FOLLICULAR UNIT TRANSPLANTATION

Hair Restoration

Hair restoration surgery has evolved greatly since its introduction more than 40 years ago. After four decades of evolution, possibly the most important advancement in hair transplantation today is the recognition of follicular unit. Follicular units are distinct groupings of one to five follicles. Every follicular unit contains 1 to 5 follicles, sebaceous glands, arector pili muscle, neuro-vascular plexus and is surrounded by perifolliculum.

As you know, the ideal goal of hair restoration include natural hair distribution, direction and adequate density , no-line hairline, invisible recipient scar and invisible donor scar. 


Nowadays, to avoid tufting appearance in scalp hair restoration, two kinds of grafts, including follicular unit grafting and mix grafting can be used. The first is follicular unit grafting which means hair restoration with implantation of naturally occurring follicular units as the basic graft. 

          

The second one is combined grafting with a mix of single and coupled follicular unit grafts. 

                                 

I routinely use follicular-unit graft at hairline and in patient with coarse donor hair, or high skin-hair color contrast, or in patients who has extremely low donor hair density and in patients who insist on absolute undetectability as recommended by Dr. Beehner.

My personal indication of mix grafting include very fine donor hair, megasession or patient’s economic consideration.

 

 

 



↑Top Patient Evaluation

At outpatient clinic, We evaluate patient’s condition and properly select patients. Then propose our surgical plan which also related to the possibility of future session.

We routinely evaluate the bald surface area and estimate the required amount of the grafts. Then,we check donor-site hair with microscope. And according to data of the hair count , follicular unit count, we decide the surface area to be harvested. Generally, in each square centimeter , we can prepare 50 to 80 follicular unit grafts.

                       


Surgical Procedure

During perioperative period, IV sedation is given . Regional supraorbital block and tumescent local anesthesia to the recipient site and donor site are performed. We then carefully dissect the strip and trim the wound edge about 2 mm so that regrowth of hair from buried follicles can camouflage scar.

                   

Occasionally, incision-beveling technique was also used alternatively. The donor wound is then closed in single superficial layer with 3-0 monocryl followed by stapler suture.

Microscopic graft dissection is our routine procedure. We use Mantis and Meiji microscope for this procedure. The stereomicroscope with its 6~10x magnification can provide the best visualization for the dissectors.

       

Microscopic dissection is quite helpful for saving hair follicles , especially in patients with white donor hair.

After donor harvesting, the scalp strip is separated into multiple narrow strips which are cut into follicular-unit grafts or coupled follicular-unit grafts.

At the recipient site of scalp, we use Minde knife or sharpoint blade to create incisional wounds .

There are 5 kinds of implantation methods. I prefer separate blade slit and graft placement.

Under surgical microscope with 4 to 10 times magnification, the recipient incisions are made carefully. 
As recommended by Dr. Woods, I adopted surgical microscope in creation of recipient incisions in 2002 .There are some advantages such as less injury of the surrounding existing hair follicles, more delicate and precise recipient incisions and providing high-power magnification if necessary and the operator can performs surgery in more comfortable position

All incisions are at right angles to hair direction. This is so-called lateral slit technique which was invented by Hasson and Wong , who make slits in the coronal rather than the sagittal direction and believe the shingling effect of regrowed hair can enhance hair coverage and naturalness      

              shingling effect 

recipient incisions


 In mix grafting, we make 20~30 incisions / cm².And in  follicular unit grafting, 35~40 incisions / cm² are made in order to achieve about 40 to 50% of the original donor density.


 

This micropicture shows regrowed hair after lateral slit procedure.

Then grafts are placed into each individual recipient incisions with microforceps. We usually finish a procedure within 4 to 6 hours for 1000 to 2000 grafting Procedure.

Postoperatively, I encourage patient to take propecia or topically apply minoxidil to prevent progressive hair loss.

Preoperative and postoperative picture

 

There are some potential complications, which may be associated with hair transplantation. The most common cause of poor hair regrowth is Follicle damage, which usually happen during preparation of the grafts as a result of dehydration. Follicle damage may also occur during insertion of the grafts because of rough handling.


 

In summary, based on our limited clinical experience, we found that the current surgical techniques have upgraded our surgical result. And we believe professional team approach and delicate technique are the key points to achieve successful hair transplantation.

 


↑Top Postoperative Guides

Here are some important postoperative guides:
1.Open care is used. No dressing on the head. Patient can wear hat or hair piece.

2.Forhead swelling may occur and may last 5 days. It subside on 6th or 7th day. Therefore, 5~6 days rest during the swelling period may be necessary.

3. Smoking should be quit during perioperative period -- 1 week before and after operation.

4. The crusts on recipient sites fall off 2~3 weeks after operation. If you are bothered by these crusts, some concealers can be applied.

5. The new hairs will start to grow about 3~5 months later and optimal cosmetic result can be seen in about 8 to 9 months. The regrowing hairs can have a nomal hair(follicle) life cycle and last through your life.

 

 

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