Follicular unit transplantation

Follicular Unit Transplantation

Follicular Unit Transplantation is a modern hair restoration technique where the hair is transplanted in groups of 1-4 hairs – exactly as it grows in nature. It is a major advance over the older hair transplant procedures that used larger grafts and often produced a pluggy, unnatural look. In a properly performed follicular unit transplant, the results will mimic the way hair grows in nature and will be undetectable as a hair transplant.

History

The first hair transplant in the United States was performed by Dr. Norman Orentreich in the late 1950s. He proposed the concept of “donor dominance” – the idea that grafts continue to show the characteristics of the donor site after they have been transplanted to a new site. This principle provides the basis for all hair transplant surgery. Although “donor dominance” insured that transplanted hair will continue to grow, it did not insure that the results would look natural.

The initial hair transplants used grafts that measured 6 to 8 mm in diameter, about the size of pencil erasers. These were obtained from the back of the scalp by literally punching out the hair bearing grafts with a sharp, round instrument and then placing them in holes made in the balding front-part of the scalp. The results of this punch-graft technique were often “pluggy” and unnatural and was referred to as a “doll’s head” or “corn-row” look.

To improve upon the appearance of these earlier procedures, doctors developed the technique of mini-micrografting where the donor hair was obtained by removing multiple, thin strips of tissue from the back part of the scalp. This was subsequently cut into different size grafts. The larger pieces, containing from 4 to 12 or more hairs (mini-grafts), were used to create fullness. The smaller grafts of 1-3 hairs (micro-grafts) were used at the hairline. This procedure, called mini-micrografting, gained popularity in the 1980s and became the standard way hair transplants were performed through the mid-1990s. Although much improved over the punch-graft techniques, the results were still not completely natural.

Follicular Units were first described in the medical literature by Headington in 1984. [1] Follicular Unit Transplantation has its roots in the single-strip harvesting method and microscopic graft dissection technique developed by Dr. Bobby Limmer in the late 1980s and published in 1994. [2]

The conceptual framework for Follicular Unit Transplantation was introduced into the medical literature by Drs. Robert Bernstein and William Rassman in their 1995 paper “Follicular Transplantation.” [3] The procedure was further detailed in their paired articles, “Follicular Transplantation: Patient Evaluation and Surgical Planning” and “The Aesthetics of Follicular Transplantation” (1997). [4, 5] The concept was further elaborated upon in the 1999 publication “The Logic of Follicular Transplantation.” [6]

By the year 2000, Follicular Unit Transplant (also referred to as FUT) was firmly established as the state-of-the-art due to its ability to produce total natural results. However, because the procedure was more labor intensive and time consuming than mini-micrografting, it was adopted slowly by the medical community. A major impetus to the development of the procedure was consumer demand expressed on the internet and through consumer advocacy programs.

References

1. Headington JT. Transverse microscopic anatomy of the human scalp. Arch Dermatol 1984; 120:449-456.

2. Limmer BL. Elliptical donor stereoscopically assisted micrografting as an approach to further refinement in hair transplantation. Dermatol Surg 1994; 20:789-793.

3. Bernstein RM, Rassman WR, Szaniawski W, Halperin A. Follicular transplantation. Intl J Aesthetic Rest Surg 1995; 3:119-132.

4. Bernstein RM, Rassman WR: Follicular transplantation: patient evaluation and surgical planning. Dermatol Surg 1997; 23:771-784.

5. Bernstein RM, Rassman WR: The aesthetics of follicular transplantation. Dermatol Surg 1997; 23:785-799.

6. Bernstein RM, Rassman WR: The logic of follicular unit transplantation. Dermatologic Clinics 1999; 17(2):277-295.