Hair Transplantation Follicular Unit Transplant Method
Authored by Bobby L Limmer, MD, Professor, Department of Dermatology, University of Texas Health Science Center
Bobby L Limmer, MD, is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Cryosurgery, American Medical Association, American Society for Dermatologic Surgery, and Texas Medical Association
Edited by R Stan Taylor, MD, Associate Professor, Department of Dermatology, University of Texas Southwestern Medical School; Richard Vinson, MD, Chief, Department of Dermatology, William Beaumont Medical Center; John G Albertini, MD, Clinical Assistant Professor, Department of Dermatology, University of Texas Health Science Center at San Antonio; Chief, Mohs Micrographic Surgery, Department of Dermatology, San Antonio Uniformed Services Health Education Consortium; Joel M Gelfand, MD, Staff Physician, Department of Dermatology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Hospital; and Dirk M Elston, MD, Consulting Staff, Department of Dermatology, Geisinger Medical Center
Surgical hair restoration has followed a logical course to follicular unit transplantation. The concept of redistributing hair in naturally occurring units of 1-4 hairs exactly as nature grows it should have been recognized and used by the hair restoration community earlier than 1988. The finding that hair grows in naturally occurring groupings of 1-4 (and rarely, more hair) has been known for many years. The histopathologic definition of the follicular unit was defined clearly by Headington in 1984. Nevertheless, modern surgical hair restoration techniques ranging from Orentreichís description of punch autografting in 1958 to Limmerís first use of follicular units in 1988 were completed via unnatural groupings of natureís building blocks, resulting in a recognizable pluggy product.
By definition, follicular unit transplantation is the redistribution of naturally occurring follicular groupings (follicular units) to the bald zone. The groupings are removed from the donor area by single-bladed elliptical excision and carefully and microscopically dissected beneath the binocular stereoscope. The donor tissue is trimmed into follicular units, removing the bald tissue between the units that contains no hair follicles. Then, the follicular units are reimplanted into the bald recipient zone using a needle tunnel or small slit incision. To minimize damage to the recipient vascular supply essential to the survival of grafts, bald tissue is not removed from the recipient zone. Relatively dense packing during the first session is usual (20-30 grafts per cm2) to create a cosmetic result that can stand on its own if no further procedure sessions are completed.
This methodology is unique among hair restoration procedures because of the following:
Other methods of transplantation group the naturally occurring follicular units into unnatural-appearing aggregations (clumps, tufts, plugs), always resulting in an unnatural tufted visibility of the final product, which requires multiple additional sessions to hide the unnatural appearance. Such restoration procedures include standard round or square plugs and all forms of minigrafts (round, square, triangular, oval slots, linear slits, strip grafts).
Flaps move follicular units in their original form but do so at great cost in terms of limited coverage, possible substantial donor and recipient site scarring, risk of partial or total flap necrosis, and highly inefficient use of precious and irreplaceable donor hair. Such donor hair may be used more effectively to cover larger bald zones as male pattern baldness (MPB) progresses, which is the natural history of this process.
Designing the Hairline | Female
| Follicular Grafts |
Hairline Dr Shapiro |
The Hair Replacement Revolution |
Guidelines for Hair
| Hair Restoration for Men
with Advanced Hair Loss
Are Fullicular Units | How
FU Transplants Work | Corn
Row Correction | Hair Transplant