Follicular Isolation Technique

When discussing Follicular Isolation Technique (FIT), a broader term for the technique is Follicular Unit Extraction (FUE). FIT is when a surgeon removes the natural clusters of hair that exist in the scalp. These clusters can have one to four follicles in the hair cluster. FIT was based on the idea that surgeons were just putting a punch in the scalp to remove the hair cluster and not trying to determine the depth of the follicle or where the dermis of the skin ended or the fat began. FIT sets a depth limit for a surgeon to enter the skin with the punch in order to get to the beginning of the fat. The surgeon can then dissect the rest of the way or pull out the graft so there is less chance of transection (severing the hair). With follicular isolation, a doctor might take only a portion of the unit and leave some hairs behind to better camouflage the donor area. The hair left behind will continue to grow but the hair that is removed will not grow back.

Am I a Good Candidate for Follicular Isolation Technique?

Patients who are GOOD CANDIDATES for FIT are:

• Young patients who are not sure if they want to continue on with hair transplants and want to wear their hair exceptionally short
• Patients with a very tight scalp that only want a small area to be transplanted
• Patients who have had their donor hair harvested several times with a strip hair transplant technique and only need small areas to be transplanted
• Patients concerned about a linear scar in the donor area

 Patients who are NOT GOOD CANDIDATES include:

• Patients with a low density of hair to the point that the procedure would thin out their already thin hair even more
• Patients with hair that is so curly that the bulb, or the bottom part of the hair, can actually curl up like a J-shape and cut off an important part of the hair follicle
• Patients who don’t want to shave the donor area

How is Follicular Isolation Technique Performed?

During a FIT procedure, the surgeon removes one hair follicle unit at a time from the donor area of the scalp. The surgeon uses a small punch instrument, which is an open cylinder usually about 0.8 mm to 1 mm in size, to score the skin and grab the follicular unit.  It is much like the old pluggy techniques except surgeons use a very tiny punch since they are only going after one unit at a time as opposed to multiple units. Doctors try to keep that unit intact although there are times where they might be trying to harvest one or two hairs within a group and not the entire group.

Once the follicular unit is removed from the donor area, it is placed in premade incisions in the area with balding and thinning hair. Depending on the results desired by the patient, one to four follicles will be placed in the incisions by the surgeon. The extraction sites in the donor area heal on their own without the need for bandages or sutures. Large transplant sessions are possible with FIT but, since the surgery is labor intensive thanks to the delicate nature of removing the clusters of hair, “mega-sessions” may need to be performed over a period of two days.

The main advantage of FIT is setting the depth to the minimal depth required in order to extract the hair. It is important to remember that FIT is a form of FUE and they both encompass the same patients. The deeper the surgeon goes with the punch, the likelihood of damage to the hair follicles increases because the punch is usually sharp. Even if the punch is dull, there might be damage to the hair. Surgeons like to go to the minimal depth possible and still easily remove a graft. FIT is advantageous over FUE because the surgeon is targeting a shallower depth.

Other Uses for FIT

FIT can also be used for eyebrow or eyelash reconstruction because it is the same approach as the scalp. The surgeon just needs fewer hairs to do it than with a hair transplant. Body hair can also be used but the hair is often not the same caliber nor does it grow like scalp hair or eyebrow hair. Taking scalp hair to do an eyebrow case means the hair basically retains the qualities of the scalp hair.

What is the Cost of Follicular Isolation Technique?

A large number of hair restoration surgeons charge per graft in the United States. The price per graft can run from $6-$18. The total number of grafts needed to achieve the desired results depends on the size of the balding area and the hair density desired by the patient. The price also includes any fees charged by the surgeon and the facility as well as the area of the country where the procedure is performed. In general, FIT can cost anywhere from $4000 to $20,000.

Recovery and Downtime

The RECOVERY and DOWNTIME process is no different than FUE. There can be some slight discomfort the first night but the level of pain varies from patient to patient. Most people can be back at work within 2-5 days. However, the procedure usually requires shaving a large part of the donor area and people have to take that into consideration in terms of appearing in public at their job or attending personal and social events.

Swelling is not uncommon the first few days after the procedure in the forehead area. Patients should sleep with their heads propped up on pillows for several days after the surgery. Scabbing might be seen for the first week before patients can wash their hair in a more aggressive manner.

“Shock loss” can occur after the procedure. Shock loss is when existing hair in the recipient area is lost due to the stress of inflammation while healing. The hair will grow back but finasteride and minoxidil are recommended to minimize the shock loss.

Results

The growth of new hair will start about 2 to 3 months after the completion of the procedure. Patients can expect to see the majority of the results within 6 to 9 months. Sometimes the final results are not apparent until one year after the surgery.  The final results of FIT should be permanent.

Limitations of Follicular Isolation Technique

Some common limitations of the procedure are:

• Surgeons are limited in the amount of grafts they can place in a single day since they have to take great care not to damage the follicles
• A surgeon can only harvest the donor area so many times before the donor area starts to thin out and cannot be effectively used anymore

Risks of Follicular Isolation Technique

Some common risks of follicular isolation technique include:

• Damage to the follicles
• Shock loss
• Bruising
• Swelling
• Redness in the treated area
• A cyst forming if the grafts get trapped beneath the skin

Do Proper Research before Having a Procedure

There is no “perfect choice” when it comes to hair transplants. The technique used is dependent on the individual goals of the patient. It is extremely important to have the procedure performed by an experienced surgeon. Patients need to ask the doctor for “before and after photos” of actual patients to get a better idea of the skill level of the surgeon. Patients also need to perform proper research before making the final decision to have a procedure.

Written by Cosmetic Town Editorial Team- MA

 Based on an exclusive interview with Paul Rose, MD in Coral Gables, FL