Is the Strip Harvesting of Hair Implants Going to Go?

The first hair transplants were conducted in Japan back in the 1930s. In the old days of hair transplant surgery relatively large strips of skin of four millimetres in diameter, the so called punch grafts, were transplanted from the back of the scalp to the frontal balding area. Hair transplantation techniques have evolved enormously since then and today’s hair transplants can give you a very natural look. This is due to the miniaturisation of hair transplants, which now contain only one hair follicle (holding between one and four hairs) and are less than one millimetre in diameter. These tiny, single follicular unit grafts are then implanted into the needle-made incisions in the balding area. Today’s technology enables dense packing of hair follicles, which gives you a completely natural-looking frontal hairline. Gone are the days of pluggy grafts that made you resemble a toothbrush.

The two main hair transplantation technologies that are used today are called Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). The main difference between them is in harvesting hair follicles. The FUT is the older method, using the so-called strip harvesting, when a linear strip of skin of up to 20 centimetres long and 1.5 centimetres wide is extracted from the back of the scalp and the opening is then sewn closed. This strip is then placed under series of microscopes and dissected into small grafts, containing just one follicular unit each and measuring max one millimetre in diameter. Such follicular grafts are then implanted into the balding area. The advantage of this method is its high yield, measured as a percentage of the follicles that are successfully transplanted into the bald area. This yield is around 98%. The greatest weakness is that it leaves the patient with a linear scar at the back of his head. The FUT is less expensive than the FUE and is used when a large area needs to be filled with transplanted hair in one single session.

The FUE method uses a micro-extraction technology to harvest individual hair follicles that can be directly implanted into the small needle poke holes in the bald area. The FUE technique is the latest technology, introduced in 2002. Its greatest benefit is the fact that it leaves the patient with only tiny scars at the back of the head, which are visible only after very close inspection, and the healing time is much shorter than with the FUT, due to the small size of the wounds. However, this method is not suitable for covering large areas in one session and it is more expensive. Additionally, its yield is significantly lower, due to the transaction of many follicles, and since the supply of donor hair is limited, it cannot be used in patients whose hair loss has progressed above NW4 level.

Potential future surgical hair restoration technologies, such as hair multiplication and the generation of new hairs in wounds, should solve the problem with the limited amount of donor hair. It seems that hair implantation will in the long future only be used for creating frontal hairlines and, therefore, the follicular harvesting should manage to provide a sufficient number of hair implants. However, none of the aforementioned potential future techniques is expected to become commercially available before 2012. Therefore, the immediate future probably lies in improving the harvesting techniques of the FUE technique in order to improve its yields and make it financially more affordable. The FUT with its strip harvesting, which sparked a revolution in the hair transplant industry less than two decades ago, may become history in the not too distant future.

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