well-planned step is the secret to achieving success. Following are a few important preparations done before the FUT began:-

1. Sterile Environment : The centers are thoroughly cleaned, disinfected and sterilized. Especial care is taken to sterilize the operation theaters to make them free from any kind of germs and bacteria. It is essential to ensure that medical and surgical instruments are sterilized well so that infectious pathogens do not spread to patient.
2. Patient’s sitting in OT : Patient is made to sit in very comfortable posture on OT chair. A supporting posture is very prominent during the entire process. This reduces the likelihood of any pain due to siting for a long duration in fixed posture. The entire procedure consumes long duration whereas OT chair supported by other equipment provides comfort to the patient.
3. Trimming of Hair:The hair is trimmed to a length of approximately 6 mm so that the strip can be precisely cut from the donor area. Although it is recommended to trim the hair of the entire head, if the patient does not want to have his hair trimmed, only the hair at the donor area is trimmed.
4. Marking of Donor Site & Hair Line: The surgeon will mark the area from where the strip of hair-bearing scalp will be removed. At same time the hair line is also marked for the insertion of the grafts at bald area.
5. Administer Anesthesia: The last step in the preparation of FUT is to numb the donor and the recipient site. The local anesthesia is injected to both the donor and recipient sites. Local anesthesia ensures the patient will remain comfortable and pain-free during the surgery. In FUT, the donor area is typically the back and sides of the scalp where hair is genetically resistant to balding.

4. Donor Strip Harvesting in FUT

In the first step, the donor area is planned to be removes surgically in form of strip of skin having hair grafts. The size of strip is decided according to the requirement of the bald area and the density of the existing hair. Specialists surgically remove the thin strip having donor grafts from the back of the head as per preplanned size. The strip typically measures about 1-2 centimeters in width and varies in length depending on the patient's specific needs. This strip is carefully excised to minimize scarring.

With precise markings in place, the surgeon carefully excises a narrow strip of skin containing hair follicles from the donor area. The donor strip is harvested and placed right away in tray having chilled regular saline solution.

The incision is done in such a manner that a longitudinal strip is excised containing the required number of follicular units in a single endeavor. It is important to take care when cutting as close to the skin so that the deep hair roots do not damage and not the tissue surrounding them, thus becoming accessible to subsequent surgery.

5. Donor Area Closure

After that donor strip is removed, the team uses sutures and a trichophytic closure procedure to stitch off the donor region and minimizes any potential scarring. The surgeon meticulously closes the incision with sutures.

The gap is being closed normally with sutures. The skin can be opposed by a running suture of 3-0 or 4-0 generally with an absorbable suture. While this result in a fine, linear scar, which is usually concealed by the surrounding hair. The sutures are typically removed after 10 to 14 days.

6. Graft Separation and Preparation in FUT

Grafts separation is one of the most critical steps in FUT. This is done with extreme care as the survival of the graft greatly depends on graft handling at this stage of harvesting and afterward. The harvested donor strip is immediately immersed in a chilled normal saline solution. This is achieved by keeping the tray containing the donor strips immersed in saline on ice.

The donor strip containing hair follicles is dissected into slices or layers under a microscope. Each slice is further divided into minor sections that contain 1 to 4 follicles called grafts. This heterogeneousness is utilized as per the patient's needs and the surgeon's strategy for achieving the most natural result.

While separating individual grafts proper light is mandatory. Proper hydration at the cold temperature of the grafts is also ensured once they are separated from the donor strip by keeping them in a cold saline solution in kidney trays or in a Petri dish. Grafts are kept in a bunch of 25 grafts. It is very important throughout the surgery as it sustains the survival rate of the grafts.

The entire process is done by specialist technicians under the higher magnification of microscopes. While doing so it is ensured that grafts along with tissues surrounding it should remain intact.

Up to 2 mm of fat is left below the hair bulb after the subcutaneous fatty tissue beneath the hair roots or bulbs is removed. It is important that no foreign bodies stick to the grafts after they have been cut, because these can later form troublesome epidermal cysts. Loupe magnification of 2X or 3X power is useful in crafting grafts. The dissection takes a little longer when the graft is prepared under a dissecting stereo microscope, but it is much more accurate. A new hairline should be made using the finer hair in the lower part of the occipital area and the temporal area.

7. Graft Insertion in FUT

Finally the last and the most important step of graft insertion are accomplished with care after creating the slits at recipient site. Following are the details of the steps considered during the graft insertion:-

1. Anesthetization: The surgeon re-checks the effectiveness of the local anesthesia given at the time of removing the donor strip. If the effect have been lessened the surgeon re applies the local anesthesia at the recipient site, then begin the graft placement.
2. Recipient Site Creation: During this step the surgeon makes tiny incisions (or slits) in the recipient area. These slits are made following the pre-marked hairline design. The incisions are strategically shaped to ensure natural hair growth and density. The surgeon pays careful attention to the angle, direction, and density of the incision made.
3. Graft Placement: The graft is placed into the recipient slit or hole using specially designed forceps with a fine angle. It is important to proceed with the grafting process very carefully to avoid any damage or loss to the graft. Each graft is handled with great care. Grafts are griped at recipient sites by grasping those 2 mm below the subcutaneous tissue above the hair bulb, not at the end of the follicle. Steady pressure is carefully applied to ensure that the grafts are evenly fused with the surrounding skin. The grafts should get fit to the holes from all sides. Pressing the graft below skin level is avoided. Because this can lead to epidermal cyst formation and a sunken appearance, whereas if the grafts remain elevated above the skin surface a cobblestone-like appearance may occur. Grafting sessions can last up to four or eight hours, in which 2000–4500 grafts may be transplanted. The whole process is accompanied by a team doctors and technician comprise of 2-4 persons working together at same time to make the procedure faster and efficient. In this way, follicular unit (hair grafts) are implanted into the recipient balding part of the scalp. It is ensured that they blend seamlessly with the existing hair, resulting in a natural appearance.

8. Post-Operative Care and Recovery

After the FUT procedure is completed, the patient will be provided with post-operative care instructions. This includes care for the implanted area, expectation during the recovery period, prescribed medications, etc. Patients are expected to follow these guidelines diligently to aid in the healing process.

9. Follow-Up

Patient is required to be in touch with the clinic and keep updating about the progress of the transplant and address any concerns or questions. There are several stages a patient will experience before he gets the final result. It takes 3 to 6 months to experience hair growth. During this course patient is advised to keep consulting to center for anything doubtful experienced.

Selecting an experienced and reputed surgeon is the most important thing in the entire FUT hair transplant surgery. While FUT may leave a linear scar, it is often hidden by surrounding hair, and the lasting benefits of restored hair make it a game-changer. Careful adherence to post-operative care instructions ensures the best possible results.
Patients can enjoy the benefits of their FUT hair transplant for many years to come, increasing their confidence and self-esteem.