29 - Follicular Unit Hair Transplantation

Abstract

• Follicular unit transplantation (FUT) is a method of hair restoration surgery that relocates hair in follicular units, its naturally occurring groupings. The small size of the units allows for tremendous versatility in their placement, the creation of hair patterns that closely mimic nature and the transplantation of a large enough number of grafts so that a full restoration can often be achieved in just one or two sessions. • Follicular unit transplantation requires large numbers of grafts, so it is important to accurately assess patients‘ donor reserves in the initial planning. Densitometry enables the physician to estimate the total amount of movable hair, the size of the individual follicular units, and the degree of miniaturization in both the donor and recipient areas; scalp laxity assessment is also crucial to the surgical planning. • Great care should be taken to screen for patients who are too young or whose hair loss may be diffuse, making the donor supply inadequate for a hair transplant. • Identifying androgenetic alopecia often proves difficult in women as other medical conditions can have a similar presentation. Options for medical treatment are more limited in women and many experience diffuse hair loss, a relative contraindication to surgery. • Determining the right size and location of the donor strip maximizes the yield and prevents problems such as widened and/or visible scars. • The follicular units obtained from donor strips are delicate structures. Careful dissection, gentle handling, and adequate hydration are essential to their survival. In order to dissect and place the thousands of grafts often required in FUT, the surgical team must be proficient in stereomicroscopic dissection and insertion techniques—skills that can take a year or more to develop. • Follicular unit transplantation requires an astute aesthetic sense for optimal hairline design, correct angling and distribution of grafts and the establishment of a master plan that anticipates further hair loss and is consistent with the long-term goals of the patient.