Reviewed by Dr Epameinondas Bonaros
Patients have long had difficulty understanding hair transplant surgery since its introduction more than fifty years ago. In those days, the only information was in a brochure and during your consultation. Nowadays, the internet has dramatically changed that. However, does the ease of access to so much more information make the process any less confusing than it was 50 years ago?
The first method, dating back to 1950, is “Plug” hair transplantation. A hair plug was a small round piece of scalp that was removed or punched out from the back of your head. Each plug would contain about 20 individual hairs. These pieces would then be “plugged” into the balding area of the patient’s scalp.
Hair plugs are no longer performed because the results were far from natural due to their size and the gaps in between. You might compare the hair plug look to the hair on a doll, which has that distinct plug-like look.
Then we have the “strip” hair transplantation, also known as FUT. During the procedure, a strip of skin with healthy hair is removed from the back of the head. This strip is then placed under microscopes so that a team of technicians select individual hair follicle units as they naturally occur.
The donor area of the scalp is stitched closed and the stitches are removed after around 10 days leaving the donor area to heal with a small linear scar. FUT or the strip procedure is still widely available today.
Lastly, we have FUE -follicular unit excision – which is the most recent evolution of surgical hair restoration and started to gain in popularity in early 2000. When you understand the basic fundamentals of how FUE hair transplant surgery works, you’ll find it’s a fairly straightforward procedure. Using a small punch, a surgeon will isolate, score, and incise each follicular unit one by one. Using forceps or tweezers, the grafts are then carefully removed and placed in a stable solution until they are ready to be implanted into the scalp.
FUE is also more expensive than FUT. According to the ISHRS 2022 Practice Census, about 75% of the hair transplant procedures are performed using the FUE method, making it the most common graft harvest method currently utilized worldwide. 22% of the procedures use the FUT method and 3% combine both techniques.
Once the grafts are harvested, the surgeon will place them back into the scalp where hair loss has occurred.
There are two basic placing techniques used in an FUE procedure, premade incisions and sharp implanters.
The majority of hair restoration surgeons typically use knife blades and needles to create recipient sites before placing the grafts. Today, a variety of surgical instruments are available for incision creation, including custom-made or sapphire blades.
The alternative way to place these grafts into the scalp is through a surgical device referred to as a hair implanter pen or inserter. Implanters are pen-like medical instruments where the grafts are loaded into a channel, and then a plunger is deployed to insert the graft into the skin. Implanters can be dull or sharp.
Dull implanters are used to insert the grafts into pre-made incisions.
Sharp implanters are used to make an incision in the skin and immediately implant the graft.
The advantage of implanters is that the hair follicle bulb is not handled directly and therefore is potentially subject to less trauma than when grafts are handled with forceps.
The term DHI, which stands for Direct Hair Implantation, is another name for the sharp implantation technique. Its distinctive feature is that it employs hair implanter pens that create the recipient sites and simultaneously transplant the grafts, instead of creating premade incisions.
There are numerous articles online dedicated to the “dhi vs fue results” debate.
In reality, what all those articles actually refer to are the differences between two implantation techniques, incisions and sharp implanters. Both techniques implant hair follicles that have been harvested with the FUE method. The question, therefore, should not be dhi vs fue, but rather sharp implanters vs incisions. The use of sharp implanters is not a hair transplant method, but rather a placing technique.
In recent years, there is also a lot of buzz about what’s become known as sapphire FUE. Sapphire FUE is the name some clinics use to describe the use of sapphire blades for creating the recipient sites during an FUE procedure. Sapphire FUE is not a hair transplant method but rather a placing technique.
The Sapphire technique involves making incisions on the scalp with a sapphire blade and placing grafts with forceps into those incisions.
The sharp implantation technique, or DHI, uses a hair implanter pen and eliminates the need for pre-made incisions.
A hair implanter pen is a graft placement device that looks like a pen. The implanter has a plunger, which is depressed to push the graft into the skin. In a single movement, the surgeon can create the recipient site and implant the grafts. The hair bulb is never handled with forceps during implantation. In contrast, the implanter pen’s wall protects the graft during the insertion. You can read more about our implantation technique here.
Both types of hair restoration surgery used nowadays – FUE and FUT – can successfully treat hair loss. Hair transplantation surgery can be life-changing when performed by experienced and qualified surgeons on suitable candidates. Dr Bonaros offers a wide variety of hair loss treatments in Glasgow, whether you want to try a non-surgical solution or undergo surgery. Please contact us today if you are interested in learning more about your treatment options or scheduling a consultation.
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