In the past days, there might have been many physicians who did not care much about the importance of the follicular unit and they have only cut the grafts to size. Now, every hair transplant physician believes the importance of follicular unit, and there is no one who cut the grafts to size ignoring each follicular unit.

However, there are some physicians who shout that a hair transplant procedure can be called FUT only when people use all single FU exclusively, and the procedure cannot be called FUT, if mixture of single FU and double FU are used in a session.

I would like to ask you, if you could accept the usage of combination of single FU and double FU under the name of FUT, as long as the grafts were cut according to each FU and intact FU are used throughout the procedure. Could you accept easing of the very strict definition of FUT, which you published about 15 years ago? Could you agree to use mixture of single FU and double FU under the name of FUT?

A: Thank you for the kind words. In thinking about hair transplantation in general, it is important to consider that a hair restoration procedure spreads hair around and, as a result, the transplanted hair will be less dense than the person’s original hair. Therefore, one would never want grafts larger than the largest original follicular units or the results will not look natural. The artificially large grafts will stand out in relatively thin surroundings. If one were to try to fix this by transplanting the doubled FUs very close together (over one or more sessions) one risks running out of grafts for other areas of the scalp. In other words, you can’t fool mother nature.

For example, if a person has thin hair and has only 1-, 2- and 3-hair units occurring naturally in his scalp, then creating 4-hair grafts (by combining two 2’s or 1’s and 3’s) can result in an unnatural, tufted look. Doubling larger follicular units also necessitates larger wounds to receive the grafts which defeats one of the main advantages of FUT, namely to minimize recipient wounding.

That said, it is not unreasonable to place two 1-hair FUs in a single site (if there are extra 1s from the FU dissection) in order to increase density in an area and to eliminate an extra wound.) We do this for crown hair transplants when we are not doing a hairline and there is no need for 1-hair grafts. However, this is the exception.

Technically speaking, anything other than transplanting individual, naturally occurring follicular units is not FUT. However, a physician should make modifications to the procedure for the specific needs at hand. This is the art of medicine. By understanding and applying the underlying principles of Follicular Unit Transplantation, rather than being limited by its nomenclature, the physician will serve his patient best.

In addition to exploring the Hair Transplant Blog, to learn more about this topic, visit the Follicular Unit Hair Transplant section of our website and read detailed information about the hair transplant evaluation, the hair restoration procedure, follicular unit grafts, the donor area, and more.

A: Graft compression refers to a tufted look resulting from the contraction of grafts caused by the normally elastic skin that contracts around the graft as the hair transplant heals. This was a common occurrence with mini-micrografting where 5 or more hairs from two or more follicular units were placed into one recipient site.

With follicular unit hair transplantation, follicular units won’t show visible compression since they are already naturally compact.

One reason why FU’s are valuable in a transplant is that they are compact enough to fit into a very small site. It is important, however to “customize” the site size to the size of the graft so the fit is just perfect. This speeds up healing, enables the patient to shampoo the day after surgery, and enhances graft growth.

In their article on FUT, the authors helped the dermatologic community to better understand the best practices of surgical hair restoration. Follicular Unit Transplantation (FUT) focuses on recognizing that the follicular unit is a discrete, anatomic and physiologic entity, and that preserving it through stereomicroscopic dissection is the best way to ensure the natural appearance of the hair restoration. Dr. Bernstein explains why this major step has brought hair transplantation into the twenty-first century.

This chapter also points out that the issues yet to be resolved in hair transplantation include determining the maximum density and number of grafts that can be used safely in a single session, deciding whether it is preferable to pre-make recipient sites or immediately place grafts into sites as they are made, and defining the precise role of Follicular Unit Extraction (FUE).

The authors conclude by stressing that the essence of providing the best care for hair transplant patients rests on proper patient selection, establishing realistic expectations, and using non-surgical management for young persons who are just starting to thin. When surgery is indicated, Follicular Unit Hair Transplantation is the ideal hair restoration procedure.

“To capture the art and practice of dermatologic surgery at the beginning of this century.”

It is to be used as the core surgical textbook for dermatologic training programs. The book is divided into four parts: Part I – Basic Surgical Concepts, Part II – Essential Surgical Skills, III – Aesthetic Surgical Procedures, and IV – Special Procedures.

The text covers a wide range of subjects on aesthetic surgery, including liposuction, chemical peels, Botox, soft tissue augmentation, laser hair removal, laser skin resurfacing, leg vein treatment, blepharoplasty, face lifts and, of course, hair transplantation.

Dr. Bernstein was honored to write the section on hair transplantation that covers the historical aspects of the field, patient evaluation and surgical planning, operating room set-up, surgical techniques and how to maximize the cosmetic outcome of the hair transplant.

The focus of Dr. Bernstein’s chapter is on Follicular Unit Transplantation, the technique that has changed the face of surgical hair restoration over the past decade. The chapter discusses strip harvesting, follicular unit extraction, the use of anesthetics, ways to optimize density and ensure the naturalness of the procedure, as well as a host of other important topics. The textbook may be purchased at Amazon.com.

Dr. Bernstein said the elements defining follicular unit hair transplantation include exclusive transplantation of hair in its naturally occurring individual follicular units…

Read the full article in the Hair Restoration Papers section of our website.