Hair Follicular Unit Transplantation (FUT)

Follicular Unit Transplantation (FUT)

Follicular Unit Transplantation or 'FUT' for short is a hair transplant procedure: it involves the removal of hair from areas of the scalp such as the back and sides which are then inserted into bald patches such as the front and top (crown).

The areas at the back and sides of the scalp are most resistant to balding which is why they are used as donor hair.

Conversely, the crown and hairline of the scalp are the complete opposite and are areas which are most likely to lose hair. These areas are known as the 'recipient' areas of the scalp and act as a repository for the donor hair. The donor hair is removed and transplanted into the recipient areas.

The donor hairs are removed in a series of strips containing 3 to 4 hairs and are known as 'follicular units'.

How is a follicular unit transplant performed?

The scalp is prepared beforehand: donor hair in that part of the scalp is trimmed to allow easy access and the scalp anaesthetised which numbs the area.

A strip of tissue containing hair follicles is removed. Each strip contains a small bunch of hairs which act as a graft. This process is repeated several times. The donor area of the scalp is closed with tiny stitches.

The recipient area of the scalp is then prepared. A set of tiny incisions are made using ultra-slim blades which vary in length. These blades are custom designed to match the follicular units: there are blades designed for 1 hair follicular units through to 4 hair follicular units.

The lateral slit technique is used for making the incisions. These incisions enable greater hair coverage than lateral incisions and follow the natural direction of the original hair. This also avoids the 'pluggy' look often seen in older forms of hair transplantation.

The donor hair tissue is cut into smaller grafts and placed in cold storage. These grafts are then inserted into the incisions in a particular pattern, e.g. the smallest 1 to 2 hair grafts at the front followed by the 3 and 4 hair units.

The end result is stubble effect around the incision which will eventually be replaced with new hair growth.

Donor hair graft process

How long is a hair graft? Every hair graft is approximately 1 cm in width but the length varies depending upon the volume needed for the transplant. As a rough guide there are 100 hair follicles per square cm of tissue so a 1,000 hair graft transplant would require a strip of tissue that is 1 cm wide and 10cm in length.

The donor strips are divided into smaller strips using a microscope and scalpel. The strips are cut around the follicular units rather than through them which prevents damage to the hair follicles. The individual strips are then trimmed of excess fat and fibrous tissue.

These donor strips include 1, 2, 3 and 4 hair grafts which are sorted in numerical order. They are then placed in Petri dishes and kept refrigerated until ready to use.

Each hair graft occupies a particular area of the scalp. Some grafts are placed at the front, near the hairline, whereas others are placed over the top of the scalp. The aim is to keep the recipient areas of the scalp as small as possible which enables the surgeon to tightly pack the grafts together.

This is the advantage of follicular units. Their small size means a maximum number of these units can be placed in a limited space which increases hair density. In other words, more follicular units mean more hair.