It is true that initially, hair transplantation was one of the most flawed, and unethical procedures in the history of cosmetic dermatology.
Punch grafting and Strip Harvesting were the traditionally performed techniques. The flaws with the procedures included
- Unplanned incision and excision techniques
- Use of large chunks of hair grafts than is natural
- No use of vasoconstriction
- Performed under general anaesthesia causing post op nausea and adding to the trauma
What Has Changed
The understanding of follicular grafting has everything changed about the techniques of harvesting donor hair, hair graft dissection as well as the use of anaesthesia.
The ideas of the former techniques of strip excision and punch grafting have stayed, but the former techniques are outdated. The new improvisations include—
Follicular Grafting— Naturally, hair grows in groups of 2-5hairs called follicular units. The units are identified after microscopic viewing, and are extracted accordingly instead harvesting of random hair plugs. The distinct procedures Follicular Unit Transplant (FUT strip procedure) and Follicular Unit Extraction (FUE) are developed to make the graft dissection minimally invasive.
Follicular Unit Transplant (FUT) — It derives from the strip procedure, but in a less invasive manner. Instead of a multiple bladed incision, a single bladed scalpel is used to take off the donor strip of skin. Sometimes, if more donor hair is required, then a second strip may be made just above or below the former wound, by increasing the height of the total wound, rather than create two rows. This is procedure is ideal for patients that have a large area of baldness to cover, and have a good density of donor hair and a flexible scalp skin laxity. The donor closure technique such as the trichophytic closure, offers least scarring potentials. As well as the use of stainless steel staples or dissolvable sutures instead of regular sutures adds to it.
Follicular Unit Extraction (FUE) — This looks a lot like the old punch grafting technique, but so less invasive that it hardly resembles. Tiny micro-punches are used to pluck our individual hair follicular units containing 1-5hairs. This results in pinprick scars, something very different from the punch graft holes. Scalp laxity is also a factor with this procedure that determines the potential for the wounds to shrink and disappear overtime. With the advent of Robotic FUE, and NeoGraft Techniques, this procedure does not only yield donor hair from the back of the scalp, it can also harvest body hair. The possibility of 1haired grafts, FUE is also performed for eyebrow hair and facial hair restoration significantly.
Use of Local Anaesthesia— The surgery becoming minimally invasive, doesn’t’ require general anaesthesia, thus cutting down on hair transplant cost.
Use of vasoconstriction— Epinephrine mixed with local anaesthetics are injected to the donor zone, that shrinks blood vessels and prevents excess blood loss.