Abstract
The roots of modern day hair transplantation firstly evolved in Japan in the year 1930s. In the year 1939, the Japanese dermatologist Dr Okuda described the procedure of surgical hair restoration intended for burnt victims in detail. Later in the year 1943, the other Japanese dermatologist popularly known as Dr Tamura refined the work of Dr Okuda and explained that each follicular unit consists of more than one hair roots which ranges between 1-4 follicular units and applied the elliptical incision to extract the donor's tissue and then dissected each individual graft.
Later, in the year 1952 a New York dermatologist named, Dr Norman Oreintreich performed the very first hair transplantation in the US on a man suffering from male pattern baldness. It was the time of re-inventing and re-defining the procedure of hair transplantation. And now it is the best option for a patient, who is suffering from the male pattern baldness and similarly applies in the case of female pattern baldness as well.
In FUT, the grafts are harvested via the strip of the skin, usually taken from the back and sides of the scalp termed as the 'safe donor zone' and transferred to the recipient zone to achieve the aesthetic goal of the procedure (hair transplant turkey).
INTRODUCTION
The hair transplant procedure finds its root in 1952 with the revision restoration procedure of Dr Norman Oreintreich that introduces the process of punching for extraction with 4mm punches. The same later got transformed into the procedure of Micrografting and minigrafting. And thenceforth, later in the year 1990, the most compatible technique of harvesting the grafts has came to the picture which involves the strip of the skin that contains the follicular units. In the technique of FUE hair transplant, the extraction involves the use of punching machine which leaves to the process of extracting the grafts, one-by-one from the scalp and if needed used to target the unsafe zone too for extracting the hair roots. As the deviation in the punching that can occur due to the random motion of the punching which automatically put the limitation for extracting the roots from the scalp. Since there is a need of keeping the aesthetic distance to take the grafts. The extraction of graft in the FUE hair transplant leaves a small open hole which heals with a small white mark.
In the procedure of FUT, an acronym of follicular unit transplant involves the shifting of follicular units that usually pairs in the number of 1-4 from the donor portion to the recipient one via the excision of the strip of the skin. In the procedure of FUT, the patient's scalp is numbed to excise the strip and make an incision to take the strip and the portion is closed by the advanced Trichophytic closure to avoid the chances of scars. If well executed, the results of FUT will look completely natural and will be undetectable.
This article presents a review of different aspects of FUT such as the prerequisites of doing FUT hair transplant, indications, and myths & facts, steps, limitations and the budget cost perspective of FUT procedure.
PRINCIPLE OF FOLLICULAR UNIT TRANSPLANTATION
In the procedure of FUT, the strip of the skin harvested from the donor area (back & sides of the scalp), the donor strip is then separated into the individual follicular units using precise stereo-microscopic dissection techniques. After dissection of the follicular units, the further step is followed by making the hairline design on the scalp to place the grafts. The incision portion of the scalp is closed by the advanced Trichophytic closure that avoids the chances of scars and makes the procedure devoid of scars.
(here put the image of donor area during the excision of strip)
NOTE: use the real patient photo rather than the drafted one!
The main advantage of FUT hair transplant is that it is suitable for covering the higher grade of Norwood class baldness as the technique provides the greatest number of follicular units via the strip. As the follicular units in the FUT hair transplant harvested from the safe donor portion are permanent in nature since these roots are resistant to the effects of DHT. It is only possible to implant the higher number of the follicular units via the FUT hair transplant and no other alternatives are being practiced in the field of hair transplantation if there is need of higher number of grafts to cover the greater degree of baldness.
PREREQUISITES FOR DOING FOLLICULAR UNIT TRANSPLANTATION
There are some prerequisites for doing FUT as jotted down below:
Adequate skill, experience and knowledge for a Surgeon
Ultra refined tools for making the incisions
Adequate magnification of at least 20x for the surgeon and technician
An advanced closure technique of Trichophytic closure to avoid the scars
A highly trained team of technicians to dissect the grafts
Use of optimized hypothermic (low temperature) preservation (holding solution) to keep the grafts outside that extends the life of the cells outside the body
Use of digital sensor machine to maintain the temperature of the holding solution at a constant level to avoid the damage of grafts
Trichophytic Closure Technique
It is important to note in the FUT procedure to make the incision scarless after harvesting the strip from the donor portion. The technique which makes the scar almost invisible is the advanced Trichophytic closure. It is a different closing technique which is far better than the general technique as the closing done in this process with a zig-zag fashion along with trimming and closing the edge of the incision area in such a manner that they overlap with each other and present the invisible scar after the closing. In Trichophytic closure, the hair grows naturally and the sutures get absorbed after the one or two weeks and there is no need to remove it out. The hair growing through the scar can provide a strip devoid of by FUT procedure and it's very hard for anyone, even a doctor, to notice the scar after the procedure is complete.