Hair transplantation surgery has slowly evolved from the crude practice of moving unnatural clusters of hair to the modern standard of using exclusively follicular unit grafts. Hair restoration surgeons have always recognized that some hair on the scalp has a transient life cycle while other haired areas will sprout follicles that are resistant to the balding process. Sadly, many doctors fail to acknowledge that simply “moving" resilient hairs to areas of baldness, without respect to the graft type, can create an unnatural-looking hair transplant result.
For many years we have known that hairs grow in discrete groupings of 1-5 hairs. These structures are called “follicular units". Despite this knowledge, some methods of hair transplantation use larger grafts, such as square “plugs" and minigrafts, as the basic building block. Unfortunately, grafts that containing multiple follicular units will not grow in a natural fashion. The more hair clusters per graft, the greater the chance that growth will appear surgical. Result may vary from the subtly detectable to the overtly “pluggy."
The process of follicular unit grafting involves relocating donor hairs in a natural fashion while honoring the anatomical structure of the follicular unit. Donor area can be harvested via single-blade strip excision or via Follicular Isolation Technique (FIT). During a “strip" harvest an ellipse of tissue is cut from the donor site with a surgical scalpel. The tissue is then broken up into individual follicular units under microscopic controls. These units are placed into small incisions over balding and thinning scalp. During Follicular Isolation, follicular units are identified prior to removal and are harvested from the donor site one by one with a tiny surgical utensil. Similarly, the units are placed into small incision over the area of loss or thinning. While FIT does not create the linear donor scar associated with strip excision, both approaches can be used to exclusively manufacture follicular unit grafts.
Follicular Unit Transplantation, via strip excision or FIT, is a unique method of hair transplantation as grafted areas on the scalp can stand alone as complete after a single surgical session. The process honors the way hair grows in nature thereby producing a natural result even upon close examination. Unlike with other methods, additional surgeries are not required to “finish" sparse or pluggy areas. Patients can opt for additional surgeries, if they so desire, but they are not forced to do so as a result of detectably.
Follicular unit grafting has evolved beyond its pioneer stages and is widely, if not unquestionably held as the gold standard in hair transplantation. The superiority of these types of grafts is self-evident and their usage should no longer be in question. We would argue that the FIT harvesting of follicular unit grafts is superior to strip excision in terms of the donor scaring and yield. FIT technology, not unlike follicular unit grafting itself, presents a new set of challenges for physicians aspiring to deliver the best surgical results. Regardless of harvesting technique, the follicular unit graft is essential in creating an authentic appearance in hair restoration surgery. Quite simply, a more natural building block cannot be derived from the donor area.
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Some years ago when I was in my mid twenties I convinced myself that as my father and uncle had both lost
the fight against hair loss that I would soon be going the same way.
There was a lot of press around at the time about a new hair transplant procedure called 'micro grafting' where small groups of hair from the back and sides of the scalp, the areas where male hair is predetermined to grow for a lifetime are removed in small strips, dissected into small groups of between one and three hairs and inserted into the frontal hairline or other balding areas of the scalp with a scalpel.
I had seen some before and after pictures and this seemed like the answer to my young prayers so I signed on the dotted line
and underwent my first procedure of 1000 micro grafts.
The surgery went well apart from a few days of bruising and it was only a month or so before my new hair started to grow but that was when the implications really started to dawn on me.
Firstly, what I didn't realise was that to build a full hairline it cannot be done in one session as the hairs have to
heal before the gaps can be filled with more hair so you are left with a fairly reasonable hairline but one which is definitely distinguishable from the real thing.
Secondly, this meant having a second procedure which meant more money and more hair from the back and sides and that was only
to fill in the frontal area. What about in a few years when the rest falls out?
Now if you can imagine a ninety year old man who only has a small amount of hair left on the sides and back of his scalp there
isn't always going to be a lot of donor hair to use and can you imagine moving all the ninety year olds hair from the back and
sides and making a full head of hair? It's not going to happen is it?
So hear I am, some fifteen years later, growing my hair long and hiding the little islands which are growing in front of where my
hairline is now and wondering what I will do when eventually my hair decides it's time to leave for pastures new.
Sure, there looks like there are some impressive results these days with all the new hair transplant ads I see everywhere but as a post op hair transplant patient I can notice a mile off when someone has had a procedure and I think that much more thought should
go into the long term implications of acting on a whim when you are very young. Better to have a short hair cut and stop worrying than to always feel conscious of staring eyes.
Finally, if you are going under the knife. Make sure you go to a reputable company and get to meet some patients who can show you some before and after pictures and don’t be afraid to ask many questions and certainly look at their hairlines so you can see what a rebuilt hairline looks like so you are under no illusions about what is and is not possible from a hair transplant.
I hope this helps you come to a more informed decision about hair surgery.
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