The principle of the autologous hair transplant is simple ; it involves removing from the donor area of the scalp (usually the part in back of the head) hair which we know is genetically programmed to ensure normal cycles for life and thus to never fall out, for the purpose of reimplanting it in the bare recipient area (generally the balding areas above the temples and the crown of the head also called the vertex) where it retains for life the ability to grow, with the longevity characteristics of the donor area.
Since the donor and the recipient are the same person, there is no risk of rejection. A hair graft from another person or a heterologous graft would be possible, on the condition of finding a perfectly compatible donor and taking an immunodepressor treatment to avoid any rejection, which seems very difficult and excessive, considering the significant side effects risked.
An autologous hair transplantation is thus a redistribution of the "hair asset" which the doctor will try to optimize to the utmost in terms of the condition of the hair and the age of the candidate for an autologous graft. In fact, although the hair reimplanted in the recipient area retains its normal cycles, as we have seen, it is clear that the pre-existing hair next to that hair will inexorably end up by falling out forever, requiring one or more new grafts, on the condition that the donor area is still dense enough with transplantable hair. This results in the concept of the operating strategy of the doctor, who must be able to extrapolate the medium- and long-term progress of the hair.
Recent progress in hair micro-grafting
Progress in hair grafts over the past five years has considerably improved the quality of transplanted hair: the density, natural appearance and homogeneity of the implants now constitute a real solution offered to men and women who no longer accept watching their hair inexorably grow thinner
A graft of hair has become a graft of follicular units, providing totally natural density that blends in with the rest of the hair, thanks to following the nature of the patient's follicle. Gone is the doll's hair look or the corn rows of the 80s!
A follicular unit is a natural group of 1 to 4 hairs (although 18% of the follicles are single, a majority of 57% are by groups of 2 hairs, 21% by groups of 3 and only 3% by groups of 4 hairs). The follicular units are distinct anatomical entities, but each hair inside the unit has its own follicle.
The two autologous micro-graft techniques most widespread throughout the world
Two primary techniques of autologous hair micro-grafting are performed today throughout the world
The one known as the Strip Technique, also called F.U.T. (Follicular Unit Transplantation): the technique most widely used by hair transplantation specialists.
The one known as the punch or direct technique and often called F.U.E. (Follicular Unit Extraction), which has more and more adherents since it is much less invasive than the strip technique.
These two hair transplantation techniques have the same objective: to implant in the recipient areas grafts (follicular units) taken from the donor area.
They only differ in the way the grafts are extracted:
With the F.U.T. technique, one or more strips of scalp are removed from the donor area then cut into grafts before being reimplanted in the recipient area. The phase of extracting the strips and then suturing is a surgical procedure performed in an operating room with local anaesthesia by a surgeon. The manual phase of cutting the strips into grafts is long and tedious; this is why it is usually performed under a microscope by a team of people specially qualified for this type of cut. Manual re-implantation of the grafts is performed by a practitioner by inserting the grafts
With the F.U.E. technique, the grafts are extracted manually by a punch in the donor area then directly reimplanted using a tweezer, into the incisions in the recipient area. This can be performed by a non-surgical doctor in a private office simply under local anaesthesia. The only disadvantage compared to the strip technique is the time it takes.
While the F.U.T. technique is restricted to advanced stages of male baldness, the F.U.E. technique is more adapted to beginning baldness in men and diffuse alopecia in women. Its clearly less restrictive, less stressful nature at the surgical level explains its growing success due to an optimum aesthetic result.