This article needs additional citations for verification .(July 2015) |
Follicular unit transplantation (FUT) is a hair restoration technique, also known as the strip procedure, where a patient's hair is transplanted in naturally occurring groups of 1 to 4 hairs, called follicular units. Follicular units also contain sebaceous (oil) glands, nerves, a small muscle, and occasional fine vellus hairs. In follicular unit transplantation, these small units allow the surgeon to safely transplant thousands of grafts in a single session, which maximizes the cosmetic impact of the procedure. [1]
FUT is considered an advance over older hair transplantation procedures that used larger grafts and often produced a pluggy, unnatural look. In a properly-performed follicular unit transplant, the results will mimic the way hair grows in nature and will be undetectable as a hair transplant.
In recent history, FUT had been the most common procedure for hair restoration. As of 2017, the newer follicular unit extraction (FUE) procedure has become the most common procedure. [2]
Follicular unit transplantation uses follicular units to accomplish a number of objectives critical to the hair restoration process:
Since the follicular unit is a distinct anatomic and physiologic entity, preserving it intact during the graft dissection is felt to maximize growth. In FUT, after hair is removed from the back of the scalp in a single strip, stereo-microscopic dissection allows the individual follicular units to be removed from this strip without being damaged. [3]
In the older mini-micrografting techniques, hair was harvested in multiple strips with the follicular units in each strip edge showing damage from the harvesting blades. The strips were then cut into smaller pieces, a process that would break up follicular units and risk additional damage to the follicles. [4]
Follicular Unit Transplantation enables the hair transplant to look natural both at the individual follicular unit level and in regards to the overall graft distribution. Since scalp hair normally grows in follicular units of 1 to 4 hairs, the exclusive use of these naturally-occurring units in FUT ensures that each graft will be identical to the surrounding follicular units. Thus, when the transplanted follicular units grow hair after a transplant, the overall results of the transplant will appear natural.
Additionally, by using individual follicular units, rather than larger grafts, the surgeon has a greater total number of grafts with which to work. This allows the surgeon to distribute the grafts more evenly over the scalp for a more natural overall distribution of hair.
The density of naturally-occurring follicular units in a normal scalp is relatively constant, measured at approximately 1 unit per mm2. [5] This helps in the planning of a hair transplant in two ways:
In patients with high hair density, there are usually a sufficient number of follicular units in the donor area to accomplish the patient's goals. However, in the patient with low hair density, a compromise must be made, and this is guided by the follicular unit constant. By transplanting a patient with low hair density using the same number and spacing of follicular units as in a patient with high density, the transplant surgeon will produce a thinner look, but will allow proper conservation of donor hair for future procedures. [6]
The key to a natural appearing hair transplant is to have the hair emerge from perfectly normal skin, so minimizing trauma to the scalp is an important aspect of follicular unit transplantation. This can be accomplished by trimming away the excess tissue around the follicular units and then inserting them into small recipient sites on the patient's scalp.
Follicular units are relatively compact structures, but are surrounded by substantial amounts of non-hair bearing skin. This extra tissue can be removed without injuring the follicles, using stereo-microscopic dissection. These small, trimmed, follicular unit grafts can then be placed into tiny incisions in the patient's scalp; thereby minimizing damage to the scalp's connective tissue and blood supply. In contrast; the larger wounds produced by mini-micrografting and plug transplants caused cosmetic problems that included dimpling and pigment changes in the skin; depression or elevation of the grafts; and a thinned, shiny look to the scalp. These problems can be avoided using very small grafts and very small recipient wounds.
Another advantage of making small recipient wounds is the ability to create a "snug fit" for the follicular unit grafts. Unlike the punch grafts and some mini-grafting techniques; each of which removes a small bit of tissue in the recipient area; the trimmed follicular unit grafts used in FUT fit into small, needle-made incisions without any need for removing tissue. This preserves the elasticity of the scalp and holds the tiny grafts snugly in place. After surgery, the snug fit facilitates wound healing and helps to ensure that the grafts will get enough oxygen from the surrounding tissue in order to maximize their survival. [3]
There are four reasons why the follicular unit transplantation procedure allows a hair transplant surgeon to transplant large numbers of grafts in each session:
Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic surgery aims to improve the appearance of it. A comprehensive definition of plastic surgery has never been established, because it has no distinct anatomical object and thus overlaps with practically all other surgical specialties. An essential feature of plastic surgery is that it involves the treatment of conditions that require or may require tissue relocation skills.
Rhinoplasty, commonly called nose job, medically called nasal reconstruction, is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery can also treat birth defects, breathing problems, and failed primary rhinoplasties. Rhinoplasty may remove a bump, narrow nostril width, change the angle between the nose and the mouth, or address injuries, birth defects, or other problems that affect breathing, such as a deviated nasal septum or a sinus condition. Surgery only on the septum is called a septoplasty.
Tissue expansion is a technique used by plastic, maxillofacial and reconstructive surgeons to cause the body to grow additional skin, bone, or other tissues. Other biological phenomena such as tissue inflammation can also be considered expansion.
The hair follicle is an organ found in mammalian skin. It resides in the dermal layer of the skin and is made up of 20 different cell types, each with distinct functions. The hair follicle regulates hair growth via a complex interaction between hormones, neuropeptides, and immune cells. This complex interaction induces the hair follicle to produce different types of hair as seen on different parts of the body. For example, terminal hairs grow on the scalp and lanugo hairs are seen covering the bodies of fetuses in the uterus and in some newborn babies. The process of hair growth occurs in distinct sequential stages: anagen is the active growth phase, catagen is the regression of the hair follicle phase, telogen is the resting stage, exogen is the active shedding of hair phase and kenogen is the phase between the empty hair follicle and the growth of new hair.
The scalp is the area of the head where head hair grows. It is made up of skin, layers of connective and fibrous tissues, and the membrane of the skull. Anatomically, the scalp is part of the epicranium, a collection of structures covering the cranium. The scalp is bordered by the face at the front, and by the neck at the sides and back. The scientific study of hair and scalp is called trichology.
Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Although in some cases augmentation mammoplasty is applied to correct congenital defects of the breasts and the chest wall in other cases it is used purely as a cosmetic surgery, primary breast augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue. When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. Keratoplasty simply means surgery to the cornea. The graft is taken from a recently deceased individual with no known diseases or other factors that may affect the chance of survival of the donated tissue or the health of the recipient.
A facelift, technically known as a rhytidectomy, is a type of cosmetic surgery procedure intended to give a more youthful facial appearance. There are multiple surgical techniques and exercise routines. Surgery usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. Exercise routines tone underlying facial muscles without surgery. Surgical facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep.
The management of hair loss, includes prevention and treatment of alopecia, baldness, and hair thinning, and regrowth of hair.
Gluteoplasty denotes the plastic surgery and the liposuction procedures for the correction of congenital, traumatic, and acquired defects/deformities of the buttocks and the anatomy of the gluteal region; and for the aesthetic enhancement of the contour of the buttocks.
Hair transplantation is a surgical technique that removes hair follicles from one part of the body, called the 'donor site', to a bald or balding part of the body known as the 'recipient site'. The technique is primarily used to treat male pattern baldness. In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding are transplanted to the bald scalp.
Follicular unit extraction is one of two primary methods of obtaining hair follicles, naturally occurring groups of one to four hairs, for hair transplantation. The other method is called strip harvesting. In 2018, Mejia published the updated guidelines adopted by the International Society of Hair Restoration Surgery. This name change came about to accurately describe the procedure which involves surgically cutting or incising a full thickness hair follicle skin graft with a circular scalpel, punch or motorized drill and subsequently carefully extracting it from the scalp to be placed in the donor balding scalp. Due to the new developments of incision punches and devices and a variety of different extraction techniques, it was necessary to more accurately define the procedure. Additionally, many places were incorrectly marketing the extraction procedure as a simple plucking of hairs and deceiving the public.
Eyebrow restoration is a surgical procedure to reposition the eyebrow. With advancing age, a common occurrence is descent of the eyebrow, or brow ptosis. A similar condition is eyelid ptosis. Eyebrow repositioning is a commonly performed procedure in cosmetic surgery. The brow is repositioned, optimally, for the wishes of the patient as well as to correct the descent.
Madarosis is a condition that results in the loss of eyelashes, and sometimes eyebrows. The term "madarosis" is derived from the ancient Greek "madaros", meaning "bald". It originally was a disease of only losing eyelashes but it currently is the loss of both eyelashes and eyebrows. Eyebrows and eyelashes are both important in the prevention of bacteria and other foreign objects from entering the eye. A majority of patients with madarosis have leprosy, and it was reported that 76% of patients with varying types of leprosy had madarosis.
Transplantable organs and tissues may refer to both organs and tissues that are relatively often transplanted, as well as organs and tissues which are relatively seldom transplanted. In addition to this it may also refer to possible-transplants which are still in the experimental stage.
Eyelash implants are a form of cosmetic surgery involving transplanting additional eyelashes around the eye. The process typically involves removing a section of hair from the patient, typically from the back of the head, and grafting the hair to the eyelids, replacing the existing eyelashes. The procedure typically involves 60 to 70 hairs per eye, and after removal and a thorough cleaning of the oil on the hair, they are reattached to patient by delicately sewing the lashes back on. Maintenance of the eyelashes is needed thereafter, as the hair continues to grow at the same rate as on other parts of the body.
Multiple follicular unit grafts is a hair transplant technique that has been developed to complement and enhance current micro grafting and follicular unit procedures by increasing density without sacrificing naturalness. A follicular unit (FU) is a naturally occurring bundle of hairs. This bundle contains anywhere from 1 to 4 hairs. A "multiple follicular unit" is a graft that contains more than one follicular unit. When combined these follicular units can total 5 to 8 hairs creating more significant results. These grafts are not to be mistaken with old style hair plugs harvested with a punch biopsy instrument, but instead are modern day slit grafts harvested from a thin donor strip in the back of the head and separated under magnification.
The cheek constitutes the facial periphery and plays a key role in the maintenance of oral competence and mastication. It is also involved in the facial manifestation of human emotion and supports neighboring primary structures.
Hairline lowering is a surgical technique that allows an individual to have their frontal hairline advanced certain distances depending on variables such as pre-operative hairline height, scalp laxity, and patient preference. It can be used to address a congenitally high hairline or sometimes a hairline that has recessed from hair loss. It is performed mostly on women.
Scalp reduction is a surgical procedure in which the hairless region of the scalp of a bald person is reduced. This procedure can reduce the area of the scalp in which hair transplantation is needed, or even eliminate the need for hair transplantation.