It may seem confusing but in androgenetic alopecia (the term that signifies patterned baldness in men and women), the hair on the sides and the back of the head is immune from the hormonal and genetic mechanisms that actually cause and propagate hair loss. This allows the surgeon to “borrow” hair from the sides and back of the head and actually “move” or “transplant” the hair to the top where thinning and baldness occurs. And once this hair grows in its new location, it too, is still impermeable to the mechanism that foster thinning and loss and will “live” forever. This is the reason that hair transplantation surgery is a PERMANENT solution to hair loss.
There are several techniques that are at the surgeon’s disposal that allow this to happen. Follicular Unit Transplantation, or FUT, is a technique in which hair follicles are “borrowed” from the “donor” area on the back and sides of the scalp by removing a strip of hair bearing skin containing the follicles. The strip is usually 1/8 to 1/4 inches wide and the length depends upon the number of follicles needed. The defect is sutured and once healed should result in a very thin scar that blends into the skin well. This area is covered by the patient’s own donor hair and is not visible. The follicular units of hair are dissected from the strip using microscopy and implanted IN THE DIRECTION of hair growth on the top or “recipient” areas of the thinning/balding scalp. The newly implanted hair starts to grow within 3-4 months and attains full growth at 12-15 months. And as I have stated, this is PERMANENT! The FUT method is wonderful for obtaining grafts of varying sizes to add density in some places and finesse in others, like the hairline. It is a very valuable technique yielding consistently good results over long periods of time.
About 25% of patients undergoing FUT as described above complain of a “spreading” donor scar in the back of their heads. This lead to several techniques called Follicular Unit Extraction, or FUE. This technique can be performed manually by inserting a tiny punch over each follicle and manually extracting. However, the technique is cumbersome and fraught with complications in the donor area. The graft survival rates are not as good as FUT or the methods I will describe below. We do not perform “manual” FUE at the clinic for these reasons.
Enter the ROBOTIC era of Hair Restoration Surgery! Several companies such as ARTAS and NeoGraft and soon to be released SmartGraft have released “automated” FUE systems in which the follicles are extracted from the donor area one by one without any incision and without any need for sutures. Therefore there is no donor scar. These grafts are inserted into the donor area through a minute needle stick, again without a frank incision on the scalp. These procedures are designed to reduce recovery, swelling, pain and downtime for the patient. In using neoGraft or SmartGraft, the physician will actively guide the arm of the unit and position it over the chosen graft. The unit then extracts the graft with gentle pressure from the surgeon. ARTAS is actually a total robotic solution in that the physician controls the parameters such as depth of incision and choice of graft from a computer screen and the robot extracts the grafts by itself. In all of these robotic methods, the extracted grafts are inserted manually in the direction of hair growth. ARTAS is releasing a new hardware update which will allow the robot to insert the grafts.
Tomorrow we will conclude by critiquing each of the methods, weighing advantages and disadvantages for the patients.