Confused about how to treat hair loss or cover bald area or is the FUT is the best method for me? Lot of questions come into the mind & you have the right to get the answers to all your queries. Dr. Sandeep Bhasin the Sr. Cosmetic Surgeon offers FUT in Delhi at his clinic situated in South Delhi. Best package/cost is offered for FUT in Delhi with best results post FUT surgery.
Follicular Unit Transplantation (FUT) is a hair implantation procedure, known for its natural looking results. It is a minimally invasive treatment in which surgeons transplant hairs in naturally occurring groups, known as follicular units. Each follicular unit comprises of 1 to 4 hairs. The units also possess tiny muscles, nerves, sebaceous (oil) glands, and fine vellus hairs.
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In FUT procedure, surgeons transplant thousands of grafts from the donor sites to the recipient regions. It all happens in just one session, thus, maximises the cosmetic effect of the medical treatment. Prior to treatment, patients are provided with local anaesthesia, which reduces their pain and discomfort. FUT technique enables surgeons to cover large areas and provides effective results.
Every individual has different hairs, in terms of texture, quality, and even genes. Such differences call for personalised approach to plan an appropriate procedure. In order to devise the best treatment, surgeons need to have good understanding of the type, nature and form of hairs of the candidate. They also need to be aware about the root cause of hair fall. And they do so by consulting the patient and suggesting the following steps:
Hair transplantation demands physical examination of hair. Through the physical tests, surgeons or dermatologists observe the type, placement, calibre, and density of hairs. They also get an idea about the total bald area to be covered by micrograft. Modern dermatologists use two different scales to measure the suitability of replacing micrografts of hairs. The Norwood scale is used to examine men hairs, whereas, the Ludwig scale is specifically used for assessing women hairs.
In the hair transplantation procedure, surgeons extract hair from the donor site of the patient and place it into the recipient site. The thickness and density of donor hairs are very important. Thicker donor hairs are more preferred, since it covers maximum baldness with minimum hairs.
According to expert surgeons, hair density of 60 to 100 follicular units per sq. cm. is most suitable for FUT. Those having less than 40 follicular units per sq. cm. are not eligible for this treatment.
The density of donor hairs also determines the number of hair follicles that are available for grafting and implantation.
It is also important to know the hair loss background. Surgeons ask various questions like:
The answers to such questions give them a fair idea about the probable causes behind the hair loss pattern. They also try to understand if the candidate has suffered a loss of hair calibre during adolescence or in their 20s. If so happens, then they are more likely to lose hairs earlier than those facing hair thinning issues in their 30s or maybe 40s.
Knowing such details help the dermatologists to gather good knowledge and information about the case history of the candidate. In this step, they also try to predict the result of hair replacement procedure. Usually, the degree of hair replacement depends on the number of transplanted hair follicles and the hair density achieved, in comparison to the progressive rate of hair loss, in the treated region.
In the last consultation sessions, surgeons discuss suitable medications. While transplanting hairs, its equally important to preserve the upcoming hairs of the recipient sites. To meet this requirement, most dermatologists prescribe minoxidil or finasteride courses to reduce further loss of hairs from the recipient regions. They also design the micrografts in a way that will proportionally distribute hairs over the bald region. Proper planning and designing of micrograft hair replacements also allow patients to discontinue their oral medications, in the future.
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Before prescribing medications, surgeons also enquire about their overall health. Of all medicines, the anticoagulant drugs interfere with FUT process and prevent its effectiveness. Therefore, candidates consuming anticoagulant drugs are asked to consult their physicians and suspend their medications, for a certain period of time.
Front portion of the scalp produces most visible hair graft results in males and females. As surgeons define the characteristics of the graft, they consider the hair loss tendency. Whether patients maintain their hair loss or increasingly lose hairs, surgeons aim to restore hairs, with maximum effect. To achieve this, they discuss the graft designs and its probable outcomes with the patients.
Scalp areas like crown is not suitable for implantation. It is because if baldness continues to spread, it hinders the natural results of FUT treatment. As a result, an isolated micrograft remains at the centre of crown and is enclosed by a ring of complete baldness.
Today, most hair grafting procedures are done with local anaesthesia. Before commencing any procedure, candidates having higher levels of stress and anxiety are provided with certain sedations, according to the requirement.
Currently, two hair transplantation techniques are prevalent- Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). In the former, surgeons take out small strips of scalp and break them into tiny grafts. Each graft consists of one or many hairs, which ultimately restores bald regions. In the latter, surgeons or dermatologists extract micrografts of 1 to 4 hair follicles from the donor sites and directly places the grafts into the recipient areas.
FUE is a better option for short and shaved hairs. It is because FUT produces residual scars, which are more visible to the human eye. Thus, if patients desire to have short and manageable hairs, they must opt for FUE.
The duration of FUT treatment varies according to the total number of grafts to be transplanted in one session. Typically, surgeons transplant 2,000 to 3,000 grafts in each session and the procedure lasts for about 8 to 10 hours.
While undergoing the treatment, patients can relax their mind by reading books, listening to music, or perhaps watching TV. Such activities will distract them from any irritation or pain, and they will enjoy their treatment. Once the treatment comes to an end, depending on the condition of the treated area, surgeons either bandage it, or leave it uncovered. Regardless of this, patients must be very cautious and ensure that the newly transplanted grafts are not hurt, in any manner.
After completing the FUT procedure, surgeons prescribe 40mg prednisone for the following three days. It helps in reducing frontal oedema. Some other dermatologists also recommend antibiotic prophylaxis. Few others prescribe antibiotics to be taken only in the first day, post-treatment. Actually, it all depends on the condition of the patient and the treated area, after FUT surgery.
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In most cases, patients require analgesic treatment, at least for the first few days. As for others, they don’t have additional discomfort and only live by post-operative medications. During the first few days after treatments, movements should be restricted. Patients must go slow and give healing time to the transplanted area.
On the first day after treatment, patients can wash their scalp, without using any shampoo. Instead of rubbing the scalp, they must allow the water to gently run through. From the second to the sixth day, they can use a mild shampoo; however prevent scrapping and rubbing their head with fingertips. Stitches and staples are mostly removed from seventh to tenth day, from the donor region. On removing the stitches, patients can gradually get back to their normal course of life and lead a hygienic lifestyle.
A typical FUT procedure includes the following:
In a normal FUT surgery, patients are provided with two medications- Minoxidil and Finasteride.
Minoxidil was used in earlier days to treat patients with certain blood pressure levels. Looking into its impact on androgenic alopecia treatment, surgeons then started prescribing it as a hair loss solution in the form of a lotion. Currently, its available in 2% to 5% solutions and 5% gel formats. Minoxidil is not however suitable for pregnant women.
Besides hair transplantation, Minoxidil is also used in various other surgeries. Those under this medication must wait for at least 6 to 9 months to witness complete results. Candidates must also take proper Minoxidil dosage, as prescribed by their surgeons.
Finasteride is commercially called Propecia. Its an oral medicine that produces 5-alpha reductase enzyme and blocks the conversion of testosterone into dihydrotestosterone (DTH). After starting the course, patients can see improvement in the density and thickness of hairs within 1 to 2 years. Since Finasteride is absorbed by blood, those consuming it, are more likely to decrease their blood lipids.
According to FDA authorisation, surgeons must not recommend this medicine for female alopecia. However, it can be suggested if the alopecia is of androgenic origin. Pregnant women must never intake this medicine, as this will lead to feminisation of a male foetus.
Most men and women have excess hairs at the back of the scalp that are not affected by baldness. Also, men tend to have unwanted hairs in the chest and pubic. Such areas containing more than sufficient hairs, serve as ideal donor sites for FUT technique.
Donor hairs retain its features and behaviour, even in the transplanted regions. It is because human hairs are genetically developed to grow and survive with its own attributes, wherever it is located.
Generally, donor sites are located between the occipital protuberances and the virtual lines passing through the ear apex. The density of hairs in the donor region is usually between 65 and 85 follicles per sq. cm. While performing FUT, the size of the scalp strip to be removed is determined according to the hair density. And to take out good quality donor hairs for preparing the FUT grafts, the experts remove less than 1 cm of strip in width. To achieve best results, they carefully take out longer and narrower strip from the donor site.
Cases when the occipital regions are genetically modified to thin hairs and lose them, the transplanted hair follicles are equally prone to thinning of hairs, in the future. There have also been cases where the occipital donor site has been bald or scarred. FUT is not the right treatment for such conditions. Instead, FUE is more effective.
While selecting the donor site, surgeons also asses the quality and quantity of hair follicles. Both these factors determine the degree of success of transplantation.
After selecting the most appropriate donor region, surgeons provide anaesthesia with a 10ml to 30ml saline solution. Some dermatologists prefer causing some turgidity within the tissue, thus facilitating extraction. It produces a tumescent effect, manipulates tissue and gives rise to transient vasoconstriction. Turgidity also prevents bleeding and eliminates risks of transection.
Surgeons then numb the anterior area of scalp by blocking the supraorbital and supratrochlear nerves through truncal and anaesthetic ring blocks. With this, they prepare the donor sites for extraction.
Before harvesting, dermatologists make certain that the donor area must not show signs of baldness, post-harvesting. In FUE transplantation procedure, the grafts leave behind 1mm calibre marks. As for strip harvesting (FUT), the grafts form linear scars. Such scars, if sutured with tricophytic closure, gets concealed and become imperceptible.
Harvesting happens at a suitable depth. Surgeons make incisions in the donor area which penetrates into the follicle bulbs of the hair follicular units and goes deep in the subcutaneous cell tissues, only to prevent any transection. Then, they prepare the graft by slicing the strip into minute scalp fragments which contains 1 to 4 histological follicles. Doctors further separate the fragments and break them down into small sections of 1 to 4 follicles. They extract the follicles from the tiny strips or fragments and place them into a saline solution. Preparing and handling the FUT grafts happen with the help of microscope.
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After taking out thick and dense strips from the donor sites, dermatologists then stitch or staple the site and close it. They remove the closures only after 7 to 10 days of FUT treatment.
Punch grafting in FUE transplantation is done in the same manner. Only that, the extraction process is comparatively slower and there’s higher risk of injury to the hair follicles.
In this stage, dermatologists design the grafts and aims to provide the best-possible natural looking results. To achieve this, most doctors take help of pre-defined distances to delineate the implant region. Simultaneously, they also consider anatomical reactions within the grafts. They mark the hairline about 8 to 9 cm between the brows.
While designing the hairline, experts also consider the shapes of candidate’s head. Physical training, skills and aesthetic sense of the surgeons are vital for creating the best hairline designs. Besides marking the hairline, dermatologists also try to assess the areas from where hair loss is more likely to happen in future and where hair is going to become finer. They never graft hairs beyond the initial hairline, before hair loss. As the frontal hairline moves away, it is obvious that the temporal line will also retreat. In order to deliver a natural look, the experienced surgeons deliberately leave certain part of the temple, hairless.
They make scalloped and irregular designs to enable consistent hair growth in the recipient area. However, when it comes to young patients, they do not provide grafts in the crown as this can lead to the formation of a bald ring, in case there’s further loss of hairs.
Since the front hairline is vital for more natural looking results, dermatologists also frame the candidate’s face in an accurate manner. In the first graft implantation process, they use a magnifying glass and focus on the one-third of the bald portion, with an attempt to preserve the pre-existing residual hairs.
Larger the skull more is the number of grafts. Besides the normal hair grafts, if additional hair grafts are implanted, surgeons then work on the next one-third of the bald area, towards the back of scalp. At the same time, they hinder from transplanting hairs on the crown, since its already covered with hairs that have been implanted on the frontal portion.
Soon after implantation, blood pressure increases. Patients also undergo through excess tumescent infiltration and oedema. Besides these, poor quality or weak collagen in the scalp creates more tension and thus makes it difficult for graft retention. This again increases the chances of popping. All such factors lead to popping out of the grafts from the recipient site. To prevent this, most hair transplantation experts use cotton swabs to promote homeostasis.
For creating space, the expert surgeons use 18 -20 G needles, having a calibre of 1.09 to 0.9mm. Using needles of calibres below 0.6mm, they create orifices. With an aim to keep proper angle of natural growth, the operators make holes (space for grafts) at an angle of 30° to 60° and maintain 4mm to 6m of depth. Also, they make the holes giving a light touch and ensure that the holes are not too close with each other. With this, they attain 20 to 35 grafts per sq. cm, i.e. 30% to 50% of scalp’s original density. Candidates having excellent donor sites accomplish about 40 to 50 grafts per sq. cm.
While creating holes, surgeons also use special pliers to carefully place the grafts in the orifices. It helps them to prevent any compromises on the vitality of the transplantation. Hair finally grows in small groups of 1 to 4 follicles. Previously, grafts were extracted with 3mm to 4mm of punches, comprising of only 10 to 20 hairs. This produced unnatural results. However, in today’s time and age, grafts are harvested with maximum 1mm punches. As a result, each graft contains 3 to 4 follicles, delivering a more realistic and practical result.
Hair that is implanted gradually enters the telogen (resting) phase. The shaft of hair gets removed, and finally it falls out. Within 4 to 6 months of falling out, new hairs start emerging and develop with proper biological behaviour in the recipient region.
Way back in 1980s, the hair grafting procedure yielded poor cosmetic results. Lack of advanced technologies and corrective surgeries left no options for the hair transplant patients. However, of late, with lots of technological advancements, FUT candidates can now correct the imperfections of previous hair transplantation procedure.
Corrective hair graft surgery is a process that allows patients to improve the FUT results and get their desired hair density. In this treatment, surgeons retouch the hair grafts and improvise the effectiveness of earlier hair transplantation.
In most FUT cases, the hair follicles remain excessively close to each other, in the group. Through corrective hair graft surgery, surgeons extract the follicles; fragment them partially through a punch, and then re-inserts them, thus producing a more natural effect.
In various other cases, patients notice scars and other surgical marks, post-FUT treatment. Such minor imperfections can also be fine-tuned with corrective hair graft surgery.
Well, that was all about the follicular unit transplantation process, from the beginning till the end. Undoubtedly, it is the most advanced and effective treatment for restoring hairs in the bald regions of scalp. It also helps to reduce hair thinning, and promotes high-density hairs. It is a minimal invasive technique, which accounts for little pain and discomfort. Based on the health condition, patients have quick recovery, with time. FUT is safe, standard and reliable.
However, patients must be wary while choosing the dermatologist and the clinic. FUT being a medical procedure requires proficient knowledge, skills, and expertise. Surgeons performing the treatment must receive good training and hands-on experience. Also, clinics should be equipped with state-of-the-art infrastructure and latest amenities. After considering such factors, candidates must wisely choose their dermatologist or surgeon, consult with them, and finally proceed towards treatment.
1, NRI Complex, Mandakini,
Chittaranjan Park, South Delhi,
New Delhi - 110019