The techniques in hair transplantation

There are currently 2 ways to get hair follicles:

FUE

FUE (Follicular Unit Extraction): using a small cylindrical punch (less than 1 mm in diameter), grafts of the follicular units are obtained one by one. It leaves no linear scar so it even if the hair is completely shaved off in the future, no scar will be seen. No stitches need to be removed.

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FUSS

FUSS (Follicular Unit Strip Surgery): A 1-1.5 or 2 cm length strip is obtained (for its density and elasticity role) from the posterior and lateral area of the scalp, then closed with the trichophytic closure technique. Stitches are removed within 10-12 days.
The strip is processed under the microscope to make the follicular unit grafts using various techniques, allowing for sessions of up to approximately 4,000 grafts (9,000 hairs). As a result there is a thin scar in this area that is aesthetically invisible unless it is scratched, since there would be a change of coloration in the skin. Before transplantation (1 month – 15 days) it is convenient to massage the scalp to improve elasticity, resulting in virtually invisible scars.

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Comparison table between the FUSS technique and the FUE

FUE TECHNIQUE

● Need to shave the hair to perform the intervention (in the center itself).
● More limited number of follicular units that are obtained per day (3.000), so if more grafts are needed it will take 1 and a half consecutive days
● Multiple imperceptible microcrystals that allow shaving to 0mm.
● Fast healing that does not require stitches.
● Very useful technique when there is little elasticity in the donor zone.
● Choice of donor area is greatly increased, even with the risk of obtaining grafts from the “unsafe” (non-removable) area.
● Somewhat higher cost.

FUSS TECHNIQUE

● No shaving needed prior to the intervention, the scar is covered by the hair.
● Greater number of grafts are obtained per session (a day).
● Massage + Trichotic closure = practically invisible scar although does not allow shaving to less than 3 mm.
● Need to take out stitches after 10 days.
● Requires some elasticity of the scalp (Previous massages).
● All grafts are obtained from a “safe” donor site (follicles that will not fall out).
● It requires less time to transplant the same number of grafts.
● More economical for the same amount of grafts.

Transplant in the man / Transplant in the woman

Man

● Generally alopecic zones are more extensive and with little or no density.
● Variable hair. In case of very thick hair, only the first line will contain grafts of 1 follicle.
● Donor zone highly variable.
● The objective is primarily naturalness and undetectability.
● The grafts should be of all sizes for an optimal aesthetic result.
● Generally the donor area allows transplants of 3.500 – 4.000 grafts.

Woman

● Generally showing signs of diffused alopecia, with dense hair first and a well-defined hairline.
● Generally fine hair, aesthetically allowing for grafts of 3 and 4 follicles.
● Often the donor area is also poor.
● The objective is primarily the density of the central area of the head.
● The grafts should be from follicular units of 2-3/4 hairs.
● Because of the above, transplants are generally around 1,800 grafts.

What is trichophytic closure?

Trichophytic closure is a surgical technique for wound closure that allows hair growth through the scar later.

If prior to the intervention (20 days before), exercises or exercises on the back and sides of the scalp, the resulting scar will be virtually invisible.

Graft Implantation Technique

Through the use of micro-scissors whose length and width are in function of the length and width of the graft (1 mm or less), the incisions are made in the scalp where the follicular units will be housed.
During this process, the following is determined:

1- That the hair density of the transplanted area will be greater or less than the area to be repopulated depending on the number of follicular units that can be obtained from the donor area. If these two factors allow us to use the dense packing technique packing (defined as the insertion of greater than 35 follicular units / cm²).

2- If the direction of hair is same as the surrounding hair or if it would grow in a different direction.

3- The angle at which the hair will grow.

Both the angulation and the direction of the hair that will grow will be determined by the hair that is still present or, in its absence, taking the natural hair growth pattern into account.

Dense Packing

Dense packing is a graft implantation technique that allows us to obtain densities greater than 30 grafts / cm2, ensuring the viability of the grafts.

In the Trius Institute we have performed the technique with 45 grafts / cm2 obtaining good density in the transplanted area.

It is not always possible to perform this technique, it depends on the size of the area to be repopulated to see if it can be done or not, we’ll advise you.

The design of the first line is crucial to achieve an absolutely natural result therefore:

1- The first line is in zig-zag form, just like naturally growing hair in this area.

2- The incisions are smaller than 1mm wide to accommodate follicle units containing only 1 follicle.

The design of the crown is as important as the picture above so that the transplant is not detectable from any angle.

With the crown, it is essential to reproduce the angle and direction of the hair growth as it varies constantly depending on the swirls, in the case there aren’t any, they will be recreated. For this purpose it is important to provide photographic material in which show the growth lines of when there was hair.

Graft Packages

In order to offer fine grafts, a large surgical team is needed, formed by several technicians equipped with magnifying glasses or magnifying microscopes, who are well trained in the art of dissecting perfect grafts.

At the Trius Institute we use specially designed magnifiers for each of the components of the team, benefiting from:

1. Adequate lighting of the work area
2. Ergonomic posture, reducing fatigue and improving work speed
3. Perfect vision both to make the follicular units and to insert them into the incisions (implants)

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