Follicular units are distinct groupings of usually one to four terminal hairs.The follicular unit is thus a naturally occuring physiologic, as well as an anatomic entity.

Patient (KM) received 2300 grafts to his hairline, frontal area, and fronto-temporal corners using the FUE (Follicular Unit Extraction) method.  After photo was taken at 6 month follow up.

Patient (KM) received 2300 grafts to his hairline, frontal area, and fronto-temporal corners using the FUE (Follicular Unit Extraction) method. After photo was taken at 6 month follow up.

Follicular unit transplantation offers the surgeon the ability to transplant the maximum amount of hair with the minimum amount of non-hair bearing skin.

In this way, recipient wounds are kept small, healing is facilitated, and with proper technique, large numbers of grafts may be safely moved per session. The use of these units helps to ensure that the cosmetic result of the transplant will appear completely natural.

In contrast to follicular units, micrografts (1-2 hairs), and mini-grafts (3-6 hairs), are small grafts cut randomly from donor hair, not specifically as individual intact follicular units. These multiple units will contain extra skin that will demand larger recipient sites, which, in turn, causes more wounding to the recipient bed and may limit the number of grafts that can safely be transplanted in a session.

Although, it is hard to argue the superiority of the follicular unit technique in theory, in practice, follicular unit transplantation is tedious, demanding on the physician and staff, and requires a relatively high degree of expertise to be properly performed. Dr. Wasserbauer has been fellowship trained in this surgical technique and is skilled in both the surgical and technical tasks.

The evolution of microscopic dissection and follicular unit transplantation has been that this procedure can be practical for other parts of the body including eyebrows and eyelashes. It has also become much more viable as an alternative for female pattern hair loss which is usually more diffuse.

The Hair Transplant Procedure

Hairs on the sides and the back of the head are not affected by male patter baldness. As a result a hair transplant surgeon can remove donor hair follicles from the sides and back and relocate them on the top of the scalp where hair loss has occurred and the newly transplanted hair will grow exactly as it had from the donor region.

Before beginning a hair transplant your physician will review several important concerns:

  1. Are you in good general health?
  2. Do you have any bleeding or healing disorders?
  3. Your age and degree of hair loss.
  4. The quality and quantity of your donor hair.
  5. What is your ultimate cosmetic goal?

These are some of the most important issues in deciding whether someone is a suitable candidate for hair transplantation.

The first step in the hair transplant process is the design of the hairline. The surgeon will sketch a suggestion for placement of the hairline. You are encouraged to participate in this decision process.

Donor Area

Safe Donor Area diagram from Walter Unger, MD

Next the donor area is prepared. Hair in the back is lifted and a narrow strip of hair is trimmed. The hair from above will cover the area. Both the top and the back of the scalp is then anesthetized. Patients are given the option for Nitrous Oxide (laughing gas) while the local anesthesia is applied. This is usually the only discomfort you will feel during the procedure, and lasts only one or two minutes.

Narrow strips are removed from the donor area and the hair from above and below are brought back together with a simple running stitch. The stitches are covered by your hair and removed in one week to ten days, leaving a fine scar line that is concealed by your on hair. (It is important to note that if you shave your hair in the donor area the scar line may show.)

An alternative procedure for acquiring donor hair is Follicular Unit Extraction or FUE. Follicular Unit Extraction (FUE) also takes grafts from the back and sides of the patient’s head individually. Depending on how the patient prefers it, you can either shave the whole head or small “micro-strips” can be shaved for optimal camouflage – but some level of shaving has to be done because the hair has to be short for effective removal.

From the donor strip naturally occurring Follicular Units, usually groups of 1-3 hairs, are separated under a microscope to preserve every follicle.

The surgeon next creates the sites where the grafts will be placed. Tiny incisions are made at the hairline for the smallest 1 to 3 hair grafts. As the surgeon works back he will place gradually larger grafts containing Follicular Unit Groups. This allows your surgeon to accomplish more density without sacrificing naturalness. During the entire procedure you will be alert; watching TV and chatting with the doctor and staff. Procedure time is usually between 3 to 6 hours and you may eat or drink during the procedure.

When your hair transplant has been completed you will be provided with post-operative instructions, medicines and shampoo. You will leave the office with a little or no bandage and will be able to shampoo your hair the next day.

Most patients resume normal activity in a day or two. Tiny crusts will form where the transplants have been placed and usually shed in 4 to 7 days. The small hairs in the newly transplanted grafts normally shed within 2 to 4 weeks after the procedure, and permanent hair growth begins in 8 to 12 weeks. You should expect significant cosmetic hair growth with in 6 months and full hair growth within 9 to 12 months.

Most patient’s can be satisfied with one or two procedures to treat a specific area of hair loss. If further hair loss occurs additional procedures may be required.

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