‘Donor Dominance. What a wonderful thing’
Going back a few generations if someone with balding was told that it was possible to have hair again which would look natural, feel natural, grow as normal, and could be styled to one’s hearts desires - the reaction would have been disbelief. Not anymore. Hair Transplantation has captured the imagination of everyone losing hair today and the number of procedures done worldwide is the highest it has ever been. There is a reason for this.
It all began in the 1960’s when a concept called ‘donor dominance’ was discovered. Hair in the frontal portion of the scalp are prone to loss on account of becoming ‘miniaturised’ by a hormone called Dihydrotestesterone (DHT). This hormone is present in both men and women but men are much more susceptible to its balding effects. The hair on the back of the scalp (the occipital region) however do not show this susceptibility to DHT induced loss. That is why most men and women never lose hair in this region . The truly wonderful thing is that when these DHT resistant hair are transplanted into areas that are DHT sensitive - like the frontal and crown area - they continue to be DHT resistant. This translates into these hair surviving for many decades - this is what makes hair transplantation possible.
That said the complaint with hair transplantation till the late 1990’s was that the results often looked unnatural since large ‘plugs’ or grafts were used to replace hair in the bald areas. Surgical advancement in the last two decades have made this a thing of the past.
Currently there are two main techniques used in Hair Transplantation - Folliclular Unit Transplant (FUT) and Follicular Unit Extraction (FUE). This might be hard to believe given the growing array of specialised names like Biostimulated FUE, Direct Hair Implantation, etc. being used by practices to market their services. All of these are just slight variations on either the FUT or FUE technique. Even Robotic Hair Transplant is just a modification of the FUE technique. So what is FUE and what is FUT? How do they compare and what are their advantages and disadvantages?
FOLLICULAR UNIT TRANSPLANTATION (FUT)
1 A ‘Strip’ of scalp is excised from back of scalp from which hair are individually sectioned and then implanted in the balding area. Also called ‘Strip Surgery’, this is an older technique and has been well established for the last two decades.
2. Stitches are required to close the wound left after the donor strip excision.
3. Does not require shaving of the scalp during surgery.
4. FUT is a faster technique. Surgery is completed in one day. Cost is often lower than FUE.
5. There is a linear scar left at the back of the scalp. In most cases this scar is very fine and hard to see but sometimes can be prominent.
6. There may be more discomfort during the recovery period than FUE. Stitches have to be removed after 7-10 days of surgery.
7. In cases of Grade VI or VII hair loss this is often the preferred technique since the donor area is very limited. This is especially true if the patient does not have good beard or body hair from where grafts can be harvested.
FOLLICULAR UNIT EXTRACTION (FUE)
1. Each hair follicle is extracted individually from the scalp using small instruments called punches. These are then implanted in the in the balding area. FUE is a newer technique and has gained popularity over the last 9-10 years.
2. No stitches are required. The small circular holes heal with minimal scarring.
3. Requires shaving of the scalp before surgery. If however a small number of grafts are needed small strips can be shaved separated by regions of normal hair which then hide the shaved areas after surgery.
4. Slower, more painstaking technique. Most surgeries can be completed within one day but when a large number of grafts are required surgery may be spread over 2 days. Cost is usually higher than FUT.
5. No linear scar. Small dot like scars are left after FUE which normally merge very well with the remaining hair and are not easily visible.
6. More comfortable recovery period. No stitches.
7. More suited to smaller areas of hair loss - very successful for levels upto Grade IV-V hair loss. Beard and body hair may need to be supplemented in cases needing more than 2000-2500 grafts.
As one can see each technique has its advantages. The two techniques are not mutually exclusive and when required can be combined to give optimum results.
Getting a hair transplant is a major decision, we understand that. That is why it is important to choose a qualified dermatologist or plastic surgeon to do your procedure. Cost should not be the dominant criterion in the decision making process - a person can only have a finite number of hair transplant surgeries in their lifetime given the limited nature of the donor area, so a failed hair transplant not only gives a poor aesthetic outcome but also decreases the donor hair available for a future transplant. The money invested in a good transplant will repay itself many times over in terms of quality of life.
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