A Look beyond Hair Transplantation

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The first hair transplantations were performed in Japan in the 1930s. In the early days of hair transplant surgery relatively large pieces of skin of four millimetres in diameter, the so called punch grafts, were transplanted from the back of the scalp to the frontal receding area. Hair transplantation techniques have evolved tremendously since then and today’s hair transplantation can give you a genuinely natural look. This is due to the miniaturisation of hair transplants, which now contain only one hair follicle (holding between one and four hairs) and are less than one millimetre in diameter. These tiny, single follicle grafts are then implanted into the needle-made incisions in the balding area. Today’s technology enables dense packing of hair follicles, which gives you a truly natural-looking frontal hairline. Gone are the days of ‘pluggy’ grafts that made you look like a toothbrush.

The two leading technologies that are used today are called Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). The main difference between them is in harvesting hair follicles. The FUT is the older method, using strip harvesting, when a linear strip of skin of up to 20 centimetres long and 1.5 centimetres wide is removed from the back of the scalp and the opening is then sewn closed. This strip is then placed under special dissecting microscopes and dissected into small grafts, containing just one follicular unit each. Such follicular grafts are then implanted into the receding area. The advantage of this method is its high yield, measured as a percentage of the follicles that are successfully transplanted into the balding area. This yield is around 98%. The weakest point is that it leaves the patient with a linear scar at the back of the head. The FUT is less expensive than the FUE and is used when a large area needs to be filled with transplanted hair in one single session.

The FUE method uses a micro-extraction technology to harvest individual follicles that can be directly implanted into the small needle-poke holes in the balding area. The FUE method is the latest technology, introduced only a few years ago. Its greatest benefit is the fact that it leaves the patient with only minuscule scars at the back of the head, which are hardly visible, and the healing time is significantly shorter than with the FUT, due to the small size of the wounds. However, this technique cannot be used to cover large areas in one session and it is more expensive than the FUT. Additionally, its yield is much lower, due to the transaction of many follicles, and since the supply of donor hair is limited, it cannot be used in patients whose hair loss has progressed above NW4 level.

Currently explored surgical hair restoration technologies, such as hair cloning and the generation of new hairs in wounds, should in the future help solve the constraints of the limited amount of donor hair. It seems that hair transplants will in the long future only be used for frontal hairlines and, therefore, the follicular harvesting should manage to provide a sufficient number of hair implants. However, none of the aforementioned potential future techniques is expected to become commercially available before 2013. Hence, the immediate future probably lies in improving the harvesting methods of the FUE in order to improve its yields and make it financially more affordable to customer. The FUT with its strip harvesting, which started a revolution in the hair transplant industry less than two decades ago, may become history in the not too distant future.