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Reviewed by Vicky Davis, FNP
Written by Our Editorial Team
If you’ve noticed your hairline creeping back and have a suspicion that your bald spot is looking a bit shinier lately, there’s a good chance you’re part of the male pattern hairloss club.
We know… This club kinda sucks. BUT...
The good news is you have company — up to 85 percent of men will experience hair loss at some time in their lives, according to an article published in the book, StatPearls.
The better news is that hair loss treatments and solutions abound.
In this piece, we’ll explore what a FUT hair transplant is, what a FUE hair transplant is, who qualifies for these surgeries (and who doesn’t), the process, the cost, the benefits and risks.
Both are performed on an outpatient basis, but vary in invasiveness and recovery time.
For FUT procedures, healthcare professionals remove a strip of healthy, strong “donor hair” from your head where others may not notice it’s missing. They then place it to cover the thinning patch of hair. The main drawback of FUT is the linear scar it can leave on the scalp.
For FUE procedures, which is newer, healthcare professionals select singular hair follicles to transplant to another location on the scalp via “micro punches” that leave scars that are barely noticeable, according to an article published in the Journal of Cutaneous and Aesthetic Surgery.
While it can take longer to perform, for the sole reason of less visible scarring, FUE transplants are often the hair restoration route chosen by many men.
The name sounds complicated, but it’s actually pretty straightforward.
Follicular Unit Transplantation (FUT) is a type of hair restoration surgery that relocates hair in “follicular units” (aka naturally occurring groupings of hair), according to a chapter published in the book, Surgery of the Skin: Procedural Dermatology.
These units can contain one, two or three hairs and their associated skin, nerves, muscle and blood vessels.
The small size of the units allows for great versatility in where they’re placed on the head. Because of this, hair transplant surgeons can create hair patterns that closely mimic natural hair patterns.
The grafts are also large enough that a full restoration can often be achieved in just one or two sessions.
Other factors that should be considered are:
If you’re 25 or older, you’re a great candidate for FUT surgery.
As a general rule of thumb, surgeons should only operate on patients older than 25 because future hair loss patterns are more predictable.
Also, expectations for the outcome of surgery are generally more unrealistic in patients younger than twenty-five.
Men with thicker hair can expect to obtain much denser coverage — and therefore achieve better aesthetic results — versus men with thinner, finer hair.
Men whose scalp donor sites have greater than 80 follicular units per cm2 are excellent candidates and the outcome will be maximum fullness.
Men with donor hair density of less than 40 follicular units per cm2 are considered poor candidates for FUT surgery, and the surgeon should set expectations accordingly.
Men hoping to correct frontal baldness can expect the most dramatic success rate, and therefore represent the best candidates.
Expect your surgeon to reiterate that concentrating grafts in the frontal scalp will provide maximum long-term density and minimal aesthetic risk.
Men with lighter skin tones and lighter hair colors (i.e., blonde, red) are better candidates than those with black hair since the color contrast between hair and skin is less noticeable.
However, proper technique helps mitigate most problems with transplanting dark-haired patients.
Men with realistic expectations of results and a history of compliance with hair loss medications and treatments (i.e., minoxidil, finasteride, platelet-rich plasma) are ideal candidates for FUT strip surgery.
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As with all medical procedures, there are some potentially exclusionary criteria, or “red flags.” This includes men who have:
Unrealistic expectations of the surgery outcome
Certain mental illnesses
Donor site miniaturization
Unusual hair loss pattern
Many broken hairs
Unexplained or visible scarring
Scalp or skin pain, burning or itching
Now that you’ve read through the criteria, you may be thinking you’re a good candidate for FUT hair transplant surgery. The next step is to cover what the surgery will look like.
During the FUT hair transplant procedure, a surgeon cuts a strip of skin from your scalp, usually from the back of your head.
The exact size of the strip depends on the number of follicles needed to cover bald spots, but the strip usually doesn’t exceed one to 1.5 centimeters (0.4 to 0.6 inches) wide.
Once the individual follicles are removed from the strip, they’re re-inserted into your scalp.
Now, let’s run through the full hair transplant procedure so you can have a better understanding of what’s involved from start to finish. Here’s the step-by-step process:
Step 1. The surgeon will re-draw your hairline, mark the area of hair extraction and take photographs for your medical record. You may have the option of taking a sedative before surgery. Local anesthesia will be applied to your scalp to numb it.
Step 2. The hair at the donor site, where your hair is removed from, will be trimmed to about two millimeters.
Step 3. The surgeon will cut out the strip of skin with the hair follicles that will be used as a graft. You’ll stay awake during the extraction process. Determining the right size and location of the donor area maximizes the yield and prevents problems such as widened and/or visible linear scar.
Step 4. A technician will remove individual hair follicles from the strip and prepare them for transplantation.
Step 5. The surgeon will close your scalp with sutures.
Step 6. The hair follicles will then be inserted into the balding area of the scalp in a pattern that looks natural.
Step 7. An antibiotic and bandages will be applied to your scalp.
Most people see results from the surgery in six to nine months. However, some people have to wait up to a year to see results.
It’s important to note that between two and eight weeks after the surgery, the transplanted hair will fall out. This is normal.
By the third month, the hair may look thinner than before you had the transplant. Again, this is normal.
There’s no way around it — FUT surgery is expensive.
This hair restoration technique can run the gamut anywhere from $3,000 to $15,000 or more, depending on where you live, the individual surgeon, the complexity of the procedure and other factors.
In addition to the reinvigorated pep in your step knowing you have a full head of luscious hair, the number one benefit is that it’s a permanent solution to male pattern baldness.
That means you won’t ever need to worry about wigs, hairpieces, spray-on concealers and messy topical medications.
In general, complications after FUT hair transplantation are rare, given the vigorous blood supply to the scalp, which allows for quick healing and low rates of infection.
Nevertheless, potential risks include:
Swelling caused by excess fluids (edema)
Inflammation of the hair follicles (folliculitis) of the transplanted hair
Numbness of the scalp
“Shock” loss, an uncommon but concerning complication characterized by shedding of native hairs at the donor or recipient site. This is likely a result of stress and microtrauma sustained during the surgery and — most importantly — is generally temporary. Patients should receive reassurance that the majority of the hairs shed will return at three to four months.
Epidermal cysts and ingrown hair, which may set off an inflammatory response affecting the entire graft population.
Infection, which affects less than one percent of patients. Treatment includes exfoliating with warm compresses, twice-daily shampooing and antibiotics.
The Follicular Unit Extraction (FUE method) is a type of hair transplant that transfers individual follicular units of hair from your skin to balding areas or areas with thinning hair.
While this hair transplant method has a high number of grafts, there are no incisions, so the implantation of hair to the recipient area is practically seamless. For this reason, there is no “hair plugs” look that may come with the FUT transplant.
Both FUT and FUE techniques take about 8 hours on average. FUE sessions can be broken up into multiple 2-hour appointments. During the FUE hair transplant, hair is restored to the scalp by replacing dead hair follicles with new, healthy follicles that still have the ability to produce hair. Once complete, blood vessels support the transplanted follicles and new hair will grow in the transplant area.
According to an article published in the Journal of Cutaneous and Aesthetic Surgery, the FUE process is as follows:
Step 1. Your surgeon begins the process by trimming the donor area on the back of the head to 1-2mm.
Step 2. You will lie down on the operating table in the prone position and local anesthetics will be applied to the donor area. This means that, yes, you will be awake for the surgery.
Step 3. Once the local anesthetic kicks in, the excision of hair grafts will begin via small micropunches.
Step 4. Your surgeon will make several small incisions using a needle or similarly sharp tool in order to create a space for the excised hair follicles to be transplanted.
Step 5. Hair follicles will officially be inserted into the new incisions.
Step 6. The surgery area will be cleaned and bandaged, and you’ll be ready for recovery.
Since hair transplant surgery is most often deemed a cosmetic procedure, it’s rare for insurance to cover it — unless your hair loss is due to an illness (such as cancer) or an injury.
Hair restoration surgery price will vary based on your geographic location, who’s performing your surgery and how much donor hair is transplanted, but expect to invest between $3,000 and $15,000.
As you can see, costs can be drastically different, and one thing for sure is that they’re never a drop in the bucket.
But you can’t put a price on your self-esteem, so it’s important to weigh the pros and cons of this hair growth procedure.
Hair restoration surgeries performed by board-certified plastic surgeons are generally very safe.
Most often, the scalp may be tender and pain medication and bandages are enough treatment during the two to five days post-FUE transplant.
Avoid physical activities during this surgical procedure’s recovery time. You may have also heard about hyperbaric oxygen therapy as a potential recovery tool for hair transplants.
Within a month the transplanted hair may begin to fall out. The transplanted hair follicles should create new growth within a couple of months, and patients can expect up to 80 percent of hair to grow back, according to an article published in the Indian Online Dermatology Journal.
In all hair transplant surgeries, there’s potential that some or all of the hair grafts won’t “take” or regrow, or hair may grow back in uneven patches.
In either of these cases, healthcare professionals often recommend additional attempts.
Possible hair transplant surgery complications are often mild, but include:
Pain, swelling or bleeding
Cyst development at the suture site
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If you are struggling with male pattern baldness and are weighing out your options, you may be considering FUT or FUE hair transplants.
Both options are permanent and will leave you with a fuller head of hair. The main difference here is the approach to hair transplantation in general. While FUT transplants may be a bit more invasive, they are just as effective as FUE transplants.