The diversity of hair transplant techniques allows a definitive aesthetic solution for most instances of vellus or hair alopecia.
The ‘follicular unit long hair’ (FUL) allows — without previous shaving of the scalp — an immediate visualisation of the result. With this procedure, the surgeon has an easier approach for the best choice and the orientation of each graft. The FUL provides a natural aspect as a result of the fine implantation of 1–4 hairs at a time (1000–4000 hairs during one session). The ‘follicular unit extraction’ (FUE) — with a previous shaving of the scalp — has pertinent indications for those patients who routinely shave their scalps. Whichever method, it is followed by a definitive hair regrowth. The most recent research with regard to cellular therapy is the platelet rich plasma (PRP) infusion of the scalp to reverse androgenetic hair miniaturisation.
A digitalised phototrichogram and a multifactorial classification, allow a computerised evaluation of bald and hairy areas, scalp thickness and laxity, hair density, length, colour and hair growth rate.
Surgical treatments of baldness are not only for the treatment of male and female pattern baldness, but also for alopecia after traumatic injury, second and third degree burns, post-radiotherapy for brain tumour, and post-lifting scars, for example.
Once harvested from the donor area, hair follicles are microscopically dissected into grafts (FUL) or extracted with a hand or power micropunch (FUE). Each micrograft contains a single follicular unit comprising between one and four hair follicles. FUE or FUL are then carefully implanted into the bald or thinning recipient area. Meticulous artistic and technical skill is required to design an appropriate hairline, as well as ensure the appropriate angle, orientation and position of each transplanted hair. FUL or FUE create a result that defies detection.
With FUL, hairs are not shaved. The ‘wait and see’ is replaced by the ‘see and wait’, and any scabs are hidden by the long hair. For the surgeon, it allows a better evaluation of the orientation and the obliquity of transplanted hairs; and refinements of the frontal hairline with thinner or lighter hairs. A strip with long hair is harvested, the donor area is closed, and the scar will be almost undetectable.
In FUE, hairs are shaved throughout the donor area. The aim is to harvest intact follicular units from the donor; 1000–1500 hairs can be transplanted in one session. FUE is for patients who routinely shave their scalp, have no laxity of the scalp, or are afraid of getting a fine linear scar (which can be corrected with secondary FUE).
The newest follicular unit transplantation techniques such as FUE and FUL provide an aesthetic and natural-looking hair restoration for the majority scalp alopecia incidences in male and female patients .