National Hair Institute, Follicular Unit Hair Transplantation & Restoration, Melbourne, Sydney, Australia, Hair Loss Solutions

Follicular Unit Grafting

In 1995 Dr Robert Bernstein of New York published the first paper on Follicular unit hair transplantation appropriatly titled “follicular transplantation”. In it he recognised the importance of the naturally occurring follicular groupings, stressed the importance of using large numbers of grafts to maximise the result and stipulated the use of very small recipient sites to aid healing and minimise scalp damage. Those very same findings are still true today.

Follicular Unit Grafting is based upon the principle that hair does not grow individually but in naturally occurring groups of up to 4 hairs. These follicular units are obtained through microscopic dissection of tissue that is harvested either in a single strip or via the Follicular Unit Extraction(FUE) method.

A patient is shown with his existing hair taped up to expose the donor region undergoing FUG with a linear strip of hair bearing skin being removed.

Using stereoscopic microscopes it is possible to identify and extract these microscopic 1-4 hair units and transfer them to the areas of balding scalp. This method literally transfers the hairs in the same way that nature grows them and allows us to mimic a totally natural looking head of hair.

The advent of follicular units was a significant step forward over the previously available mini and micro grafts. Mini grafts were up to 2.5 mm in diameter and could contain up to 12 hairs resulting in a tufty appearance and an uneven or “cobblestone” appearance on the scalp. Micro grafts were 1-1.5 mm in diameter and whilst their size allowed for for a natural appearance because they were cut with the naked eye the natural grouping of follicles was ignored and vital anatomic structures were damaged in the dissection process. As a result growth rates of 50% were not uncommon.

At the National Hair Institute all grafts are cut using the stereoscopic microscope. They allow us to identify and dissect the follicular unit whilst sculpting around around the sebaceous glands and other appendages that are crucial for the grafts survival. The resulting grafts are the smallest possible grafts you can achieve that will experience a very high growth rate, 95% or above is common in the hands of the right surgical team.

A Step-by-Step Explanation

Before Surgery

One week prior

• Do keep a record of any medications you take one week prior to surgery and advise your doctor on the day of surgery.
• Do not take aspirin or any other anti inflammatory medication as this affects your bloods ability to clot and may increase bleeding.
• Restrict and if possible cease smoking as it decreases blood flow to the scalp and can result in poor healing.
• Do not drink alcohol three days prior to surgery as this can thin the blood.
• Do not engage in strenuous exercise three days prior to surgery as this can thin the blood.
• Do not drink coffee or any other caffeinated products the day prior.

The morning of your procedure

• Wash your hair as you normally would and do not apply any styling products.
• Wear upper body clothing that opens at the front and does not require it to be pulled over the head. i.e. button shirt and cardigan.
• Eat breakfast as you normally would, even though you will be nervous and not feel hungry it is beneficial to have something in your stomach when undergoing anesthesia.

The procedure

• You will begin with a review by your surgeon, during which he will explain the process, discuss any preferences you may have regarding hairline or graft placement and answer any questions you may have.
• Then you will get changed into a surgical gown and be escorted to theatre where you will be given some mild sedatives to help you relax.
• We will then attach some monitoring equipment to you to ensure that your are safe and comfortable during the procedure.
• Next we select a narrow strip of donor scalp from the permanent hair zone. The hair in this area is clippered to a #1 so that the uncut hair will cover the donor area when the patient leaves the office.
• The donor scalp is then anesthetised (frozen) using a local anesthetic. This ensures that the procedure will be virtually pain free.
• Once the donor tissue is removed he two edges are closed with either dissolving sutures or surgical staples, and a thin bandage is placed around the donor area. (In FUE the follicular units are removed one at a time directly from the scalp and the donor region is covered with an antibiotic ointment and no bandage is required)
• The tissue is then placed under microscopes and dissected into their naturally occurring groups of 1, 2, 3 or 4 hairs. And then sorted and stored depending on how many hairs they contain.
• Once sufficient grafts are cut we will commence making the recipient sites with a very fine gauge needle and placing the grafts immediately after the hole is made. This is known as a “stick and plant” process and whilst it is more labour intensive it ensures that the smallest hole possible is made and reduces vascular damage to the scalp.
• If we are performing a large procedure that started in the morning we will take a break for lunch at which time you are free to get up and stretch your legs and you will be given a meal you pre ordered in the morning.
• Once all the grafts have been placed your surgeon will double check the position of all the grafts.
• You will then get changed back into your clothes and a technician will read your post operative instructions and give your medications for the next week.

After Surgery

• The night of your procedure we encourage you to sleep semi upright at a 30-45 degree angle to reduce blood pressure to the scalp.
• Your post op medication will assist with sleep and any pain you may experience.
• The following day we encourage you to return to our office so we may remove your bandage and check and wash your transplanted area and donor region.
• You may resume showering normally with a low temp and pressure applied directly to the scalp after 5 days.
• You should avoid alcohol for three days and abstain from smoking if possible.
• You should not engage in any strenuous activity or heavy lifting for two weeks after the procedure. Any activity that stretches or puts undue pressure on the back of the scalp should be avoided for one month.
• Most scabs in the recipient region should be gone after 7-10 days and the procedure should be virtually unnoticeable at this time.
• The newly transplanted hair will begin to grow through after 10-12 weeks.
• The final growing result is expected after 12 months.