Follicular Unit Hair Transplant

Hair transplant in modern times was probably first described by a Japanese plastic surgeon Akuda as a reconstructive procedure in his burn patients. He used to harvest hair plugs from permanent donor area which were then implanted in scarred areas of scalp. It was not used for male pattern baldness. However, due to censorship applied during WW II, these reports and techniques were not available to the rest of the world.  Dr. Norman Orentreich in New York City was the first to use this technique for male pattern baldness in 1950s. He laid the foundation of modern hair transplants and defined the basic principles of hair transplant. He noted that the hair coming from the permanent zone maintained the characteristics and growth pattern of the area from where it came rather than changing to the implanted area characteristics. He called it the 'principle of donor dominance' which is the fundamental feature of hair restoration surgeries. This image is from Dr. O'Tar Nor...

In simple words donor zone is the area from where the tissue is being borrowed for placement in another location. In hair transplant this is a ribbon shaped area centered over a bony prominence in the skull called occipital protuberance. This area described as  "Universal Safe Zone"  forms the basis of hair restoration surgeries. It extends from the area around ear going back towards temples over to the occipital protuberance and is best seen in Norwood VII patients. Norwood VII is the "Universal Safe Zone" for scalp hair. The height of donor area is around 5-6 cm in midline and it is approximately 30-35 cm long. If we were to utilise all of it there would be no hair left in the donor zone of a class VII patient. However, it is possible to utilise around 50% of this hair without a visible reduction in hair density on the back. This means a total usable area of around 90-100 square cms.  Assuming an average density of 100 FUs /cm squ...

Recently, there has been a flood of hair transplant clinics who are willing to do transplants at  ridiculously low prices. As a consumer, you think this is because of growing competition in the field. And like other commodities prices had to fall one day. You are happy that now the procedure is within your 'budget' and you quickly get a transplant before you lose this golden opportunity. Few months pass by and you see some hair growing. You are overjoyed by this new growth and give yourself a pat on the back for a wise decision. Few more months pass by, and you don't really see the results you expected. You talk to your hair transplant physician ( who you now realise is just a general surgeon or not even that) and he reassures you of great results in few months time. This patient received ' state of the art'  'No stitch No scar' transplant at a leading clinic in New Delhi. Two years later his whole scalp is scarred, hairline is low a...

For contemporary hair transplants, there are two basic methods of harvesing donor hair. The conventional strip technique and follicular unit extraction. In Follicular Unit Extraction (FUE) technique donor hair are harvested one by one and is therefore more labour intensive. During this technique a small micropunch usually sized 1mm or smaller is used to isolate a group of hair from its skin attachments. These groups having one to four hair, called follicular units, are then gathered (pulled out) from the head. This leaves a pin point wound from the area of harvest. In this way the hair are taken out one after another, until adequate number of hair required for that session have been harvested. This surgery is done at a "micro" level and requires 8X magnification and expert hand control. Since FUE procedure requires careful and delicate handling, it is possible to harvest only 1200-1500 follicular units per session. An average session may last 8 hours and may need to be...