Follicular unit transplantation (FUT) is the oldest method of harvesting hair follicles from the scalp to correct alopecia or baldness. The birth of FUT dates back to the early days of hair restoration surgery of the 1960’s and hasn’t changed significantly since that time. In those historic times, the only technology which existed to harvest hair follicles was a surgical blade or scalpel.
It became popular because it was very inexpensive, relatively easy to learn, and required no formal or ongoing training for the doctor or staff. While it was possible to harvest large numbers of hair transplant follicles in a single session many problems were created, some of which were difficult if not impossible to correct.
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Wound Healing and Scarring in FUT
As plastic surgeons we are considered the surgical authorities on wound healing. We are seen as the experts on the closure of difficult and even complex wounds. In fact, plastic surgeons are often consulted by their surgical colleagues in all other surgical specialties for the closure of surgical wounds including general surgery, neurosurgery, orthopedic surgery, and OB/GYN, to name a few. A basic principle of surgery is that closure of a wound under tension results in a noticeable and wide scar.
For example, if you excise an area of scalp to obtain hair grafts then the resultant defect is usually closed under tension. This is because most people who undergo hair restoration surgery have no excess scalp laxity or looseness unless they are elderly. This means that removing a strip of scalp which is a half inch wide will usually result in a scar which will ultimately heal a half inch wide. This is especially true on the scalp where it is closed under tension over a rigid and fixed object underneath – the skull.
Limitations of FUT
Besides unpredictable scarring other limitations of FUT or strip surgery include prolonged pain and permanent scalp numbness. Our patients who previously underwent a strip procedure routinely describe the experience as quite painful with prolonged swelling and scalp numbness. They are often forced to wear their hair long on the back of the head to hide the noticeable scar. Thinning of hair around the linear scar is also quite common.
Hair Transplant Advancements
Fortunately, medical research evolved over the decades resulting in FUE or follicular unit extraction. Manual devices were ultimately replaced by more sophisticated devices like Neograft®, Smart Graft, and Artas. All of these devices focused on individually extracting hair follicles with a small punch, often less than a millimeter in diameter. The surrounding scalp was left intact.
The FUE was less invasive than older strip methods resulting in a much easier recovery for patients and less scalp numbness and pain. The tiny holes created by removal of the hair follicles were allowed to heal in avoiding the need for stitches. No visible linear scar was created, allowing patients to wear their hair short.
Revolutionary New Devices
The new devices for FUE have revolutionized hair restoration surgery. I tell my San Diego patients that hair transplantation has come a long way since its infancy in the 1960’s. But this is also true in many surgical specialties such as general surgery and orthopedic surgery.
We used to remove gall bladders in the 1960’s through a large incision in the upper abdomen. Recovery included many days in the hospital. With the invention of the laparoscope, surgeons can now remove the gall bladder through tiny incisions as an outpatient procedure.
Orthopedic surgeons can now examine and repair many joint disorders with a scope avoiding long scars and painful recoveries for patients. Plastic surgeons have also developed endoscopic techniques for numerous cosmetic (aesthetic) procedures such as brow lifts to avoid the long scars in the hairline with possible hair loss seen in older methods to lift the brow.
So Why FUT?
The question then remains : Why do so many hair restoration practices still offer FUT in 2019? There are clearly more sophisticated and improved methods to perform hair restoration than the FUT or strip procedure. Practices who commit to these new FUE technologies make a significant financial investment in the equipment and supplies whether it is Artas, Neograft, or Smart Graft.
Physicians devote much time and effort in certification, education, and training of themselves and staff. Many physicians who are not surgeons by training could understandably be intimidated by the sophistication of these devices and not comfortable incorporating such devices within their practices.
On the other hand, physicians from the “core specialties” of dermatology, facial plastic surgery, and plastic surgery are trained in many devices during their residency programs including lasers, endoscopic equipment, and even these newer FUE devices. New technology is comfortable to such physicians and a natural evolution of their practices. We constantly seek out the best drugs and devices to provide optimal patient care; it’s inherent in our training and commitment to continued education.
In Conclusion
Unfortunately, the FUT or strip procedure remains popular because the financial burden to a hair restoration practice is negligible. It is a simple technique to perform and requires no formal staff training. Many of the most popular hair restoration “franchises” still see FUT as the most cost effective and financially rewarding technique. Patients may be lured into considering a strip procedure because it is generally less expensive than the newer FUE devices.
However, many of the problems associated with strip surgery such as noticeable scars require patients to spend even more money to hide them. Sometimes, these FUT scars cannot be hidden because the donor area lacks sufficient hair follicles to implant into the scars. Many such clinics downplay the unpredictable nature of strip scars. All too often, we see patients in our practice who have undergone a strip procedure in the past; most patients regret that decision.
The Good News
The good news is that hair restoration can now offer patients technology which is minimally invasive and results in completely natural and undetectable hairlines (you can see real patient photos here). Recovery is relatively short as compared to the older strip method. Permanent scalp numbness and prolonged scalp pain can be avoided.
So become an educated consumer. Seek out an experienced hair restoration practice that uses the latest FUE technology such as ourselves. Look for such a hair restoration practice with a physician who is board certified by the American Board of Dermatology, American Board of Plastic Surgery, or American Board of Facial Plastic & Reconstructive Surgery. You deserve the best!