Conditions & Diseases: Hair Loss & Hair Loss Treatment (Surgical & Non-Surgical)

Follicular Units & Follicular Unit Extraction

Follicular Units is a term that you will read and hear a lot about if you are seeking a hair transplant. Two anocronyms that go along with this are FUT (Follicular Unit Transplantation) and FUE (Follicular Unit Extraction).

FUT - Follicular Unit Transplantation

The definition of a follicular unit is a group of 1 to 3 hairs that grow naturally together. The follicular unit also includes one to two fine hairs known as vellous hairs, glands, muscle, nerves and blood vessels. By keeping the transplanted micrografts to the size of a naturally occuring follicular unit, hair transplant doctors are able to provide hair restoration that is natural looking and undetectable.

To accurately reproduce a hair line, doctors will implant single hair follicular units in an irregular pattern in the front. Hair lines do not start suddenly as you might see from a wig or hair piece. Hair lines start gradually with single hairs in un-even line. Doctors replicate this natural occurance to produce a new hair line that is undetectable. A few centimeters in from the hair line, doctors will implant larger follicular units to provide more density.

Follicular unit hair grafting is standard procedure for all hair transplant clinics in the United States as it offers the most natural looking results.

Follicular units are extracted by two methods. In the most common and traditional method ( called strip excision or single strip harvest) a strip of hair approximately 10 to 20 cm long is removed from the donor area (back of the head below the ears) and is then divided and cut into follicular units under a microscope. A newer method that is gaining popularity is the Follicular Unit Extraction method.

FUE - Follicular Unit Extraction

In this new method first pioneered 1990s, each follicle of hair is removed from the donor area individually by using a small punch-like circular scalpel. These grafts are then implanted into recipient slits in the balding area.

"There has been debate regarding the scarring left at the donor site by harvest of FUs. Single-strip harvest leaves a single, fine incision that usually heals in a few days. Follicular unit extraction (FUE) leaves small holes 1 to 2 millimeters in diameter at the site of FU extraction. These holes are not stitched but are rather left to heal on their own. Proponents of the FUE procedure claim decreased or complete lack of scarring but others have cautioned that in some patients these extraction sites may leave dimpled white spots similar to a golf ball." (1)

Doctors still skeptical of this new method have outlined several drawbacks compared to single strip harvesting.

1. FUE requires more time to harvest less grafts and thefore is very time consuming. This can mean increased costs for the patient.
2. Because fewer grafts can be removed at one time, patients might have to undergo more procedures as opposed to the large hair transplant sessions of 1500+ grafts that single strip harvesting can provide.
3. Another limitation of Follicular Unit Extraction is that it can't provide as much donor hair as Follicular Unit Transplantation. Because Follicular Unit Extraction only removes the hair follicles, as opposed to a strip that can be closed up with stitches, some of the intervening donor hair must be left behind to cover the scalp, or there will be a bald area where the grafts were taken. Additionally, the procedure itself takes a long time. (2)

However, there are doctors that think FUE has a role to play in modern hair transplant surgery. Patients who only require a small amount of grafts or have poor elasticity in the donor area are excellent candidates for FUE. FUE is also ideal for eyebrow or facial hair transplants. Men who like to keep their hair short in the back make great candidates. Traditional single strip harvesting leaves a thin scar that can only be covered by hair half an inch or longer.

The other major group for whom this technique is appropriate is people who have had a lot of prior transplant surgery that has left bothersome scars. As Dr. Unger explains, follicular unit extraction allows the doctor to work around the scars and select individual follicular units. (2)

Potential patients considering hair transplantation should inquire during consultation whether their doctor specializes in single strip or FUE harvesting. When it comes to either method, patients should use caution when selecting a hair transplant doctor and educate themselves beforehand.

Further Reading:
Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation
Rassman W.R.; Bernstein R.M.; McClellan R.; Jones R.; Worton E.; Uyttendaele H., Dermatologic Surgery, 1 August 2002,

Sources:
(1) International Society of Hair Restoration Surgeons
(2) Source: A Scar-Free Technique for Hair Transplantation: Christine Haran, Healthology.com

Article by Staff
OmniMedicalSearch.com

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