Hair Transplant FUSS or FUT Technique: Definitive Guide

FUSS or FUT Technique: Definitive Guide

The FUSS Technique or FUT Hair Graft Technique is considered an advance over older hair transplant procedures that used larger grafts.

Follicular Unit Transplantation (FUT Technique) is a hair restoration technique, also known as a "strip" procedure. In it the hair of a patient is transplanted into natural groups of 1 to 4 hairs, called Follicular Units (UFs), also known in English as Grafts). Follicular units also contain sebaceous (oil) glands, nerves, a small muscle, and occasionally fine hairs. 

It is also known as the FUSS Technique (Follicular Unit Strip Surgery)

In the FUSS Technique, these small units allow the surgeon to safely transplant thousands of grafts in a single session; which maximizes the cosmetic impact of the procedure, leaving an almost imperceptible scar on the scalp.

History of Hair Graft Techniques

The FUSS Technique of hair graft it is seen as an advance over older hair transplant procedures using larger grafts; for example, the "punching" technique and often produced an irregular and unnatural appearance; sometimes known as "doll hair". 

In recent history, the FUT or FUSS technique had been the most common procedure for hair restoration; since since the 70's it was practiced on a daily basis. According to the latest survey carried out by the ISHRS (International Society of Hair Restoration Surgery) in 2017, the most recent follicular unit extraction procedure, also known as FUE technique, has become the most common procedure.

In a properly performed follicular unit transplant (FUT), the results will mimic the way hair grows in nature; and they will be undetectable like a hair transplant.

FUSS technique
FUSS technique for hair transplant

Generalities

Follicular unit transplantation uses follicular units to achieve a number of critical goals for the hair restoration process:

Prioritize naturalness 

Follicular unit transplantation allows hair transplantation to look natural both at the level of the individual follicular unit and in terms of overall graft distribution. Since scalp hair typically grows in 1 to 4 hair follicular units, the exclusive use of these natural units in the FUSS or FUT Technique ensures that each graft is identical to the surrounding follicular units. Therefore, when transplanted follicular units grow hair after a transplant, the overall transplant results will appear natural.

Also, by using individual follicular units, rather than larger grafts, the surgeon has a greater total number of grafts to work with. This allows the surgeon to distribute the grafts more evenly over the scalp for a more natural overall distribution of hair.

Optimize the Follicular Units Extracted

Since the follicular unit is a distinct anatomical and physiological entity, its preservation is perceived intact during graft dissection to maximize growth. In the FUSS or FUT Technique, after removing hair from the back of the scalp in a single strip, stereoscopic dissection allows the individual follicular units to be removed from this strip without damage.

In older mini-micrografting techniques, hair was harvested into multiple strips with the follicular units on each edge of the strip showing damage by the harvesting blades. The strips were cut into smaller pieces, a process that would break the follicular units and risk damaging the follicles.

Allow the best boarding strategy

The density of natural follicular units on a normal scalp is relatively constant, measured at approximately 1 unit per mm2. This helps in planning a hair transplant in two ways:

The hair transplant surgeon can accurately estimate the number of follicular grafts that can be obtained by dissecting a donor strip of a certain size.

The same number of follicular units can be used to cover a bald area of ​​a specific size, regardless of the actual density of the patient's hair.

In patients with high hair density, there is generally a sufficient number of follicular units in the donor area to achieve the patient's goals. However, in the patient with low hair density, a compromise must be made, and this is guided by the constant follicular unit. By transplanting a patient with low hair density using the same number and spacing of follicular units as in a patient with high density, the transplant surgeon will produce a slimmer appearance, but will allow proper preservation of the donor's hair for future procedures. 

Reduce inflammatory and surgical aggression

The key to a natural-looking hair transplant is getting hair out of perfectly normal skin, so minimizing trauma to the scalp is an important aspect of follicular unit transplantation. This can be accomplished by trimming excess tissue around the follicular units; and then insert them into small receptor sites on the patient's scalp.

Follicular units are relatively compact structures, but are surrounded by substantial amounts of hairless skin. This additional tissue can be removed without damaging the follicles, using stereoscopic dissection. These small clipped follicular unit grafts can be placed in small incisions in the patient's scalp; Thus minimizing damage to the connective tissue of the scalp and blood supply. Unlike the larger micrograft wounds and "plug" transplants, they caused cosmetic problems that included dimpling and pigment changes in the skin; depression or elevation of the grafts; and a slim and shiny look on the scalp. These problems can be avoided by using very small grafts and very small recipient wounds.

Another advantage of making small recipient wounds is the ability to create a "perfect fit" for the follicular unit grafts. Unlike perforated grafts and some mini-graft techniques; each of which removes a small piece of tissue in the recipient area; The cut follicular unit grafts used in the FUSS Technique fit small incisions made with a needle without the need to remove tissue. This preserves the elasticity of the scalp and keeps the small grafts in place. After surgery, the snug fit facilitates wound healing and helps ensure that the grafts get enough oxygen from the surrounding tissue to maximize their survival.

Ability to perform large sessions of hair transplant.

There are a few reasons why the follicular unit transplant procedure (FUSS or FUT Technique) allows a hair transplant surgeon to transplant large numbers of grafts in each session:

Hair restoration can be completed quickly so that the patient has minimal interference with their lifestyle,

A larger number of grafts can compensate for the shedding that often accompanies a hair transplant, called telogen effluvium,

Using large amounts of grafts in each session preserves donor supply by reducing the number of incisions in the donor area,

Extraction of large numbers of grafts provides enough 1 and 2 hair grafts to create a smooth frontal hairline and enough 3 and 4 hair grafts to give the patient the most complete appearance possible. 

Related topics: Why is the Strip Technique, FUSS or FUT no longer used?

Trichophytic Closure / Approach

Unlike the normal FUT or FUSS Technique suture, the trichophyte closure allows practically imperceptible scarring on most occasions; avoiding the visible mark after the excision of the "Strip". This especially applies to younger people.

Trichophytic Closure involves butting the edges of the wound when suturing or stapling. One side of the existing skin is cut at an oblique angle, then the adjacent skin sides are brought together to close the wound. Due to the angle of the cut, these overlap. One piece of hair tissue is now below the other. The hair follicles then grow slowly through the tissue (i.e. the resulting scar), thereby hiding the scar and making the donor area look natural. 

This technique is also used in an initial FUSS or FUT Technique operation and is appropriate for reconstructive or corrective treatment. The success of trichophytic closure is not only dependent on the ability and experience of the hair surgeon, but also on the healing process and the characteristics of the patient's skin. Not every patient is suitable for a trichophytic closure.

Advantages of the trichophytic closure

When this closure method is used after a FUT or FUSS, it becomes quite possible for patients to wear short hair; ie 6 - 8 mm long. This means that this technique is an alternative to Follicular Unit Extraction or Excision (FUE technique) for patients who want to wear short hair. The trichophytic closure can also be used in patients who have had surgery with the FUSS Technique to improve the donor scar, in a second intention surgery. Additional advantages over previously used methods are that the scar becomes much finer, and that the method can be used in all commonly used transplantation methods.

Surgical Technique of the Procedure with FUSS Technique

Through a thin band of skin with hair about 15-20 cm long by 1-1.5 cm wide we obtain a high number of follicular units. The resulting scar through normal or trichophytic suture (with the latter it is practically imperceptible to the eye). 

With this FUSS Technique, fewer sessions could be required to achieve higher hair density, although it is a very interesting debate. It is very useful in women, because it is not necessary to shave the hair to proceed to the intervention; although lately women also prefer FUE Technique.

The intervention is performed under local anesthesia and on an outpatient basis, being its process from its beginning to its completion faster than the FUE technique.

Hair grafting with the FUSS or FUT Technique does not require any special preparation. The donor area is marked by varying the dimensions of the strip depending on the area of ​​alopecia to be covered in each patient. Sometimes it is recommended to do skin elasticity tests to provide some difficulty in closing and later lengthening it. 

The first results can be observed 3 months after the intervention and the definitive results at nine.

The FUSS technique is the most economical method and allows us to implant between 1.500-3500 follicular units (3.300-7700 hairs) in a single session.

Advantages of the FUSS Technique

It is a faster procedure compared to FUE Technique

It allows to extract multiple hair follicles at the same time.

Treatment used to be cheaper as it requires less work from the specialist team; although now the difference is not so clear.

Disadvantages of the FUSS Technique

You have to make a suture in the area where the skin and hair iron has been removed, so there will be a small scar. Which by the way, almost does not notice.

It has a longer postoperative period. This is because the suture is not removed until two weeks later.

Less survival of the follicles. Since there is greater manipulation of the Follicular Units and their passage through the microscope. 

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Dr. Enrique Orozco
Dr. Enrique Orozcohttps://dreoclinic.com/
General Director, Specialist in Trichology and Hair Transplantation Certified by ABHRS. Only ABHRS Certified with residence in Mexico.

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Dr. Enrique Orozco
General Director, Specialist in Trichology and Hair Transplantation Certified by ABHRS. Only ABHRS Certified with residence in Mexico.

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