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Follicular Unit Hair Transplant Surgery

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What are Follicular Units?

Human hair grows in tiny bundles called follicular units. The follicular unit from an adult human scalp consists of between one and four terminal (full thickness) hair follicles. In areas of the scalp affected by genetic balding, the healthy terminal hairs gradually grow finer in thickness and shorter in length, which is called "miniaturization" of hairs.

In addition to the full terminal hairs, follicular units contain one or two fine vellus hairs, sebaceous glands, a small muscle, tiny nerves and blood vessels, and a fine band of collagen that surrounds the unit (the perifolliculum). The follicular unit is thus the hair bearing structure of the skin and should be kept intact during the hair transplantation process to assure maximum growth.

The follicular unit is seen on the surface of the scalp as a tiny group of hairs that appear to be growing together. They are best viewed under a microscope where they are seen as well-formed structures in the skin.

What is Follicular Unit Hair Transplantation?

Follicular Unit Hair Transplantation is a technique that was pioneered during the late 90s, in which hair is transplanted from the permanent zone in the back of the scalp into areas affected by genetic balding (and some other types of hair loss), using only naturally occurring, individual follicular units.

Rick Edwards during procedureIn order to remove follicular units from the back of the scalp without damaging them, the donor tissue must be removed in one piece. This "single strip" harvesting technique was first described by Dr. Brandy in the article, "A Single Scar Technique for Donor Harvesting in Hair Transplantation," which was published in the American Journal of Cosmetic Surgery. This innovative method of harvesting is an essential component of follicular unit hair transplantation, as it not only preserves the follicular units, but also prevents damage (transection) to the individual hair follicles. Dr. Brandy has further developed this technique by inventing a multi-bladed scalpel, which affords patients a cleaner incision that heals leaving one fine scar in the donor area.

Another essential component of Follicular Unit Transplantation is the dissection using stereo-microscopic dissection or loupe magnification. With these techniques, the follicular units are removed individually from the donor tissue to avoid damage. Stereomicroscopic dissection and loupe magnification have been shown to produce an increased yield (as much as 30%) of both the number of follicular units, as well as the total amount of hair.

A major advantage of follicular unit transplantation (besides preserving follicular units and maximizing growth) is that it allows the surgeon to use tiny recipient sites. Grafts comprised of individual follicular units are small because follicular units are small, and because the surrounding non-hair bearing tissue removed under the microscope is not transplanted. Follicular unit grafts can be inserted into tiny needle sized sites in the recipient area that heal in just a few days, leaving virtually no obvious scars.

When performed by a skilled surgical team, Follicular Unit Hair Transplantation can produce totally natural-looking hair transplants that maximize the yield from the patient's donor supply to give the best possible aesthetic results. Because the tiny follicular unit grafts (and the very small wounds they are placed in) allow large number of grafts to be safely transplanted in one procedure, the total restoration can be completed in the fewest possible sessions.

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Dominic A. Brandy, MD & Associates
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