The techniques of Follicular Unit Transplant (Strip) or FUT Strip Procedure have improvised in a lot many ways from the old traditional strip harvesting procedures.
The improvisations including microscopic follicular grafting, inclusion of tumescent local anaesthesia, lesser invasive incision methods and donor closure techniques make FUT procedure a worthwhile procedure, despite being the invasive type.
It is the most substantial technique in yielding large number of good quality donor hair and makes a large hair transplant session faster and more predictable.
About Follicular Grafting
Follicular grafting entails the identification and extraction of naturally occurring hair follicular units that are groups or units of hair follicles, with each unit consisting of 2 to 5hairs at the most that look like close knit bundles tiny dots through a microscope. These 2-5 hair units are extracted as a whole hair graft, with each hair graft consisting of a minimum of 2 hairs and the maximum of 5 hairs with a little fatty tissue of the scalp to be wrapped around them giving them moisture and a bind.
The old techniques having not the knowledge of the follicular units used larger hair grafts consisting of a minimum 5 hairs, and a maximum of 12hairs that was apparently unnatural.
Best Candidates of FUT
The actual full head coverage with the transplantation of over 2,500—3,000 hair grafts is best accommodated with the FUT technique, and in many cases it is obtainable within a 7-10hour session, cutting down on the total hair restoration cost. However, for patients that has a thin density of donor reserve, and then it is likely that the linear scar would be visible, and unwanted.
Ideal candidates for FUT are those who are at an advanced stage of androgenic alopecia, and have a good donor reserve at the back of the scalp and above the ears and have a flexible scalp to resist against scarring.
The strip surgery is not ideal for smokers, and those under certain medications, including beta blocker and blood thinning drugs.
The Course of the Procedure
After your initial consultation and adequate evaluation and hair loss tests, the patient will be instructed about some before surgery preparations, verbally explained by the surgeon as well as given printed leaflets. These instructions would typically include refraining from smoking, and avoiding certain drugs for a certain period of time such as, aspirins, beta blockers and blood thinning drugs.
On the day of the surgery, the patients are asked to wash their hair using normal shampoo, but avoid using any after wash products like conditioner, hair gel, oil, and such. Patients may have a light meal before the arriving for the surgery. Patients are restricted to have coffee or any caffeinated beverages on the day of the surgery, for it might stimulate blood circulation raising risk of excess bleeding.
As the patient arrives at the clinic, they are readily greeted and revised about the course of the procedure and how the day is going to be. They are given any oral sedatives prior to entering the operating room.
At the operating room the patient is seated at a comfortable recliner specially designed for this procedure. Just the area from where the strip is to be removed is cropped short or shaved followed by the injection of the local anaesthesia.
Use of Local Tumescent Anaesthetic
Traditionally, strip harvesting techniques used general ansesthesia in the 90s, wherein the patient was put to sleep and they didn’t feel a thing during the surgery. However, this technique was associated with lots of blood loss and invasiveness.
The improvised technique, now replaces general anaesthesia with local tumescent anaesthesia, wherein the patient can stay awake and watch a movie, or take a nap, without any discomfort. Meanwhile the tumescent agents prepare the donor zone, by constricting the blood vessels and capillaries and prevent blood loss to be very minimal.
The Local Anaesthesia is injected into the ring block of the scalp that goes on to numb the whole scalp at once. This way, there is no more excess blood loss associated with this procedure. Vibration injections are used to reduce any sensation of pain and make your surgical experience as comfortable as possible.
Single Blade Skin Excision
The use of single blade scalpels against the multiple bladed ones is a far less invasive and avoidant in causing wider scars. Performed by an expert’s hand, the opening of the single blade incision saves far greater number of hair grafts from transecting in way of the sharp razors.
As the skin strip is removed from the donor zone, the skin strip is then divided into smaller sections and placed under the stereo microscope to be dissected according to the natural follicular units along with a little fatty tissue to make individual hair grafts. The hair grafts are separated according to their numbers in separate dishes. The open dissection and microscopic vision makes the process fast and minutely precise, without sacrificing healthy hair follicles, as less as none. The hair grafts are then immediately placed onto a hypothermic holding solution of that mimics bodily fluids and placed onto cold storage.
The Donor Closure
The donor wound is closed using absorbable sutures or stainless steel staples. For tight scalp conditions, sometimes techniques like “undermining” is used, which is to separate inner tissues from the wound edges to relax tension. Trichophytic is another decent technique to minimize the appearance of closure, that systematically exices a little bit of tissue from the wound edges, allowing hair growth over the donor scar and camouflaging the scar at its best.
Creating Recipient Site
The creation of the recipient site is same as FUT, wherein tiny punches are used to slit the mouth of the receiving hair follicles and placed the hair grafts from the cold storage.
Completion of the Procedure
On completion of the procedure the patient are given a head band to bar any seeping fluid and blood, are discharged to go home as soon they please. Patients are given some post operative instructions and are recommended leaving the office with an accomplice. After surgery, patients are shifted to the list of further follow up sessions.