During a follicular unit transplant, a linear strip of hair bearing tissue is extracted from the donor region located on the back or side of the patient’s scalp. This strip is then dissected into thousands of tiny follicular units of hair using stereo-microscopic dissection. This dissection method allows naturally occurring follicular units to be separated under the microscope without damage, ensuring their survival.
This method is also known as FUT, linear or strip harvesting. This method has been used to successfully transplant hairs for over 50 years and to this day, thousands of patients enjoy great results obtained from FUT procedure. However, when performed incorrectly, this method may leave a patient with unsightly scar, which explains the bad reputation strip donor harvesting endured in the last several years. Dr. Lam uses a combination of advanced techniques and technologies that allow for almost undetectable donor scars.
With proper technique and attention to details, visible scarring is typically a thing of the past. An advanced wound closing (suturing) technique called trichophytic closure is used to minimize donor scars.
As seen in the illustration taken from Dr. Lam’s textbook, Hair Transplant 360, Volume 1 (2nd Edition), the small removal of the bottom edge of skin will allow the hairs to grow through the incision to make in many cases the incision virtually undetectable.
This illustration taken from Dr. Lam’s textbook on hair transplant shows how a trichophytic closure can help make a donor incision virtually undetectable by allowing hairs to grow through the scar.
This photo shows how donor strip harvesting can result in an almost invisible incision when done by experienced hands. Of course, there can be a slight widening but typically this is invisible with hair worn at a normal length.
Although the trichophytic closure is an important dimension to favorable donor healing, there is so much more. It begins with preparing the donor tissue in order to achieve minimal disturbance to the hair structures and maximum hair yield. It includes regenerative medicine treatment called platelet-rich plasma (PRP) that promotes healing and minimizes scarring. Finally, during the recovery period, a nutrient-rich scar gel is used to further the healing for the best results possible.
Each method has its advantages and Dr. Lam is skilled in all donor harvesting methods of hair transplantation so that he can tailor the best option for you. When compared to the FUE method, the main advantage of the strip method is that it can typically move substantially more hair without significantly thinning the “safe donor area.” For example, a thin donor strip can yield 3,000 grafts in a single session but if the same number of grafts removed with FUE method, there is the risk is causing a moth-eaten appearance in the back. A so-called mega session allows for moving large number of grafts that allow to restore hair from the front to back, the entire top of the scalp in a single session. This larger session can only be achieved with both the skill of the surgeon and his team.
The FU-strip procedure offers an unparalleled number of hairs that can be moved in a single session while carefully preserving the donor hair. When someone has significant hair loss, especially from front to back, and does not wear his hair short, the FU-strip megasession may be ideal. After a consultation with Dr. Lam and his staff, you will have a better understanding of which procedure would be better suited for you.
Dr. Lam believes that without the aid of meticulous graft dissection from a very experienced team, there is no way to perform this procedure in a reasonable timeframe with quality grafts. Dr. Lam’s team with EminaKaramanovski Vance at the helm is very seasoned with over 20 plus years of experience so that such a large procedure can be performed in a day’s time. There are many factors that contribute to an overall good result andafter a consultation with Dr. Lam and discussing with you the merits and suitability of each method, he will help you select the best technique for you.
- Ideal candidate
- Men who have hair loss and are diagnosed with male-pattern hair loss
- Men whose hair-loss progression is slow and stable
- Men who have more extensive loss across the scalp (from hairline to crown) that want to achieve overall or denser coverage in one surgery
- What to do
- Schedule your procedure and plan on one week for recovery during which time you are functional but may not be socially presentable for 3 to 5 days.
- If you are not already on any hair-loss management therapy and you have miniaturized hairs, you may be recommended to start one or several treatments (such as finasteride [Propecia], minoxidil [Rogaine], and/or low-level laser) in preparation for the procedure. Depending on your unique situation, you may be asked to be on a hair-loss management treatment for anywhere between 4 to 6 weeks in order to strengthen your hair and minimize postoperative, temporary hair shock loss.
- If you are from out of town, you will be required to arrive the day before the procedure and will be allowed to travel the day after, staying in town for a total of two nights. However, if you are not in town at two weeks after the procedure, you will need a professional to remove your sutures (stitches). Dr. Lam has many colleagues across the United States and the world who may be able to help remove your sutures so that you do not need to stay in Dallas for two weeks or return in two weeks to have your sutures removed.
- What to expect
- You may have visible scabs around transplanted hairs and swelling of your forehead and around the eyes that may last 3 to 5 days.
- You can wear a hat immediately after the procedure, and you can wash your hair 24 hours after and resume most physical activities 48 hours after. You can travel the next day.
- You can wear hairstyling products 2 days after, camouflaging products 7 days after, and color your hair 15 days after the procedure. Your stiches should be removed 2 weeks post-procedure, and we will help you schedule your appointment.
- You may experience postoperative shock loss that may arise 4 to 6 weeks post-procedure. Don’t be alarmed since this is a temporary shedding representing weak hairs being pushed into dormant phase, which should regrow around the same time as transplanted hairs.
- Transplanted hair should start growing 3 to 4 months post-procedure, achieve visible change in many cases at 5 to 6 months post-procedure, and continue improving in growth up to 12 months post-procedure or longer.
I am very concerned about the scar. How does Dr. Lam minimize the appearance of the scar?This is a very common concern, especially with the negative Internet hype that is promoting the FUE procedures as the only way to avoid a scar. First, FUE is not scarless. You will have tiny dots that prevent you from shaving your head. Second, FUT scars can heal tremendously well. Dr. Lam performs a very careful harvesting method, the details of which he has published in his textbook, Hair Transplant 360, Volume 1 (2nd Edition). The care of the harvesting begins with minimal transection (injury) to the hair follicles during harvesting. Second, it is important to lessen any injury to the nerve and blood supply around the hair follicle. Third, it is important to reduce wound tension prior to closure. Fourth, Dr. Lam uses a trichophytic closure in which a millimeter of epidermal skin is removed off of the bottom edge of the incision to allow the top of the hair to grow through the scar, making the incision very hard to see. Fifth, Dr. Lam closes the incision with tightly spaced suture loops placed at a correct depth and left in for two weeks, which all contribute to fine, undetectable scars. Sixth, Dr. Lam uses platelet-rich plasma injections to accelerate the wound healing. All of these techniques allow Dr. Lam to achieve very difficult to see scars in the majority of cases. This is why Dr. Lam has filmed and published so many comb-through videos of his scars to show how difficult to detect they are with the naked eye even in high definition close-up comb-through evaluations.
I have heard some of my friends have more discomfort with the strip method and also have pain and numbness that linger after this procedure in the donor area. Should I be concerned about this?There is always a risk of prolonged numbness or discomfort but Dr. Lam has never experienced this outcome because of the care with which he performs his procedures. These poor outcomes are related to bad surgical technique. That being said, he does have patients who have mild to moderate discomfort in the donor area for the first 1 to 2 weeks due to swelling and nerve irritation. He has methods to diminish this discomfort in the rare patient who should require anything more than some pain relievers.
What if I want to shave my head after an FUT procedure?You will be unable to shave your head following an FUT procedure because you will most likely see a fine line in the area of harvest. However, as mentioned, you will not be able to shave your head after FUE either because you will have fine white dots in the donor area. FUE does permit you to wear your hair shorter than FUT without a visible scar, but patients who have favorable hair density and good exit hair angles (something that Dr. Lam can counsel you on during your meeting with him) can oftentimes have relatively short haircuts without any visibility of the incision at all.
What are some of the after-care instructions I should be aware of following an FUT procedure?The general after-care instructions listed on Dr. Lam’s website applies to both FUE and FUT techniques. However, following an FUT procedure, it is important not to have direct physical impact with high-velocity blows, e.g., being hit in the head very hard, for 4 to 6 weeks. You can resume normal workouts after the first week but listen to your body so that you do not overtax yourself or fall down through exhaustion and thereby hurt your head. Also, it is advisable to avoid submersion in dirty water (no swimming in pools or lakes or immersing head under bathtub water but showering is ok) for at least 3 weeks (preferably 4 to 6 weeks). The reason is that water can cause infection in the scalp. Also, be careful when you are in the gym not to lean your head against any commonly used surfaces for the first 1 to 2 months to minimize exposure to the bacteria and germs that are in these public and sweaty environments.
FUE vs. FUT
|Procedure||Follicular Unit Excision||Follicular Unit Transplant|
|Harvesting method||Small round punches||Linear Incision (Strip)|
|Ideal candidate||Men||Men and Women|
|Graft survival||Grafts fragile and easily injured; good survival||Grafts robust and resilient; great survival|
Please watch Dr. Lam’s SlideShare presentation on his philosophy, strategy, and design for crown hair transplantation.
Please watch Dr. Lam’s SlideShare presentation on the fundamentals of male hairline design.
Please watch Dr. Lam’s SlideShare presentation on recipient site design and distribution.
Please watch Dr. Lam’s SlideShare presentation on temporal point reconstruction.