Today, hair transplantation is a very refined outpatient procedure that can produce full and natural looking results, even after only one hair transplant session. When performed correctly, not even a hair stylist will detect that a person has had a hair transplant. However, it is critical that the hair transplant procedure be performed correctly to achieve such natural results. To do so requires a hair restoration clinic that can perform both Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) at the highest levels of skill, experience, and dedication. Manzanares Hair Restoration Center is in the forefront of this surgical hair restoration.

Follicular Unit Transplantation (FUT)

A great hair transplant is the result of using a state of the art surgical procedure and performing it with great skill and artistry.

The acknowledged “gold standard” in hair transplant surgery is the Follicular Unit Transplantation (FUT), also commonly known as the “strip harvesting” procedure.

The basic concept of FUT is to relocate hair from the donor area (back and sides of the head) to the recipient areas (front, mid scalp, crown, eyebrows, eyelashes and facial hair). Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected with local anesthesia which typically last about 6 to 8 hours.

In the usual FUT procedure, Dr. Manzanares harvests a strip of scalp from the back and sides of the head. The excised strip is about 1-2.5 cm x 15-35 cm in size. The excised strip will leave a wound which is then closed using a combination of nylon and absorbable sutures. The surgical team aided with special magnifying lenses, then begin to carefully dissect individual follicular unit grafts from the strip. Each of this follicular unit grafts may contain single, two, three, four hairs.

This type of dissection approach allows us to transplant thousands of follicular units and ultimately thousands of hairs in one surgery at one time. A session may vary from few hundred grafts to more than 5,000 grafts in one procedure.

Dr. Frank then uses a fine needle to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. Then, the final part of the procedure is to insert the individual grafts in place.

The disadvantage of this Follicular Unit Transplantation (FUT) technique is that it produces a linear scar in the donor area, although the scar is generally very fine and can be easily concealed with existing hair.

Dr. Frank employs a unique way of removing the strip and closure, known as the trichophytic scar.  The advantage of this scar closure technique is to allow the hairs at the closure point to grow right through the scar. This will add camouflage to the scar and reduce its visibility.

Follicular Unit Extraction (FUE)

Historically the Follicular Unit Extraction (FUE) is actually an older harvesting technique. It was originally the harvesting method used when the “plugs” (large circular grafts with 5 to 16 hairs) were being transplanted way back in the early ‘80s. The large grafts were as such because of the limited size of the circular punches (4.0 mm, 3.5 mm, and 2.0 mm) available back then. The FUE harvesting was temporarily abandoned in favor of the FUT – strip harvesting technique, where finer micro-grafts were being made and transplanted. With the dawn of the newer, more refined, better designed hand held machines and smaller punches (0.6 mm, 0.7 mm, 0.8 mm, and 0.9 mm) now available, the FUE procedure has made a comeback. Instead of removing a strip of hair-bearing skin from the donor site, this modern FUE technique allows surgeons to extract individual follicular units from the back of the scalp or the body without the use of a surgical scalpel.

Scalp hair grows in naturally occurring groups called follicular units. Each follicular unit contains from 1 to 4 hairs. In FUT harvesting, a single strip of skin is harvested from the scalp in the back of the head and then, using special magnifiers, the strip is dissected into individual, naturally occurring follicular units of 1 to 4 hairs.

With the FUE procedure, 1, 2, 3, and 4 hair follicular unit grafts are carefully extracted one at a time using a mechanized hand held machine with circular punch of one millimeter or less. Dr. Manzanares shaves (buzz cut) the patients donor area (back and sides of the head), to be able to better visualize the angle of the hair, to harvest the perfect grafts.

The follicular units are crafted by placing the spinning circular punch around a single follicular unit and cutting a small circle through the scalp around the follicular unit. The follicular unit is then gently extracted from the loose tissue underneath the scalp.

The small hole left after the follicle is extracted forms a scab and heals over the next few days to a week. This small round incision contracts as it heals, making the resulting round scar smaller than the size of the punch that made the incision. The FUE patient ultimately ends up with hundreds of small round scars, which are normally not detectable once the patient’s hair grows out.

During the free patient consultation, both the FUT and FUE harvesting procedures will be explored in depth, where the pros and cons of both procedures will be discussed. 

The following before and after photos are some scalp hair transplant and restoration via Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) done at Manzanares Hair Restoration Center:

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