By Dr. Mark Korman MD FRCSC,
Hair Restoration Surgeon

The key to modern hair restoration surgery is the concept of the “follicular unit. When the scalp is examined under a microscope, hair can be seen to grow in natural groupings that generally contain between one and four hairs. These natural groupings are called follicular units (FU’s). When donor hair is harvested for transplantation, preservation of the integrity of these FU’s allows the hair to be placed in a way that maintains a completely natural appearance. This is in stark contrast to the “hair plugs” and large “minigrafts” that could yield unacceptable cosmetic results.

At Follicle HT, we perform we use only single follicular unit grafts. This allows us to achieve results that are totally natural and truly undetectable. During a follicular unit hair transplant, the grafts are placed into very tiny recipient sites that are created in the bald or balding area using ultra fine needles or micro-surgical instruments. No tissue is removed in the recipient area and because of the refinement of the technique, it is possible to create very natural hairlines and to insert grafts in between existing hairs in order to add density to thinning areas.

There are 2 main techniques available: follicular unit strip surgery (FUT) and follicular unit extraction surgery (FUE).

FUT

Follicular unit strip surgery (FUT) involves removing a strip of hair bearing skin from the donor area and then dividing that strip into follicular units for transplantation to the hairline or other areas. When performed using meticulous surgical technique, this procedure leaves a fine-line scar along the back of the scalp that is generally difficult or impossible to detect unless the hair in that area is cut very short. At Follicle HT, our board certified head and neck surgeons often utilize a technique called “trichophytic closure” that allows the surrounding hairs to grow directly through the scar, making it very difficult to detect.

The advantage of FUT is that each graft is dissected individually under a stereotactic microscope leading to minimal rates of transected follicles and optimum graft health and growth. The other main advantage is that with FUT, only the hair that is being harvested for transplant is clipped short, unlike FUE that requires a larger area to be trimmed. This means that with FUT, the donor scar is covered by the hair above and is not visible, even on the day of surgery. This is particularly important to our female patients. The disadvantage of the FUT technique is that is does leave a linear scar that can be visible if the hair is cut very short (i.e. shorter than a #3 razor guard).

The alternative to FUT surgery is what is referred to as follicular unit extraction (FUE). This involves extracting the donor follicles by hand, one by one using a precise, motorized surgical punch that is generally only 0.8-0.9mm in diameter. The donor sites are so small that they do not need to be closed with sutures, but rather heal over on their own after a few days.

FUE

The advantage of the FUE technique is that it avoids a longer, fine-line scar so that the hair in the donor area can generally be cut to a fade, or even shaved with little or no visible scar. The disadvantage of FUE surgery is that it can take longer, and that theoretically, follicle transection rates can be higher. This may be particularly true with some of the automated graft harvesting systems that use rotating, sharp punches. At Follicle HT, we use state of the art hybrid punches that minimize graft transection and maximize graft viability and growth. A further disadvantage is that with the FUE technique, a larger area at the back and sides of the scalp needs to be trimmed short for the graft harvest process. This can be an issue for female patients, or for males who have longer hair that they do not wish to cut short.

FUE surgery is sometimes marketed as a “no cut” or “no scalpel technique”. In our opinion, this is potentially misleading to patients. While it is true that FUE does not involve a long, linear incision and does not require stitches, it does leave very tiny scars that in some patients, can be visible if the hair is cut very short or shaved.

At this point, about 80% of our male patients elect to undergo FUE surgery but it is important to recognize that both FUT and FUE have advantages and disadvantages. Unlike some clinics, our team at Follicle HT is highly experienced at both techniques and our surgeons will help you to decide which technique is right for you.

Both FUE and FUT have advantages and disadvantages. At Follicle HT, we offer both FUT and FUE techniques because we feel that it is important that a full service hair transplantation center be prepared to offer care that is individualized to the needs of each patient.