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What is Follicular Unit Transplantation?

Follicular Unit Transplantation (FUT) is a procedure in which hair is transplanted from a permanent zone, the area in the back and sides of the scalp where hair is more resistant to balding, to the bald or balding areas of the scalp. This is accomplished using naturally occurring groups of 1, 2, 3, or 4 hairs, these are known as follicular units. After the patient’s scalp is anesthetized by the Surgeon, the Surgeon removes a strip of tissue from the donor area, an area within the permanent zone. Once extracted, the donor strip is cut into multiple individual follicular units using microscopic dissection techniques. As these follicular unit grafts are being prepared by our highly skilled & experienced techs, tiny little pricks in the scalp are made, called recipient sites, where the grafts are placed.

The arrangement and positioning of these follicular unit grafts determines the aesthetic qualities of a hair transplant, and so this arrangement must be decided on a case-by-case basis, depending on the patients’ history of hair loss and likelihood of future hair loss. Because follicular unit transplants mimic the way hair grows in nature, the results, in expert hands, will look completely natural and be indistinguishable from one’s original hair. See some of these results during your free initial consultation.

Hair Grafting Microscopic Follicular Dissection & Grafting

The major advance by Follicular Unit Transplantation is that in FUT, the use of special stereo-microscopes enables surgeons and staff to meticulously dissect the hair grafts. This helps preserve the integrity of the follicular units and allows us to keep all of the growth elements of the hair follicle intact. The survival of the grafts is maximized and as a result, both the hair transplant and the underlying skin will look completely natural when the transplant matures over time. With FUT, thousands of grafts can safely be transplanted in one session, allowing the patient to complete the hair restoration as quickly as possible.

For more information on how the FUT hair restoration procedure has evolved, schedule your private, free initial consultation with us.

Follicular Unit Extraction uses similar methodology, with the main exception being that the follicular unit grafts are extracted individually from the donor area.

doctor examining the hair
graft cutting by machine

Graft Dissection

One of the most key, important aspects of Follicular Unit Hair Transplantation is the use of stereo-microscopic dissection. This allows follicular units to be removed from the donor strip without being broken up or damaged. During the dissection, it is critical that the whole follicular unit is kept intact as this will maximize its growth. Intact follicular units will also give the most fullness to the hair restoration, as they contain the full, natural complement of 1-4 hairs.

Recipient Sites

At Washington Medical Hair Clinics, the recipient sites in all of our hair transplant procedures are generally made using lateral slits (also called coronal or horizontal slits). Lateral slits have the advantage of orienting the hair within the follicular unit to match the way it grows in nature. They give the hair transplant surgeon and technician the highest degree of control over the direction and angle in which the transplanted hairs will ultimately grow.

Follicular units placed in lateral slits will provide more coverage than those placed in vertical slits, as the hair tends to fan out over the surface of the scalp rather than lying on top of one another. Lateral slits also helps to angle the grafts more acutely and to follow the natural angle of the patient’s original hair. This is particularly important at the temples, in the crown, sideburn areas and in eyebrow restoration.

To create the recipient sites, we use a variety of instruments depending upon the patients situation. In all hair transplants, the goal during the procedure is to create a snug fit between the follicular unit and the skin surrounding the graft. This will maximize oxygenation of the grafts, promote healing and increase graft survival. Tiny recipient sites also helps to ensure that there will be no visible scarring, pitting or other surface irregularities as a result of the hair restoration procedure.

Controlling the depth of incision is also critical in making the recipient sites, as limited depth incisions minimize injury to the deeper blood vessels in the scalp, allow grafts to be placed more closely together, decrease tissue swelling after hair transplant surgery and facilitate healing.

We use fine hypodermic needles or a series of custom made, ultra-fine blades to create the hair transplant recipient sites. The chisel-shaped blades differ in size by increments of one tenth of a millimeter and range from 0.6mm for single-hair follicular unit grafts to 1.5mm for 4-hair follicular units.

Before site creation begins, the different size follicular units are fitted to specific site sizes to determine exactly the best size instrument to use for each graft. By custom fitting the sites to the grafts, healing is facilitated and our patients are able to return to showering and gentle shampooing the day following the hair restoration.

Donor Area

Minimizing the scar from the donor incision is a critical part of a successful hair transplant procedure. A fine donor scar allows a person to keep his/her hair relatively short after the hair restoration (if one wants to do so) and increases the amount of hair that can be harvested (removed) in subsequent hair transplant procedures if desired.

A number of techniques have been developed to minimize donor scarring when using a strip excision during follicular unit hair transplants. These include the use of tumescent anesthesia, undermining, absorbable sutures, buried sutures, staples, and trichophytic closures. The technique of FUE Follicular Unit Extraction, where follicular units are removed directly from the scalp without a linear incision, is covered in another section. Follicular Unit Extraction FUE.

Strip incisions are widely used because they enable the hair transplant surgeon to efficiently perform large hair transplant sessions and, at the same time, minimize damage to hair follicles. The reason this is possible is because the strip of donor tissue that is removed from the scalp is placed under a series of stereo-microscopes where the individual follicular units can be dissected from the tissue under direct visualization.

There are five main aspects to having the donor incision heal in a fine line; 1) placing the incision in the proper location 2) using the correct donor strip dimensions, 3) removing the strip without damage to the tissue, and 4) closing the donor area with impeccable surgical techniques, and 5) having a Board Certified Plastic Surgeon.

Position of the Donor Incision

The ideal placement of the donor incision is in the mid-part of the permanent hair zone located in the back and sides of the scalp. This area lies in a band that starts above the occipital protuberance (the bump felt in the middle part of the back of the scalp) and extends to either side in a gentle, upward sloping curve that follows the contour of the scalp. If hair is harvested below this region, there is a greater risk of scarring from the wound stretching, since the incision will be too close to the muscles of the neck. If the incision is above this area, the hair may not be permanent and may fall out as the baldness progresses.

Size of the Donor Strip

Although the length of the donor incision is determined predominantly by the number of follicular unit grafts required for the hair restoration, the width (height) of the donor incision depends upon the patient’s scalp laxity. This is a genetic attribute of the patient’s scalp that must be carefully measured by the hair transplant surgeon during the pre-operative evaluation. With good scalp laxity, a wider strip may be harvested from the donor area without the risk of scarring. If the scalp is too tight, taking a normal size strip may be impossible.

Donor Closure


The advantage of using staples is that, of all the donor closures, staples conserve the most hair. There are two main reasons for this. The first is that stainless steel staples are inert. This means that, unlike sutures, the body tissues do not react to them and therefore staples cause minimal inflammation (which has the potential to damage hair follicles). The second advantage of staples is that they are interrupted, in contrast to sutures which are used in a long running loop stitch. A running stitch had a tendency to strangle hair follicles, particularly if there is any swelling after the surgery. The use of interrupted staples avoids this potential damage to grafts.

The advantage of sutures had been that the surgeon had the most control in approximating (closing together) the wound edges. For a long time we felt that the better control of the wound edges offered by sutures outweighed its disadvantages. However, with new stapling techniques and modifying the time that the staples are left in the scalp, excellent wound edge approximation is achieved and the main advantage of sutures has largely been eliminated.

For those patients who will benefit from sutures, or for those who prefer them, we still offer this type of closure. This will be decided at your pre-operative visit.

Trichophytic “Tricho” Closure

In a trichophytic closure, the plastic surgeon makes the initial incision parallel to the hair follicles and then trims away 1 to 3-mm of tissue of either the upper or lower wound edge (or both), so that the top of the hair follicles at that wound edge are removed. During the “tricho” closure, the trimmed wound edge is pulled towards the opposite edge so that the bottom parts of the cut hairs are pointing slightly towards the incision (rather than parallel to each other). The goal is that these hairs will eventually grow through the incision and thus decrease the visibility of the scar.

Trichophytic closures generally require the wound edges to be sutured, although it is possible to get benefit with a trichophytic closure when staples are used. We are currently evaluating this combination of a trichophytic closure with staples. The advantage of this type of trichophytic closure is that staples enable the maximum conservation of donor hair.

close up of hairlines

Pursuing the Perfect Transplanted Hairline:

The scientific and artistic techniques that Washington Medical Hair Clinics provides allows us to recreate soft, natural, living hairlines that are virtually indistinguishable from the original hairlines that have eroded away. Your finished hairlines are so soft and natural, that only you should know.

Please call the office at 888-793-4769, email, or click FREE ONLINE CONSULTATION to schedule your private, free initial hair restoration consultation. Find out how easy and affordable it is to have your own growing hair back. We offer evening and Saturday appointments for your convenience.

Hair Transplants
the Right Way