Our vanity needs to be appeased every so often - and hair loss gives many of us a lot of grief, regardless of the cause. One of the fastest-growing segments in hair restoration procedures has been hair transplants. As projected by the global market research firm, Allied Market Research (AMR), the global hair transplant market will reach $30.13 Billion by 2031. These estimates are driven by the rampant cases of androgenic alopecia or male pattern baldness, the rising awareness of our physical appearance and the advancements in technology in the hair transplant segment. 

Dr Manoj Khanna, one of India’s leading Plastic, Aesthetic and Cosmetic Surgeons, and an expert in hair transplants, with celebrities such as Harsha Bhogle and leading cricketers etc as his clients, says that owing to the recent advancements in the healthcare industry, hair transplantation surgery has emerged as an extremely safe procedure. Hair transplantation doesn’t have side effects. The operation, he points out, is on the scalp outside the skull bone and the brain is inside the skull, so there are no adverse effects of hair transplantation. The hair transplant practice is dominated by two procedures–Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). Dr Manoj Khanna specialises in both the techniques of FUT and FUE. 

What is the FUE method?

Since Follicular Unit Extraction (FUE) is a minimally invasive hair restoration technique, it’s an easier technology than FUT; it doesn’t require surgical skills–just some hand-eye coordination to cut the hair follicle till the muscle which holds it. The procedure can be done by dermatologists, gynaecologists, neurologists etc. Hair follicles are extracted under local anaesthesia, from the back of the head from the permanent hair growth area (‘donor area’). Follicular units have to be harvested individually and directly from the scalp with a series of micro-punches by the physician with a hand-held punch. The FUE method is suitable for covering a small area.

What Is The FUT Technique?

Also known as the ‘strip’ method, Follicular Unit Transplantation (FUT) is a process by which a long, slim strip of tissue is removed from the back of the scalp from the permanent hair growth area. This is an invasive procedure, Dr Khanna says, as the surgical procedure requires a skilled doctor and his team to work simultaneously to complete the sitting, which can take between 3-6 hours. By using a stereo-microscopic dissection technique, individual follicular units are removed from this strip. The harvesting of follicles is completed, and the wound from the incision is stitched up. The thin linear scar left behind is easily concealed by the surrounding hair. The transplanted hair appears just like normal hair, never falls and grows continuously at a rate of 1 cm. per month like other hair, says Dr Khanna. After surgery, the patient can see the outline of hair growth after 2-6 months. However, the results will continue progressing for around 10 to 18 months after undergoing the procedure. By that time, your transplanted hair will grow fully and the bald patches will have been covered. FUT, Dr Khanna says, is an excellent option for patients who have large bald parts on their heads. It’s also less expensive than the FUE technique.

Which is the best method?

As shared by Dr Khanna, who is an expert in both FUE and FUT techniques of hair restoration, FUT or ‘Strip’ is the golden standard for hair transplantation procedures all over the world and makes up 67.5% of all procedures for hair transplants. 

In 2022, there were four deaths reported, but they were all FUE procedure cases because of unskilled people handling the procedure. The National Medical Commission of India has made a rule now that only plastic surgeons and trained dermatologists may do it. 

The Promise of Hair Regrowth - Though the FUE method is not a surgical method and can be done even by a dermatologist, it cannot guarantee hair growth if the root of the hair follicle is cut during the extraction. The principle of surgery, says Dr Khanna, is to see–and then cut. In FUE it’s the opposite–you cut first–and then see. There is a stem cell in the hair's shaft from which the hair grows, so if you are using a punch blindly you might cut the stem cell. If that happens, the hair might grow for 3-4 years, but if it falls out, it will not regrow,

In FUT you are seeing–and then cutting the follicle under a microscope. The hair grafts are thicker, they have more tissue, and survival is better than regrowth. In FUE, because you are cutting blindly, the chance of missing the root itself is higher- this is called transaction; the rate of transaction varies from 5 to 20% in FUE, and in FUT the rate varies between 1-2%.

Hair Follicle Extraction - Usually a maximum of 6000 to 7500 follicles can be transplanted in one sitting in FUT. But in FUE not more than 2500 to 3500 follicles can be transplanted in one sitting. In FUE, follicles might get extracted outside the permanent zone to get more hair, which when it falls out after some years, it’s not guaranteed it will grow back.

Scarring - Despite the number of FUT sessions undertaken by the patient, only one thin scar, 30cm in length and 2.5mm wide, remains, as opposed to the 2000-odd punch marks left behind by the FUE method.

In India, people don’t like to shave their heads (as required by the FUE method) as it shows a tragedy in the family, so they opt for the FUT method. 

Pain Factor - It’s a misconception that FUE is a painless procedure. In both FUE and FUT, it’s about the same. That happens if you hit a nerve end. Dr Khanna has evolved a method in which they peel back the strip in the FUT procedure so it does not impact the bundle of blood supply and nerves below it.

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