Popular Techniques
for Hair Transplantation
at FMS
FUT is also called strip method or stitch method. It’s a gold standard method in hair transplant procedures till date though it’s an old method.
This includes harvesting a strip of the skin layer from the donor area usually from the back (occipital) area of the head above the nape of the neck in the so-called safe zone for harvesting.Strip measurements are variable with 30 cm being the maximum length and 1–2 cm width depending on skin laxity of the patient. However, the length and width are variable as per the indication of the case. At times we have to limit strip width to 1 cm if the skin laxity is limited. Usually a strip of 30 cm in length and 1.5 cm in width will give around 2000–3000 grafts depending on the hair density of the individual.
Assessment of the Donor Hair
Hair transplant outcomes will greatly depend on the donor hair quality and quantity.
The important factors that the clinician has to bear in mind are as follows:
- The number of grafts that are present per square centimetre. Few individuals have thick density being good or best donors, with the number of grafts per sq cm varying between 25 and 65 grafts on an average in healthy Indian adults. Usually, the occipital area has thick density whereas the parietal area has less density.
3. Donor skin area, Few individuals have a large donor area as their scalp size is larger while a few individuals have donor bearing area which is smaller. This entity will decide the number of grafts that are available for harvesting. Shaft diameter Individuals with thick.
4. Shaft diameter will have better density and the outcome of the results is enhanced.
5. Skin laxity
Donor Site Preparation and Anaesthesia
- Trimming is essential in the donor site to harvest the strip and the team member in charge of the preparation ensures trimming the hair to 3 mm all over the scalp.
- The next step is to wash the scalp.
- The donor area strip length and width to be harvested are marked out based on the skin laxity tests and depending on the individual’s follicular density per square cm.
- Once the marking is done, local anaesthesia is administered to the donor area, usually preferring field blocks in that area.
- With betadine solution.
- The harvesting of the strip is done with the patient in prone posture following the standards of care with an iv line, monitoring of the vitals with a 3 parameter monitor, and following a dose of prophylactic antibiotic under aseptic conditions.
- The strip that is harvested is preserved in cold saline on a petri dish at 4°C.
- Wound closure is done (Trichophytic Closure).
How do we prepare the graft for transplantation?
Slivering is a process where the strip is sliced into small bits of tissues with rows of hair follicles in them, through meticulous deft handwork. It is the first step of the separation of grafts from the strip while avoiding any transection of the graft. Higher magnification is used to perform this important step.
At the end of this step, we get slivers which are ready for the separation process of the individual grafts. For this process, we use 3× magnification which can be done on a sterilised wooden spatula or an acrylic illuminated sheet. All skin has to be trimmed and removed from the graft and finally these prepared grafts are preserved in cold normal saline around 4–8 °C temperature. These are segregated further in different bowls and are used up for implanting starting with single units for the frontal hairline and progressing on to multiple follicular units as we go posteriorly in a progressive manner.
Follicular Unit Extraction (FUE)
In this technique, we extract the individual follicles one graft at a time with the help of small punches. Also known as no stitch and no cut method, it’s a minimally invasive procedure compared to the FUT. The advent of FUE has expanded the scope of harvesting follicles from other sites of the body like beard, chest hair etc. Most of the Indian skin is favourable for FUE procedure because of thicker skin types.
Hairline
The hairline design and location are the most critical factors in the success of hair transplantation.
The Recipient Sites Preparation and Implantation of hair follicles
Recipient sites are prepared to receive the grafts by making slits in the skin with either special needles or microblades. This step could be done prior to implantation for all the grafts (pre-slit method) or individually for each graft while simultaneously implanting it (stick and place method).
Once the slits are done, implantation is done by using jeweller’s forceps, which are pressure graded. Implantation of 3000 grafts by forceps would need around 3–3.5 h approximately
Combi Technique
Recipient sites are prepared to receive the grafts by making slits in the skin with either special needles or microblades. This step could be done prior to implantation for all the grafts (pre-slit method) or individually for each graft while simultaneously implanting it (stick and place method).
Once the slits are done, implantation is done by using jeweller’s forceps, which are pressure graded. Implantation of 3000 grafts by forceps would need around 3–3.5 h approximately
Post-operative Care after hair transplantation
- Immediately after the procedure, little heaviness, numbness or tightness may be experienced for a few hours.
- Mild swelling on the forehead and temple area is normal.
- After the procedure, antibiotics and analgesics are provided for 5 days.
- Patients are allowed to sleep on the back or on the sides.
- Patients are asked to massage the forehead from the middle to the sides for 5 min every hour for the first few days.
- Patients are restricted to perform any contact sports/ gymming for a period of 12 days and should avoid swimming for up to 3 weeks.
- They should also not get to field work under the sun for the first 3 weeks.
- Topical minoxidil can be restarted in the transplanted site after a waiting period of about 15 days post-operatively.
- Patients are forbidden from riding a bike or driving in an open vehicle for up to 2 Patients who ride a bike are allowed to wear a helmet only after a period of 4 weeks.
- Patients are advised to sprinkle or spray normal saline over the grafts every 3–4 h for 8–10 days.
- Suture removal is performed on the 11th day.
- Initially for 10 days the grafted area should be washed without rubbing the grafts.
When do you see hair Regrowth after transplantation?
After 11–20 days your new implanted hair will shed. Now the new follicles are in its dormant (sleeping) stage. There will be a lag phase before hair growth is initiated. Complete growth can be seen only as late as 8 months and hair continues to grow until 12–14 months.