The follicular unit hair
transplant is a four phase procedure for men or women, whether
undergoing a hair, beard or eyebrow transplant. Doctor Clas uses
magnifying loupes during all phases of the procedure to ensure
maximal precision and guarantee optimal results. The technicians
use microscopes to dissect the follicular units with maximal precision.
This ensures the maximal number of grafts and maximizes the growth
of the follicular units. The first phase is to obtain the donor
follicular unit micro grafts, the second phase is the preparation
of the micro grafts, the third phase is the preparation of the
graft sites, and the fourth phase is the implantation of the follicular
units. The technicians will assist Doctor Clas in several steps
of the procedure; this will allow some phases to progress simultaneously.
Obtaining the donor
follicular units
This phase is critical to obtain the maximal quality of donor
follicular units in the desired quantity with minimal scaring.
There are two techniques for obtaining follicular units; follicular
unit strip surgery (FUS) or follicular unit extraction (FUE).
With either approach, perfect surgical technique and respect of
scalp tissue are critical in ensuring invisible scars. Follicular
unit strip surgery (FUS) has been practiced for over 12 years.
It remains the only technique for obtaining large quantities of
follicular units in a single session. Follicular unit extraction
(FUE) is a newer technique that avoids creating a linear scar.
However, with this technique, a much lower number of follicular
grafts can be obtained. Instead of a linear scar, there will be
hundreds of small circular scars less than one millimetre in diameter.
The final appearance of your transplant will be identical in both
cases if the same number of grafts is transplanted. However, in
some patients, there will be lower growth of hair following follicular
unit extraction. Some patients have tightly tethered hair follicles
and follicular unit extraction is not possible. Follicular unit
extraction is the only technique possible for patients with tight
scalps or who have had multiple previous hair transplants.
Follicular unit
extraction (FUE)
Some transplant clinics claim that FUE is a non invasive technique.
This is not exact. Micro punches of 0.7 to 1.0 mm are used to
extract individual hair follicles. This is definitely an invasive
procedure; however, a scalpl is not used, leading other clinics
to claim that this procedure is scalpl free. We want you to understand
that this is a surgical procedure in the same sense as follicular
unit strip excision (FUS). All hair transplantation is minimally
invasive, none is non invasive.
After shaving the donor
hair to a 3mm length, the area is cleaned to ensure sterility.
Compared to follicular unit strip surgery, in FUE an area three
to four times larger must be prepared. For this reason, it will
be more difficult to hide the donor area. Local anaesthesia is
infiltrated in the donor area. Doctor Clas will use specially
designed micro punches to extract individual follicular units.
It is crucial to respect the angle of the hair in the scalp to
ensure the highest quality grafts and maximal subsequent growth.
The micro punch sites are so small that they do not require closure
with stitches. They will be hidden by the remaining hair. A bandage
is applied for the duration of the procedure. It will be removed
at the completion of your procedure.
Follicular unit
strip surgery (FUS)
After shaving the donor hair to a 3mm length, the area is cleaned
to ensure sterility. Local anaesthesia is infiltrated in the donor
area. Strip excision must be performed while precisely respecting
the angle of the hair roots. This ensures the maximum quantity
of follicular units for the quantity of excised scalp. Respecting
the angle of the hair ensures an invisible scar. When performing
strip excision, a narrow scar is ensured by minimizing wound tension
and in some cases, the use of a trichophytic closure. Ensuring
minimal tension in the wound edges is probably the most important
element in obtaining beautiful narrow scars. In some cases, it
will be necessary to undermine the wound edges to decrease tension.
In the trichophytic closure technique, two millimetres of one
edge of the strip excision site is removed before closure of the
donor site. The wound edges are brought in approximation with
some deep stitches. The wound edges are then closed with a superficial
suture. We only use absorbable “melting” stitches.
These sutures absorb the tension of the wound for several weeks
to ensure a narrow scar. A bandage is applied for the duration
of the procedure. It will be removed and the donor site inspected
before you leave the clinic at the completion of your procedure.
You will not need to return for suture removal. The sutures are
hidden by combing the surrounding hair over the scar. This is
why we recommend that you not cut your hair shorter than one centimetre
before the procedure.
Preparation of
follicular unit micrografts
The follicular units must be maintained moist at all times. Under
magnification and using backlighting, Doctor Clas and his technicians
will inspect all follicular units. The follicular unit micro grafts,
whether obtained by the strip or extraction technique, must be
dissected free of unnecessary skin and fatty tissue to ensure
the thinnest grafts possible. There must be sufficient single
hair follicular unit micro grafts to create a natural appearing
hairline. In some cases, it may be necessary to divide larger
follicular units in order to ensure a sufficient number of one
and two hair follicular units. The micro grafts must be of a consistent
size to facilitate implantation. The ultimate size of the micro
graft depends on the characteristics of your hair.
Preparation of
graft sites
The hair line is drawn directly on the area to be grafted before
the start of the procedure. Certain principals guide the creation
of hairlines, eyebrows and beards. However, the creation of a
hair line is guided by patient preference and the aesthetic and
artistic sense of Doctor Clas. This is why we claim that hair
transplantation is 95% art and 5% science. The recipient region
is then cleaned with disinfectant and anesthetised. Slits are
created in specific densities and orientations to obtain the desired
effect. Slit size is based on the size of the micrografts. We
use custom prepared blades and needles to create implantation
sites that most closely match the size of your follicular units.
The depth of the recipient sites must be precisely controlled
to avoid damage to underlying blood vessels and nerves.
Implantation of
follicular units
The technicians will assist Doctor Clas in placing the correct
follicular unit micro graft their precise recipient site in the
correct orientation. Different areas to be grafted will require
specific types of follicular units. For example, the hair line
is created using only one hair follicular units. A zone of higher
density will be created in the central area behind the hair line
using multi hair follicular units or occasionally, even multiple
follicular units.
At the end of the
procedure
Once all the grafts have been inserted, we will clean and inspect
the transplanted zone to ensure proper placement of all grafts.
The bandage at the back of the head will be removed and the donor
sites inspected and cleaned. In most cases, you will leave without
a bandage. You do not need to cover your head after your transplant.
If you prefer, you can wear a hat or a bandana to hide your fresh
graft. Your must keep your head elevated. Every day, you will
need to wash the donor and recipient sites. We will explain how
to do this without dislodging and grafts. A small crust will form
at every recipient graft site. These crusts will fall off in about
10 days. Do not pick them off; this crust is important in keeping
the grafted hair roots in place until healed. The crust that forms
around the sutures will remain about four weeks. In most patients,
the grafted hairs will fall out in about one month. New hairs
will be visible after about three months. Most of the hairs will
have grown in by six months. After the first year, you should
not expect any new growth.
