Surgical Hair Replacement Options

It wasn’t until 1995, about the time I started performing transplants, that the hair plug technique, a truly unrewarding disfiguring procedure, was replaced by today’s common technique. Hair transplantation involves moving follicles from a high-density permanent (donor) area at the back of the head to a low-density balding (recipient) area on the hairline or in the crown area. A patient with a large donor area and small recipient area is a great candidate for a transplant. As well, an older patient, who can expect less future hair loss, is a better candidate for hair replacement than a young man who can expect more hair loss in the coming years.

Also important is the density of the donor area, which can vary widely from person to person. Higher donor density is obviously a great asset. Curly and wavy hair also gives better coverage than straight hair, and the shaft diameter or thickness of the hair follicle is also important. If the skin color and hair color are similar, the density will appear to be greater. All of these factors must be taken into consideration and discussed with the patient when considering a surgical hair replacement procedure.

These two procedures are considered state of the art by the majority of hair replacement surgeons worldwide.

1. Follicular Unit Transplantation (FUT)
This procedure involves removing a strip of hair from the back of the head (the permanent donor hair) and dividing it under a microscope into “follicular units”. This hair is then planted into small needle holes. About 60 or 70 grafts can be planted per square centimeter, allowing for a density that approaches that of naturally grown hair.

When the procedure is done properly, it will produce a completely natural appearance. By “properly”, I mean that the graft density is full, and that the hairline has been designed accurately and with aesthetic consideration Many patients voice concern about the scar left across the donor site with this procedure. A new closure technique used by some physicians, called “Trichophitic closure”, allows the hair to grow through the scar, making the scar almost invisible.

2. Follicular Unit Extraction (FUE)
The concept is simple. Grafts are removed using a tiny punch, which varies its depth and angle according to the follicle. Once the punch releases the graft, it can easily be removed with forceps. The downside of this technique is that it requires a lot of work and practice on the part of the doctor, as removing the grafts can be quite difficult in some patients, and it requires the patient to buzz their head. (For women or men with long hair, you can get away with buzzing just a strip on the back of the head to use as a donor area). I have now performed enough FUE procedures that I can easily extract 1,500 to 2,000 grafts in one day, but it is an incredibly tedious and time-consuming procedure, and it is for this reason that it is so expensive — two to three times as expensive as an FUT.

Another advantage of FUE is the possibility of extracting body hair. When performing an FUT on a patient with a limited donor site, I often remove several hundred hairs from the body (chest, abdomen, back, etc.), allowing for more hair to be transplanted. It is a last resort for patients with minimal hair in donor sites on the head. FUE heals very quickly.

Source: Excerpts from Dr Jones’ book The Complete Hair Replacement Guide