Modern hair transplant techniques were first developed in Japan in the 1930s where surgeons used grafts to help restore eyebrow and eyelashes as well as the scalp hair of burns victims. It did not develop as a treatment for male pattern baldness until the 1950s when dermatologist Dr Norman Orentreich planted the first grafts in balding areas.
Techniques progressed from there and follicular unit transplantation (FUT), or strip harvesting, became the first popular method of hair transplantation.
FUT is where a strip of hair is surgically removed from the back or side of the scalp and follicular unit grafts (one to four hairs) are extracted and replanted in the balding area by the surgeon, using very small micro blades or fine needles. However, the main drawback with this method is that a scar is left in the donor area, which is visible if the patient likes to wear his or her hair short.
A different hair transplantation method, follicular unit extraction (FUE), was first developed as a technique in the 1990s by Australian physician Dr Ray Wood and his sister Dr Angela Campbell.They felt that cutting out a big patch of skin to harvest the donor hair was unnecessarily traumatic so developed a new technique where the follicular units were taken one-by-one, directly from the donor area, with fine needles. Early FUE techniques were fairly unsophisticated and there was noticeable scarring from punch grafts used to the remove the donor hair, which ranged in diameter from 1.5mm to 2mm. However, more recently, these punches have become much smaller – between 0.6 mm and 1mm in diameter – meaning the scarring is almost indiscernible to the naked eye.
Modern-day FUE treatments involve removing individual follicular unit grafts, containing one to four hairs, under local anaesthetic using tiny punches. The grafts are replanted in the donor area using a fine needle, typically over the course of one day. Most surgeons are able to transplant up to 4,000 grafts in a single day, though operations commonly involve between 1,500 and 3,000 grafts. FUE is much more time-consuming than FUT and therefore it is more expensive – costing approximately 50% more per procedure.
Over the last five years FUT has been superseded as the most popular method for treating baldness in men and women by FUE. Several high profile celebrities who have had hair transplants using the FUE method – most notably the England football captain Wayne Rooney and model and Crown Clinic patient Calum Best. Other Crown Clinic FUE patients include the football pundit Didi Hamann, Gogglebox star Chris Steed and Martin Roberts, presenter of the BBC1 property show Homes Under The Hammer. Crown Clinic patients who have had FUT include the TV doctor Christian Jessen.
This shift in the preferences – from FUT to FUE – has been apparent in Crown Clinic and the procedures carried out by our surgeon Asim Shahmalak.
Five years ago, 80% of Dr Shahmalak’s patients opted for FUT and 20% for FUE; now, it is the complete opposite with 80% opting for FUE.
The main advantage over strip harvesting is that the scarring with FUE is minimal. Due to the smaller punch holes developed over the last five years, the scarring is barely visible two weeks after the operation. For the first few days, a patient has red pin-pricks in the areas of the scalp used for harvesting but these fade. All incisions and cuts leave a scar, but an FUE scar is barely visible to the naked eye because each FUE scar shrinks to less than 0.5mm. We have also noticed a surge in men wanting to wear their hair short around the back and sides of the scalp – and this style favours FUE over FUT.