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Hair Transplant Surgery and Follicular Unit Grafting

Hair transplantation surgery has slowly evolved from the crude practice of moving unnatural clusters of hair to the modern standard of using exclusively follicular unit grafts. Hair restoration surgeons have always recognized that some hair on the scalp has a transient life cycle while other haired areas will sprout follicles that are resistant to the balding process. Sadly, many doctors fail to acknowledge that simply “moving” resilient hairs to areas of baldness, without respect to the graft type, can create an unnatural-looking hair transplant result.
For many years we have known that hairs grow in discrete groupings of 1-5 hairs. These structures are called “follicular units”. Despite this knowledge, some methods of hair transplantation use larger grafts, such as square “plugs” and minigrafts, as the basic building block. Unfortunately, grafts that containing multiple follicular units will not grow in a natural fashion. The more hair clusters per graft, the greater the chance that growth will appear surgical. Result may vary from the subtly detectable to the overtly “pluggy.”
The process of follicular unit grafting involves relocating donor hairs in a natural fashion while honoring the anatomical structure of the follicular unit. Donor area can be harvested via single-blade strip excision or via Follicular Isolation Technique (FIT). During a “strip” harvest an ellipse of tissue is cut from the donor site with a surgical scalpel. The tissue is then broken up into individual follicular units under microscopic controls. These units are placed into small incisions over balding and thinning scalp. During Follicular Isolation, follicular units are identified prior to removal and are harvested from the donor site one by one with a tiny surgical utensil. Similarly, the units are placed into small incision over the area of loss or thinning. While FIT does not create the linear donor scar associated with strip excision, both approaches can be used to exclusively manufacture follicular unit grafts.
Follicular Unit Transplantation, via strip excision or FIT, is a unique method of hair transplantation as grafted areas on the scalp can stand alone as complete after a single surgical session. The process honors the way hair grows in nature thereby producing a natural result even upon close examination. Unlike with other methods, additional surgeries are not required to “finish” sparse or pluggy areas. Patients can opt for additional surgeries, if they so desire, but they are not forced to do so as a result of detectably.
Follicular unit grafting has evolved beyond its pioneer stages and is widely, if not unquestionably held as the gold standard in hair transplantation. The superiority of these types of grafts is self-evident and their usage should no longer be in question. We would argue that the FIT harvesting of follicular unit grafts is superior to strip excision in terms of the donor scaring and yield. FIT technology, not unlike follicular unit grafting itself, presents a new set of challenges for physicians aspiring to deliver the best surgical results. Regardless of harvesting technique, the follicular unit graft is essential in creating an authentic appearance in hair restoration surgery. Quite simply, a more natural building block cannot be derived from the donor area.

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About the Author: John P. Cole, MD, chief surgeon and founder of IHTI, has been involved in hair transplant surgery for over 16 years.During that time he has been intimately involved in the development of cutting edge technology and tools.

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