What is Follicular Unit Transplantation?
Follicular Unit Transplantation (FUT) is a procedure where hair is transplanted from the permanent zone, the area in the back and sides of the scalp where hair is more resistant to balding, to the bald or balding areas of the scalp. This is accomplished using naturally-occurring groups of 1, 2, 3, or 4 hairs, called follicular units. After the patient’s scalp is anesthetized, the doctor removes a strip of tissue from the donor area, an area within the permanent zone, and, once extracted, the donor strip is cut into many individual follicular units using microscopic dissection techniques. As these follicular unit grafts are being prepared, the doctor makes tiny holes in the scalp, called recipient sites, where the grafts are placed.
The arrangement and positioning of these follicular unit grafts determines the aesthetic qualities of a hair transplant, and so this arrangement must be decided on a case-by-case basis, depending on the patients’ history of hair loss and likelihood of future hair loss. Since follicular unit transplants mimic the way hair grows in nature, the results, in expert hands, will look completely natural and be indistinguishable from one’s original hair. See some of these results in our Before & After Hair Transplant Photos galleries.
For years it was thought that scalp hair grew as individual strands, but scalp hair actually grows in tiny little groups of 1-4 hairs each. These groups are called “follicular units.” Surprisingly, even after doctors learned about the existence of these groups, they didn’t think to use them in the hair transplant.
One of the most important aspects of Follicular Unit Hair Transplantation is stereo-microscopic dissection. This allows follicular units to be isolated from the donor strip without being broken up or damaged. During graft dissection, it is critical that the whole follicular unit is kept intact as this will maximize its growth. Intact follicular units will also give the most fullness to the hair restoration, as they contain the full, natural complement of 1-4 hairs. Read more about Graft Dissection »
There are a variety of solutions that grafts can be stored in during the hair transplant procedure to maintain their viability and insure maximum growth. Our understanding of the ideal holding solution continues to evolve. In our practice, we are currently using HypoThermosol. Read more about the Holding Solution we use at Bernstein Medical – Center for Hair Restoration. »
Recipient sites are the tiny slits or holes that the hair transplant surgeon makes in the patient’s scalp, where the follicular unit grafts are placed during a hair transplant procedure. At Bernstein Medical, the recipient sites in all of our hair transplants are made using lateral slits (also called coronal or horizontal slits). Lateral slits have the advantage of orienting the hair within the follicular unit to match the way it grows in nature. This gives the hair transplant surgeon the highest degree of control over the direction and angle in which the transplanted hairs will ultimately grow. Read more about Recipient Sites »
The donor area is the area of the scalp (generally the back and sides) where hair-bearing skin is removed during a surgical hair restoration procedure. For hair transplants to be effective, the hair in this area must be permanent (i.e. not subject to the effects of DHT).
Minimizing the scar from the donor incision is a critical part of a successful hair transplant procedure. A fine donor scar allows a person to keep his/her hair relatively short after the hair restoration (if one wants to do so) and increases the amount of hair that can be harvested (removed) in subsequent hair transplant procedures. Read more about the Donor Area in a hair transplant »
Determining how many follicular unit grafts will be transplanted in a hair transplant is an important aspect of planning and designing a hair transplant for the maximum possible aesthetic effect. The graft numbers page gives general guidelines for the number of follicular unit grafts needed in a patient’s first hair transplant procedure and for subsequent procedures, if more than one session is indicated. Read more about Graft Numbers in a hair transplant »
Dr. Bernstein’s lecture on Follicular Unit Transplantation (FUT) includes an historical review of hair transplant techniques, from the out-dated “plugs” and “cornrows” to the current, refined FUT procedure. Watch the FUT lecture, narrated by Dr. Bernstein to see images of surgical tools, illustrations of the newest techniques, and before and after patient photos »
Brief History of Follicular Unit Transplantation
Follicular Unit Transplantation was conceived by Dr. Bernstein and first described in the medical literature in his landmark 1995 publication, “Follicular Transplantation.”
FUT was a major advance over the, now obsolete, “mini-micrografting” hair transplant procedures that preceded it. In mini-micrografting, the graft sizes were arbitrarily determined by the hair restoration doctor, who would cut the donor tissue into different size pieces. These larger grafts, commonly known as “hair plugs,” might have contained up to 12 or more hairs, were bulky, and could produce a tufted appearance. They could also result in a dimpling of the underlying skin.
The major advance brought by Follicular Unit Transplantation is that the use of special stereo-microscopes enables surgeons to meticulously dissect the hair grafts. This helps preserve the integrity of the follicular units and enables the surgeon to keep all of the growth elements of the hair follicle intact. The survival of the grafts is maximized and, as a result, both the hair transplant and the underlying skin will look completely natural when the transplant matures. With FUT, thousands of grafts can safely be transplanted in one session, allowing the patient to complete the hair restoration as quickly as possible.
Follicular Unit Extraction uses similar methodology, with the main exception being that the follicular unit grafts are extracted directly from the donor area.