The main stages regarding FUT- Strip hair transplant procedure are the following ones:
- Design of the strip that is situated in the donor area and that it will be used as a transplant. The strip width ranges usually from 1 to 2 cm, so that any difficulty in the closure of the surgical wound is eliminated. Furthermore, in this way the possibility of creating a dysmorhic wound is avoided. The strip is usually taken from the scalp’s occipital area and it is extended from the one outer ear (pinna) to the other.
- Application of local anesthesia along the strip. A lidocaine and adrenaline combination is used.
- Strip’s detachment. It is performed by an incision that extends from both sides up to the subcutaneous fat. Then the strip is detached from the subcutaneous fat by using scalpel or scissors. At this stage, great attention is needed to avoid the creation of a deep skin incision and a possible destruction of the area’s sensory nerves as there lies the danger of postoperative hyperesthesia in the area above the strip or even the creation of a painful neuroma. Furthermore, it is required a meticulous hemostasis after the strip’s removal as the area is full of vessels. If a meticulous hemostasis does not take place, there lies the risk of a postoperative haematoma or even worse the decomposition of the wound.
- Wound’s suturing. It is usually carried out in layers. Subcutaneous absorbable stitches are being used in the deep layers of the skin. Nylon stitches or endodermic consecutive stitches are being used for the upper skin layers’ suturing. Recently, it is being applied the most advanced suturing technique, trichophytic closure, as it enables the approximation of the epidermal edges allowing hair growth in the scar for an optimal and cosmetically acceptable result.
- Grafts’ processing. After the strip has been detached, it is handed to the surgeon’s team of assistants. The strip is gradually cut into pieces so as grafts of appropriate diameter occur. A major disadvantage of FUT – Strip method is that the majority of hair transplant professionals produce grafts consisting of 5-10 hairs (minigrafts), thus big enough for implantation purposes. As a consequence, extremely unnatural results are being produced, especially when those big grafts are implanted in areas such as the head’s forefront and hairline. On the contrary, very few cases are those during which grafts containing 1-4 hairs (micrografts) that resemble the natural hair follicles can be isolated.
- Hair follicles implantation. The majority of doctors and clinics that apply FUT – Strip technique, perform graft’s implantation by applying the old technique: Receptions are being created with the use of scalpel or needle. Afterwards the grafts are being implanted in the receptions by using forceps. The disadvantage of this technique is that is a bloody procedure and it leads to serious postoperative swelling and scarring of the donor area.
The surgical team’s experience and skill set play a decisive role in the success rate of a FUT - Strip hair transplant. Those results can be excellent in terms of density. On the contrary, especially in the area of hairline, FUT - Strip method does not provide a natural-looking result as FUE method does. This happens mostly because FUT - Strip method leads to large-sized grafts that do not resemble with the natural, thin, one-haired follicles that originally exist in hairline.
Androgenic alopecia, being an evolving phenomenon, might necessitate a second, future hair transplant operation. In the case that a FUT - Strip hair transplant has been performed in the past, the application of a future operation might be a challenging action, because it should be created a second - parallel to the first - incision (double-cut incision) or an expansion of the existing incision, eventually worsening the already existing aesthetic issue.