Hair Transplantation Techniques

The two hair transplantation techniques that are commonly used these days are follicular unit transplantation (FUT) and follicular unit extraction (FUE). The major difference between these two basic methods is in harvesting grafts. The follicular unit transplantation is an older technique, often called strip technique, where a thin donor strip is extracted from the back of the scalp. The opening is then sewn closed. Such a strip can be up to 20cm long and max. 1.5cm wide. The donor strip is placed under a series of special dissecting microscopes, where the individual follicular units, of one to four hairs, are carefully dissected into tiny grafts. Tiny incisions are then made in the bald area for inserting the grafts into. This method leaves patients with a horizontal scar at the back of their head that is visible if their hair is cut too short. Follicular unit transplantation is often used for large scale operations whereas follicular unit extraction is applied to cover smaller areas.

The follicular unit extraction method is more recent, introduced in 2002 whereas the follicular unit transplantation has been used since the early 1990s. As its name suggests, follicular unit extraction consists in extracting individual follicular units of up to one millimetre in diameter. The grafts are so small that they can be directly implanted into very small needle poke-holes in the bald area. The small holes in the donor area fill up a few days after the surgery, leaving behind just tiny scars. The scars are visible only on close inspection or if the head is shaved. The greatest benefit of this method is that patients can cut their hair short. Another great benefit of the follicular unit extraction technique is that it can be used selectively to transplant only pigmented hair or, if one wishes, only grey hair. The follicular unit extraction procedure is much more labour intensive and therefore more expensive. There is a limit to how many grafts can be transplanted during one session of follicular unit extraction.

Some clinics only perform the follicular unit transplantation, some specialise in the follicular unit extraction only, but for many patients a combination of the two methods is the ideal treatment option. The weakness of the follicular unit extraction procedure is the variable yield in harvesting grafts that very much depends on the surgeon’s experience, as many follicular units can be transacted and thus destroyed in the hands of inexperienced surgeons. The yield can vary from 50% to 95%. The follicular unit transplantation procedure usually does not kill more than 2% of the donor follicles, which gives it a min. 98% yield.

Improved derivations of the follicular unit transplantation, such as the ultra-refined follicular unit transplantation and the Choi technique are gaining in popularity. These methods are also called dense packing techniques. It is almost impossible to draw a clear dividing line between the traditional follicular unit transplantation and dense packing techniques, but the essential difference is in the size of grafts and the resulting density of transplanted hair. The dense packing techniques are said to use very skinny grafts (cutting away all unnecessary skin tissue), enabling the placement of grafts closer together than the traditional follicular unit transplantation. From a marketing point of view, dense packing is a good alternative to clinics that only perform follicular unit extraction. Please note that the term follicular unit grafting technique (FUG) also refers to follicular unit transplantation.

Follicular unit extraction, also called the FOX technique, has some synonyms too, such as direct hair implantation (DHI), GHO technique, follicular isolation technique (FIT) and Wood’s technique. When talking about the so-called, non-invasive hair transplantation techniques the aforementioned procedures are usually involved.

The old grafting techniques of hair transplantation are called strip graft, punch graft, slit graft and mini graft techniques. Some clinics may still perform some of these archaic techniques and they should be avoided.