Dr Carlos Wesley
1050 Fifth Avenue * New York, NY 10028 * 844-745-6362

Follicular Unit Transplanting (FUT)

PRINCIPAL: Over the past decade the desire shared by both patients and physicians to achieve a natural-appearing cosmetic improvement in hair density and aesthetic facial framing led to the advent of micrografting, or Follicluar Unit Transplantation (FUT). By isolating the critical microscopic components within a hair follicle that are required for continuous regeneration of the hair, large “hair plugs” gave way to more refined, healthy micrografts, also known as follicular units (FUs). As a result, fine hair grafts containing a single FU can be safely transplanted into hair-bearing areas. The number of patients benefitting from this approach to surgery, in turn, has expanded to include women and younger men in the early stages of male pattern baldness (MPB) [see photo gallery].

The advantages of this advanced FUT technique are fourfold:
1. Less damage to any existing hair in the recipient area.
2. Less post-operative redness.
3. Micrografts grow slightly faster than traditional types of grafts.
4. Micrografts produce no clumping or plugginess.

The micrografts or FU are obtained in the following manner.

DONOR STRIP: Hair within the donor area (generally less than 1/2 inch wide and 5-10 inches long) is initially clipped to a length of about 2mm. Once the patient’s donor region is completely numb, a narrow “strip” of hair-bearing scalp is removed (any previous scar is also taken out at this stage). A single suture is used to repair the donor area and, with surrounding hair falling over the stitch, the area is immediately and effectively concealed. Afterwards, our patient’s scars are nearly imperceptible (averaging just under 1mm in width). Please view the images within the photo gallery that illustrate the natural appearance of the donor scars of our patients.

MICROGRAFT CREATION: Under microscopic visualization, tissue from the donor region is divided into a variety of graft sizes. From this delicate process, the finest single-haired grafts are generated to produce a natural appearance and multi-haired grafts are generated to achieve hair thickness. While each of the grafts created are unique, they are all referred to as micrografts.

A micrograft, or FU, refers to a graft that has retained the natural groupings of hair as seen on the surface of the scalp. Generally, FUs grow one-to-four-haired follicles. While there is variation with age, the majority of FUs naturally occur in two-or-three-haired clusters. In the early years of FUT, various factors contributed to the sub-optimal survival rates of transplanted grafts (please see table below). Neither the optimal graft trimming technique, nor the ideal graft-to-recipient-site sizing had been clarified. In addition, instrumentation used for graft preparation still required further improvement in order to achieve current levels of transplanted graft viability.

Early studies evaluating the viability of transplanted micrografts with respect to the density at which they are transplanted revealed only a 72.5% survival rate when placed at a common density of 30 FU/cm2. Refinements in the technique of dissection and FU creation enhanced survival over a five-year time period to ensure transplanted FU survival of 98%. This encouraging survival rate was enough to convince the vast majority of surgeons within the field to abandon the status quo and adopt FUT into their hair restoration practice.

Table 1

Hair Survival
Studies By Mayer with and without Keene and Perez

Year 20 FU/cm2 30 FU/cm2 40 FU/cm2
2000* 92.5% 72.5% 78.10%
2003** 95.0% 76.7% 70.0%
2005*** 95.0% 98.0% 90.0%

*Leavitt, M., Perez-Meza, D., Barusco, and M. Research Symposium 1999-2000:
Clinical Update on Research Studies (Mayer, M) Reported at the World Hair Restoration Society/International Society of Hair restoration Surgery Live Surgery Workshop, Intl. Jl, Cosm. Surg., and Aesth. Derm. 2001; 3(21):135-138.

**Mayer and Keene’s Study Comparing FU Growth with Different Planting Densities, Presented at the 2003 annual meeting of the International Society of Hair Restoration Surgeons.

**Mayer, Keene, Perez 2004 Study Hair Transplant Orlando Workshop, presented at the 13th annual meeting of the International Society of Hair restoration Surgery Sydney Australia, August 2005

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