[2] Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia.
Strip harvesting (also known as follicular unit transplantation or FUT) is the most common technique for removing hair and follicles from a donor site.
A single-, double-, or triple-bladed scalpel is used to remove strips of hair-bearing tissue from the donor site.
While closing the resulting wound, assistants begin to dissect individual follicular unit grafts, which are small, naturally formed groupings of hair follicles, from the strip.
Working with binocular Stereo-microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting.
Strip harvesting will leave a thin linear scar in the donor area, which is typically covered by a patient's hair even at relatively short lengths.
Because individual follicles are removed, only small, punctate scars remain which are virtually not visible and any post-surgical pain and discomfort is minimized.
[7] It is challenging for new surgeons because the procedure is physically demanding and the learning curve to acquire the skills necessary is lengthy and tough.
[citation needed] Some surgeons note that FUE can lead to a lower ratio of successfully transplanted follicles as compared to strip harvesting.
[8] The ARTAS System was FDA approved in 2011 for use in harvesting follicular units from brown-haired and black-haired men.
The use of both scalp flaps, in which a band of tissue with its original blood supply is shifted to the continue bald area, and free grafts dates back to the 19th century.
In 1897, Menahem Hodara successfully implanted hair taken from the unaffected areas of the scalp on to the scars that were left bald by favus.
Their efforts did not receive worldwide attention at the time, and the traumas of World War II kept their advances isolated for another two decades.
For the next twenty years, surgeons worked on transplanting smaller grafts, but results were only minimally successful, with 2–4 mm "plugs" leading to a doll's head-like appearance.
In the 1980s, strip excisions began to replace the plug technique, and Carlos Uebel in Brazil popularized using large numbers of small grafts, while in the United States William Rassman began using thousands of "micrografts" in a single session.
[17] The follicular unit hair transplant procedure has continued to evolve, becoming more refined and minimally invasive as the size of the graft incisions have become smaller.
These smaller and less invasive incisions enable surgeons to place a larger number of follicular unit grafts into a given area.
With the new "gold standard" of ultra refined follicular unit hair transplantation, over 50 grafts can be placed per square centimeter, when appropriate for the patient.
[citation needed] One of the advantages of sagittals is that they do a much better job of sliding in and around existing hairs to avoid follicle transection.