For today, Follicular Unit Transplantation – FUT is the basic method in hair restoration surgery. In case of strip method donor material is taken from the permanent zone (the area in the back) in a shape of elipse. On the following stage, individual follicular units are prepared from the donor strip and then placed in premaked recipient sites (See: “what is hair grafting”).
Follicular unit transplantation gives an effective cosmetic outcome. The main reason is that hairs in case of FUT are transplanted in a form of follicular units exactly like in nature. Strip method gives an opportunity of harvesting and transplanting big amount of grafts, performing mega-sessions (in our clinic, in case of need, till 6000 follicular units during 5-6 hour lasting procedure). Wastage of follicular units (transection) during strip surgery is minimal and the survivability of transplanted grafts is high (90-100 %).
The only disadvantage of strip method is a linear scar which appears on the back of the head on the same area from where donor strip is harvested. Though, our method of the donor wound closure based on trichofitic closure excepts noticeable postoperative scars on the back of the head. The area from where the donor strip is harvested , is hardly observable even for the private barber (See: “about our clinic”).
On a preoperational, face-to-face consultation, Dr.Akaki Tsilosani examines a donor zone of the patient using computational scanner, Folliscope (Phototrichogram system) for hair and scalp checking.
Phototrichogram system helps doctor to define the hair density of the donor zone – quantity of follicular units in each square centimeter and the quantity of hairs in each individual FU. Checking also shows a ratio of growing and having rest hairs in phase’s anagen/telogen, the percent of the healthy and miniaturized hairs.
Surgeon signs separate follicular units on the monitor, and system automatically defines the quantity of follicular units in 1cm2.
Hair density of Mr.Han in 1cm2 is 80 follicular units.
Follicular units in Mr.Han’s case mainly are 1 and 2 hair. 3- Hair FUs are rare. Average quantity of hair, contained in per graft is 1,64 Dr.Akaki Tsilosani explains to Mr.Han that in reality this index is lower than medium, but it is characteristic for the Asians, especially for Koreans.
Data’s that phototrichogram analysis give, helps surgeon to determine the sizes of the donor strip.
Scale of Han J.H’s surgery is minimum 3000 graft (follicular units) transplantation.
Now doctor divides 3000 (figure of grafts that are needful to be transplanted) on 80 (figure of follicular units in 1cm2 ) and formulates needful sizes of the donor strip for harvesting 3000 grafts.
Thus, for getting 3000 grafts, surgeon must harvest donor strip not less than 37, 5 cm2.
Patient’s hair is prepared for starting procedure of transplantation.
Patient’s hair trimmed up to 2,0mm on 40 cm2 area.
Doctor examines scalp laxity.
Presumable length of the donor strip is up to 20cm and average width 2,0cm.
Doctor Tsilosani paints the future hairline of the patient.
Foreseeing patients wish, doctor slightly lows lateral sides of hairline.
Doctor Tsilosani agrees with patient about the hairline design – a bit flat hairline looks better in Asian patients.
Doctor starts making local anesthesia.
Surgeon starts excision of donor strip.
After excision, surgeon prepares wound edges for trixophitic closure.
Surgical team closes donor wound.
During this time, our surgical assistants prepare grafts. At first they prepare slivers from the donor strip and then separate grafts.
In our clinic, we use stereo-microscopes, which are of 20X magnification. It helps surgical assistants to prepare refined grafts practically without transection.
Each surgical assistant-cutter in our clinic prepares 200-250 follicular units (grafts) per hour.
8 surgical assistants, who take part in surgery, need 2 hour for preparing 3000 grafts.
At the same time, Dr. Akaki starts creating recipient sites along the hairline.
Special automatic system, which was created under Dr.Tsilosani’s guidance, automatically counts recipient sites in a process of their creation.
In case of Mr.Han’s surgery, Dr. Tsilosani uses mix of two different techniques of creating recipient sites: In hairline area and the front area – sagital (vertical) recipient sites for refined 1-hair and 2- hair grafts. In midscalp and crown area he made – coronal (horizontal) recipient sites for large 2-hair and 3-hair grafts.
Final stage of hair transplantation procedure is – graft placement.
Experienced surgical assistants carefully take grafts from container with special jeweller’s forceps.
Assistant with masterly movement places graft into the recipient site.
3 mostly experienced assistants take part in this step of surgery process. Each of them places 12-15 graft per minute. One team fills up to 40 recipient sites per minute. Though, for transplantation of 3000 grafts, our assistants need 75 minute ( 1 hour and 15 minutes)
Mr.Han's surgery totally lasted for 3 hours and 15 minutes.