come a long way since it began in the early 1950s. In 1939, a Japanese dermatologist, Dr Okuda, published details in a Japanese medical journal of a revolutionary method of using small grafts that was similar to the way Hair Transplantation
is performed today. In the late 1950s, one physician in particular b
egan to experiment with the idea of transplanting hair from the back and
sides of the head to the balding areas. 'Donor Dominance' establi
shed that hair could be transplanted from the bald-resistant donor areas
to the balding areas, and that it would continue to grow throughout the
recipient's lifetime. This laid the foundation for modern
During the 60s and 70s Hair Transplants grew in popularity
- however this involved the use of larger grafts that were removed by
round punches and often contained many hairs. The problem with
this method was that there had to be a minimum of 4 procedures for the
final results to be noticeable, and therefore patients who underwent this
type of Hair Transplantation usually gave up by the second procedure, for
In the 1980s, Hair Restoration surgery evolved dramatically as the large punch grafts were gradually replaced with a more refined combination
of Mini and Micrografts. This 'combination'
Mini-micrografting Hair Transplantation procedure no longer used a punch
to extract the bald-resistant grafts. Instead a strip of bald-resis
tant hair was surgically removed from the back of the head and then
trimmed into mini and micrografts. Typically the minigrafts (4-8) hairs were used to create fullness and density, whilst the one, two and three hair micrografts normally used more grafts - several hundred grafts per session, rather than
the approx 50-200 large grafts of the original punch graft procedure.
1990s saw a gradual use of the creation of a refined and feathered
hairline in the front. This combination procedure also introduced a
very refined surgical procedure now known as 'Follicular Unit Hair
Transplantation' or 'FUT', by Drs Limmer, Bernstein and
Rassman. This exacting and labour intensive procedure transplants hairs in their naturally occurring 1,2,3 and 4 hair 'Follicular unit groupings' in
which they grow naturally.
'Follicular Unit Extraction' or 'FUE', by
Dr True, is a Hair Transplantation technique in which a small round punch
is used to extract follicular units from a patient's bald-resistant donor
These 1,2,3 and 4 hair follicular unit grafts are then
transplanted into the patient's balding areas.
Given the time consuming
and tedious nature of this procedure a surgeon is often limited to
transplanting 1000 follicular units grafts in one day, The donated
hair follicles, surrounding tissue and skin, are called 'Follicular
Units'. Each Follicular Unit contains one or more hair follicles
with accompanying hair, tissue and skin The art of Hair Transplanta
tion is as important as the mechanics of this medical technique - and it
is very important to remember that no two heads are alike, and each
procedure should be looked at on an individual basis. Hair density is
the number of hair follicles per square centimetre of scalp. Scalp laxity
constitutes the flexibility or looseness of the scalp and the more
flexible the scalp the easier it is to harvest donor follicles.
ely, the tighter the scalp the more difficult it is not only to harvest
donor hair, but also to close the donor area after excision. More
hair can be transplanted if the scalp is loose and the density is high.
IS FOLLICULAR UNIT TRANSPLANTATION?|
Unit Transplantation' (FUT) is
a technique in which hair is transplanted from the permanent zone in the
back of the scalp into areas affected by genetic balding, using only the
naturally occurring, individual follicular units. In order to re
move follicular units from the back of the scalp without damaging them,
the donor tissue is removed in one piece. This technique, called 'Single
Strip Harvesting' is an essential component of Follicular Unit Transplantation, as it not only
preserves the follicular units, but it prevents damage (transection) to
the individual hair follicles. It differs dramatically from
the 'Mini-Micrografting' technique of using a multi-bladed knife that
breaks up follicular units and causes unacceptable levels of transection
of hair follicles.
The other harvesting technique, 'Follicular
Unit Extraction' (FUE), allows the surgeon to remove indivi
dual follicular units without a linear donor incision. The most essential component of
Follicular Unit Transplantation is 'Stereo-Microscopic Dissection'.
In this technique all of the follicular units are removed from the d
onor tissue under microscopic control to avoid damaged. Comp
lete steroe-microscopic dissection has been shown to produce an increased
yield of both the absolute number of follicular units, as well as the
total amount of hair (upwards of 25%). This procedure differs from Mini-Micrografting in which the grafts are cut with no microscipical magnification.
A major advantage of Follicular Unit Transplantation (besides preser
ving follicular units and maximising growth) is the ability to use small
recipient sites. Grafts comprised of the individual follicular units
are small because follicular units are themselves small, but also become
surrounding non hairbearing tissue is removed under the microscope and
does not need to be transplanted.
Follicular unit grafts can be inserted into tiny needle-sized sites in the recipient area, which heal in just a
few days without leaving any marks.
performed by a skilled surgical team, Follicular Unit Transplantation can
provide totally natural looking Hair Transplants that make the full use of
the patient's donor supply to give the best possible cosmetic results in
the fewest possible sessions!
DOES FOLICULAR UNIT HAIR TRANSPLANTATION DIFFER FROM MINI-MICROGRAFTING?|
This is one of the most commonly
asked questions, and it is a very important one for those deciding which
Hair Restoration procedure to choose. In contrast to Follicular
Unit Transplantation, where the follicular unit sizes are determined by
nature, in Mini-Micrografting the graft sizes are arbitrarily determined
by the assistants who cut the donor tissue into the sizes of pieces they
Another name for this technique is 'Mini Micrografts cut to
In Mini-Micrografting, neither preserving follicular units nor even
keeping hair follicles intact are considered to be of great importance.
ead, the speed and economics of the procedure are the deciding factors.
ters use a multi-bladed knife or a single-bladed knife to quickly generate
thin strips or a strip of tissue, and then use direct visualisation or
back lighting (rather than microscopic control) to cut the tissue. The resulting grafts are generally larger than follicular units and since the excess skin is not trimmed away the donor sites
(wounds) are also larger - or the follicular units are trimmed under
backlighting but the hair shafts or the hair bulb of the follicular unit
are trans-sected due to poor visualisation - and therefore the final
results are poor. It should be readily apparent from the above comparison that Follicur Unit Transplantation is far superior in producing a natural, undetectable result, in maximising healing, and preserving precious
HAIR TRANSPLANTATION PROCEDURE
On arrival at the Hair Transplant clinic in Budapest, prior to your surgery
the transplant staff will begin by going through and explaining everything
that is going to happen throughout the procedure.
The Hair Transplant
surgeon will review the goals that have been established and will answer
any last minute questions that the patient might have. The surgeon
will take the time to ensure there are no outstanding issues, areas of
confusion or concerns. The surgical consent form is signed, followe
d by the taking of pre-treatment photos. Mild medication is given to relax
the patient and to make him/her feel more comfortable. Routine antibiotics
are also given before and after the procedure.
OF THE HAIR TRANSPLANT PROCEDURE
The Folllicular Unit Transplant may require many hours of work by
a team of very experienced professionals. Some of the longest proced
ures (between 2000-2500+ follicular units) may take hours of surgery and
during that time many highly trained members of the transplant team will
participate in the process. The work must be organised efficientl
y so that the total length of the procedure for the patient will be
minimised. On average, a procedure of 1000 follicular units would
take approximately 6 hours.
The procedure may be long, but from the patient's point of view the time does pass
quickly! Light sedation is administered so that the patient can, if h
e or she wishes, sleep through it. Most though choose to watch TV an
d/or films for at least part of the time. Everything is done to make
your experience a pleasant one, so that the actual time the surgery takes
is transparent. However, some patients may prefer to be fully a
wake throughout the entire procedure.
Usually the patient will sleep for a few hours, watch a film or two, and also chat to the Hair Transplant
surgeon and nurses. A relaxed and informal atmosphere is encourage
d so that the day stands out as one of the better and more pleasurable
experiences ever encountered! The patient takes a series of breaks -
for lunch - or just to stretch and move around.. Often patients report that being the centre focus of the day's activities is really very enjoyable - and further report that watching all the members of the surgery team working on them was like watching an orchestra playing beautiful music
whilst having their every need catered for!
ANAESTHESIA FOR HAIR TRANSPLANTATION
After preparatory medication is given orally, the actual anaesthesia
is administered. A combination of Lidocaine (Xylocaine), which you have
probably been given by your dentist, and a longer acting local anaesthetic
called Marcaine is used. Injections around the perimeter of the
scalp (called a ring block) will make the entire scalp numb. With this
technique, there is no need to use anaesthesia directly in the area that is
being transplanted. Once anaesthetisation is complete, there is generally no
pain or discomfort during the remainder of the procedure. If further
anaesthetic is required, it will be given before the first wears off.
SURGICAL HAIR TRANSPLANT TEAM
The procedures can be long, and during the initial period when the donor
hair is removed, the surgical team must work without stopping. The team must prepare the grafts according to the surgeon's exacting
specifications. The preparation of 2,000 or more follicular units and placing
them into the recipient area may take a team hours of intensive, concentrated
work. Care must be taken to keep the surgical team free of stress.
Just as the
patient needs a break, so do team members. It is
important to focus on the needs of the transplant team, as well as those of the
patient to ensure that the best-trained staff in the world is always operating
at peak performance.
After a strip of donor scalp is removed, it is temporarily placed into a
container with chilled Lactated Ringer's, a solution that closely mimics the
body's own natural fluids. The area from where the donor strip is removed is
sutured and closed. This usually leaves a very fine scar that heals within 1-2
weeks and the sutures are removed during this time.
Ideally, the scar may heal so well that it is almost undetectable even
when the hair is combed back by a barber or hairdresser. After the tissue has
been harvested, the individual follicular units (each containing from 1 to 4
hairs) are meticulously dissected out in their naturally occurring groups under
strict stereo-microscopic control. The follicular units are trimmed of extraneous fatty tissue, and the
bald intervening skin between the groups is discarded. The isolation of
individual naturally occurring follicular units, that were obtained from the
donor area as a single strip and then carefully dissected under microscopic
control, is an essential part of Follicular Unit Hair Transplantation. If this
step is not carried out correctly the follicles can be injured and growth
impaired. It is important that these steps be carried out only by a highly
experienced surgical team.
LENGTH OF TIME THE GRAFTS ARE AWAY FROM THEIR BLOOD SUPPLY
A number of hours may elapse between the time the donor follicular units
are removed from the back of the scalp to the time they are placed into the
recipient area. Great care must be taken to preserve the viability of the
follicular units during this process. The procedure starts with the removal of
a strip of scalp from the donor area. Once the strip is removed, it is
immediately immersed into a cold bath of Lactated Ringer's saline to lower its
temperature. Once the individual follicular units are prepared, they are cooled
to 3.8-4.0C and kept at this temperature while awaiting placement.
DURING THE HAIR TRANSPLANT PROCEDURE
Many people are under the impression that Hair Transplantation
is a 'bloody' procedure. However, in the hands of an experie
nced specialist Hair Transplant surgeon and his expert team, this is most
definitely not the case! Surgical techniques have been developed and
put into practice at the Hair Transplant clinic in Budapest that greatly
minimise the amount bleeding throughout all stages of the procedure.
The surgical team wears masks, surgical gloves, and gowns and uses
instruments that are sterile.
The procedure is performed while the patient sits
in a comfortable, adjustable reclining chair. For added comfort the hair
Transplant suites are equipped with music, TV, and an assortment of films.
After the local anaesthesia is administered, the patient should feel nothing
other than pressure sensations. Many patients have long and chatty conversations
with the Hair Transplant specialist and assistants during the time it takes to
complete the transplant. The atmosphere in the treatment area
will make the patient feel very secure and relaxed. Concern and compassion on
the part of the doctor and medical staff make a tremendous difference and they
always make a great effort to ensure that the patient’s experience is a
THE RECIPIENT SITES
The creating of the recipient sites
determines much of the aesthetic look of the transplant - it determines the
angle at which the new hair grows and also determines the distribution and
density of the follicular units. This is a very important part of the procedure
and requires considerable artistic knowledge and surgical skill. It may be the
one part of the procedure where your Hair Transplant specialist is completely
silent as he concentrates on creating these sites. Don't be concerned if he isn't
chatty during this time! Your Hair
Transplant doctor is well used to working in, and around, existing hair
so there is no need to cut your hair short for the procedure. Your existing
hair may help to cover any traces of the transplant.
PLACEMENT OF THE NEW GRAFTS
The placing of the new grafts is the longest part of the
placement process is exacting and during this time the patient will be asked to
keep his or her head relatively still.
Watching TV or a film, or even sleeping
will make the time pass quickly. Breaks can be taken as needed to eat or drink
something, or just to stretch the legs. When placing is complete, post-op
instructions are given both verbally and in writing. A baseball cap is placed on
the head and is worn to leave the clinic.
THE HAIR TRANSPLANTATION PROCEDURE
On the night of surgery, and for the next few afterwards, patients are
encouraged to sleep with their heads elevated on pillows. Medication will be
given, if needed, to aid sleep. Patients return to the clinic the following day
for hair washing and instructions how to shower and gently clean the
transplanted area. The follicular unit grafts are made to fit snugly in the
recipient site and will not be dislodged in the shower provided the
instructions provided are followed. If the post-operative
instructions are followed carefully, the transplant is, in most patients,
barely detectable after a few days and practically undetectable after the first
Patients are given medication for swelling,
but in spite of this some do, over the following few days, experience swelling of the forehead that
settles around the bridge of the nose. If this does occur, it almost always disappears on the
5th day after the surgery and should not be a cause for concern.
Frequently, the newly transplanted follicular
units can be made less noticeable by minor changes in hair style to cover the
area. Makeup consultants can help in choosing the appropriate shade and type of
makeup. Any problem of visibility can also be minimized by altering the
appearance of the face. If shaving is left for a while, most people will focus on
a new beard, and not on the head! For those having a moustache or beard, consider removing it for the first few
weeks and then letting it grow back.
Linda Briggs® Ltd © Cosmetic Surgery Abroad | page last updated 11 February 2016