FUT treatment

Before the treatment - important preoperative instructions

In order for a hair transplant to be performed as pleasantly and successfully as possible, patients need to follow the various pre-operation instructions and restrictions. Following these instructions is not just important for the transplantation itself, but also for the healing process and the overall success of the FUT.
These instructions are available as a pdf file below the page under IMPORTANT INSTRUCTIONS.

Basic information:

  • If you are young and healthy and do not suffer from any notable disease, a blood test is usually not necessary. Where this is not the case, we recommend you have a blood test. This can be carried out either by us or your local GP. Please inform us beforehand of which option you have chosen.
  • Alcohol can have a negative influence on the transplantation, as it stimulates blood thinning and also can lead to over-sensitivity with regard to medication. For this reason, we advise you to desist from drinking alcohol for three days prior to the transplantation.
  • Smoking constricts blood vessels and demonstrably slows down wound healing, while at the same time increasing the risk of infection. It can also slow down the rooting of hair follicles and blood vessels. If you are a smoker, we would ask you to desist from smoking at least 1 week before the transplantation and for the 3 following weeks.
  • Comfortable clothing not needing to be pulled over the head is advisable for the day the transplantation is done. Please wear clothing done up with buttons or zips. Please also desist from wearing a T-shirt, sweatshirt or pullover.
  • On arrival at the clinic you will be given suitable operation clothing. Please wear this throughout your stay here.
  • Please desist from wearing jewellery.
  • We recommend arriving at the clinic feeling relaxed and having slept well. On the evening before the transplantation, you may ask to be given a sleeping pill, should you feel excited or not be able to sleep well.
  • Have a light breakfast and do not eat anything heavy, as overeating can cause tiredness or sickness during the transplantation.
  • During the break in treatment (generally at midday), we will serve you a meal of your choice.
  • Should you want to stay in a local hotel, we will be pleased to book you a room in the Radisson SAS Hotel. Please inform us beforehand whether you require a room to be booked.


Medication:

  • Certain medication, for example preventing inflammation or containing acetylsalicylic acid (such as aspirin), should not be taken 7 - 10 days before the FUT, as these can cause bleeding during the operation. They also thin the blood. Such negative effects can occur even after taking just one tablet containing acetylsalicylic acid, as this will thin blood for up to 7 days. It also effects coagulation.
  • Please inform us about any prescription medication you usually take. Bring this with you on the day of the operation.
  • Should you be unsure whether your medication could have a negative effect on the transplantation, please contact your GP or pharmacist.
  • Should you take supplementary vitamin B and/or E pills, you should desist from doing so 7 days before the FUT, as both vitamins can cause blood thinning.


Supporting medication:

  • You may continue taking Propecia/Finasteride without a problem.
  • Any use of Minoxidil should be stopped 24 hours before the transplantation. Use should only be restarted - and in consultation with Dr. Feriduni - 2 weeks after the transplantation, as the lotion contains propylene glycol, an ingredient possibly causing irritation and dryness of the skin. If you use foam without added polyglycol, you may start using this again directly after the operation.
  • Swelling will probably occur after the transplantation. This should disappear within 5 - 7 days. Though no miracle cure, the homeopathic medicine Arnica D30 can alleviate swelling and may be taken preventively.


Pre-operation haircut / hair shave:

We advise you to let us cut the hair in the recipient area short. This is however not always necessary and we therefore advise you to discuss this with the surgeon. One of the advantages of short hair is that hairs can be implanted much easier, more accurately and more densely. The time needed for making the incisions and implanting the FUs is also much shorter and has a positive effect on the survival chances of hair follicles. 
In the section "Instructions & Paperwork" you will find a downloadable version of our brochure on the importance of a short hair-cut. Please read this carefully. Should you have any further questions, please contact us.



Physiotherapeutic preparation: scalp massages

Scalp elasticity is an important factor for any successful FUT. Please start massaging your scalp some 8 weeks before your Follicular Unit Transplantation. This should be done daily for 5 - 10 minutes in the mornings and evenings. Massage the back of your head in particular. In the section "Instructions & Paperwork" you will find our downloadable brochure on scalp massages. Please read this and follow the stretching exercises carefully. Should you have any further questions, please contact us.
 

Scalp massages - stretching exercises for greater scalp elasticity

The following two exercises need to be done regularly, as they help give your scalp greater elasticity. This in turn has a number of positive effects on your FUT treatment:

  • More hair follicles can be extracted from the donor area in one go.
  • Scalp tension after the transplantation is reduced.
  • Scars caused by the FUT are more acceptable and not so visible.

Exercise 1:

  • Hook your hands together behind your head and move your scalp as seen on the photos in the brochure. The arrows indicate the requisite up-and-down movement.
  • Use your fingers to feel where the base of your skull is at the back of your head. Place your hands about 2 - 3 cm above this position, with your palms flat on your head.
  • Move the scalp to and fro by pulling your hands forwards towards the forehead.
  • Press your hands firmly on your head so that you can actually move your scalp and not just stroke over your hair.
  • Do this exercise once in the morning and once in the evening, each time for 5 - 10 minutes.


Exercise 2:

  • Press your hands hard against both sides of the head - as shown in the photo in the brochure.
  • Move your scalp up and down as far as it will go. Take care that you actually move your scalp and not just glide your hands over your head.
  • Do this exercise once in the morning and once in the evening, each time for 5 - 10 minutes.
The treatment: a step-by-step guide

On the day of the operation

On the day of the operation:

  • On arriving at the clinic, you are welcomed in the lobby and taken to a private room. This room remains available to you throughout your stay in the clinic. Relatives or friends accompanying you can stay here during the operation. The private room is equipped with a television (including satellite programmes), a DVD player and a selection of magazines.
  • You can then choose what you would like to have for lunch.
  • You are then given a disposable operation gown to put on.
  • A surgeon will then welcome you and will take you through the details of the operation once more. A set of preoperation photos are taken.
  • A medical assistant will then give you a medical hair-wash.
  • You are then taken to the operation room and seated. Vital parameters such as blood pressure, heart rate, oxygen saturation and (when deemed necessary) ECG are checked and venous access established.

Preparing the donor area for extraction

  • The operation is usually done under sedation, with the patient generally being given Midazolam as a sedative. This has an effect similar to that of Valium. The donor area is also numbed by a local anaesthetic.
  • The hair surgeon, Dr. Feriduni, and at least 2 - 3 medical assistants are present throughout the FUT.
  • The incision area, i.e. the slits into which the individual FUs are to be implanted, is also locally anaesthetised, thereby ensuring that no pain is felt.

Transplantation of follicular units

  • The incisions in the recipient area are made using tiny slit needles, also known as blades. These custom-made blades can be perfectly adapted to the respective size of the patient's FUs. Customized blades are usually 0.6 - 1.0 mm wide. Nearly all incisions are made before implantation (Premade Incision Technique). This part of the operation takes about 2 hours.
  • Dependent on the duration and scope of the treatment, a break is now taken. This can be used for relaxation or having lunch.
  • Again dependent on the method used and the duration, implantation of the FUs may follow immediately afterwards. This takes 1 - 2 hours and is performed by medical assistants and Dr. Feriduni.

Stick and place – the fine-tuning phase

It is now the turn of the Stick and Place technique. This is used to optimise the patient's appearance, making the transplantation look as natural as possible. This fine-tuning, which involves making additional incisions and directly implanting single FUs in certain areas, is of major importance for the end result, and in particular the shaping of the hairline, making it look as natural as possible.

End of treatment

The operation ends with a further medical hair-wash and Dr. Feriduni then checks the result, discussing the operation with the patient.
The patient is then given written instructions on what needs to be done over the next 24 hours. We provide our patients with a so-called after-care kit, containing a post-surgery mousse shampoo, post-surgery serum, post-surgery oil and hair spray treatment. 

An inflatable cushion for the neck is also given to the patient as well as a bandana for covering as far as possible all visible signs of the treatment. The patient will receive an emergency telephone number, under which he can contact the surgeon and the head assistant on a 24-hour basis. After a final check-up by Dr. Feriduni, the patient is taken to his hotel by taxi. In most cases the operation lasts the whole day, generally ending sometime between 16:00 and 19:00.
The patient generally returns the next day for a postoperative check-up, he/she then has the opportunity to discuss any issues that might be relevant for the next few weeks. A medical assistant also washes the hair again. There are no stitches needing to be pulled.

After the treatment

Following an FUT transplant you should always follow our instructions (these can be found in the section Instructions & Paperwork and can be downloaded and printed out).
The instructions have a great influence on the healing process and the end result of the treatment and should be followed as closely as possible.

A short overview of the instructions:

  • In the first nights after an operation, patients should sleep on their backs with their upper body slightly raised. This minimizes danger to the transplanted area.
  • The main thing is to avoid pressure to the head. This means that patients should avoid bending down, not hold their heads in a downward position, not shout loudly or cough too much. All these movements can cause blood pressure in the head to rise, leading to possible bleeding in the transplantation area in the first few days after an FUE operation.
  • Sports and other physical activities should be avoided for a period of 2 weeks.
  • The hygiene rules, which you will have received from Dr. Feriduni and his team, must be followed in detail over the next two weeks.
  • In the first 2 weeks after an FUE transplant, patients should not wear a helmet, hat or wig. In most cases, a bandana may be worn.
  • For a period of 4 weeks after the transplantation, patients are advised not to go to a sauna or solarium.
  • Please follow as closely as possible the instructions on hygiene handed out to you by Dr. Feriduni and his team and discussed with you. You will need to follow them as closely as possible for the first 2 weeks after the transplantation.
  • Please also avoid increased pressure to the head, as this increases the pressure in the blood vessels in the head and scalp, and can cause bleeding. Avoid bending over and do not hold your head down. Avoid excessive coughing or sneezing, or shouting loudly. Be careful getting in or out of cars. Bumping your head can cause bleeding. Quick movements of the head can also cause bleeding and should be avoided. Try to hold your head as upright as possible, not bending down in any direction.
  • In the first 4 - 5 days, the only thing holding the implants in position is the surrounding tissue. After this period they will slowly start taking root in the scalp. Do your best therefore to avoid damaging the implants in the first few days.
  • In the first week after an FUT transplant, try and sleep as much as possible on your back, with your upper body slightly raised. A neck roll or neck pillow can be of help here, enabling you to sleep relaxed, while at the same time helping to avoid touching the donor area and the grafts.
  • The local anaesthesia and the liquid sprayed onto the scalp during the transplantation will often cause a certain amount of swelling. This may also affect your face in the first 2 - 3 days. Further swelling is possible around the eyes and might somewhat impair your sight. Generally speaking, this swelling should start disappearing after 3 days. Once the swelling has gone from the neck, it will no longer be visible. The liquid sprayed is gradually transported away by the lymph.
  • In the first few days a scab will develop in the graft area. This normally drops off after about 10 days, along with a number of hairs. This is a natural process, as the hair roots are weakened by the treatment and the lack of oxygen. Any hairs remaining in the follicles fall out. As the follicles are only weakened and not permanently damaged, hair will start growing again within 4 - 5 months. At first these hairs are quite thin, but they get stronger over time. In exceptional cases, the hair surrounding the transplantation area might also fall out, though this is very seldom.
  • The healing process may lead to itching in the donor and recipient areas in the first few days after the FUT. Please avoid scratching these areas, as this can have a negative effect on healing.


Please follow the following recommendation in the first 2 weeks after the operation:

  • In the first 2 weeks after the operation, avoid all forms of sport, do not go to the gym, do not do any heavy physical work, lift heavy objects or bend down. Stay away from dirty or dusty areas.
  • We will give you a special hat - a sort of cap / bandana. Please always wear this when you go outside. Please avoid wearing any other type of head ware - a hat, cap, helmet or toupee - in the first 2 weeks after the FUT.
  • Avoid swimming (especially in chlorinated water) and stay away from the solarium in the first 4 weeks.


Removing stitches / staples:

  • About 2 weeks after the transplantation, the stitches / staples should be removed. This should be preferably done here at the clinic.
  • Appointments can be made daily between 08:30 and 09:30 and 13:30 and 16:30. Should these times be inconvenient, please contact our medical team, who will try and give you an appointment at a different time.
  • Please understand that not every requested time is convenient, as we carry out transplants every day.
  • Should you wish your own GP to remove the stitches / staples, please inform us. We will then provide you with the appropriate instrument.
  • Please be aware that existing threads need also to be removed.


Instructions for the first months after the transplantation:

Irritation of the sebaceous glands:
From about the third month onwards, you will start noticing new young hairs beginning to grow. This can cause irritation of the sebaceous glands and possibly small pimples. These are formed under the skin and can cause irritation. This is a sign of hair growth - these irritated places are where the new hairs are trying to make their way through the skin. If this irritation becomes too much to bear, you can try putting a warm compress on the affected areas for a few minutes. Please contact us for further help if this does not work well enough.



Hair Loss Shock:

A very small percentage of our patients suffer from so-called hair loss shock. This refers to the temporary loss of both healthy and transplanted hairs. These will however start growing again 3 - 4 months later. Hair roots are subject to a certain life cycle. This means that the lost hair may possibly not grow again when the end of the cycle has been reached. As a rule, the possibility of hair loss shock setting in is taken into account in the transplantation and has no negative effect on the end result.



A numb feeling:

Following an FUT transplant, a numb feeling can occur in the donor area. This will however gradually disappear of its own accord. In general, feeling returns to normal by itself 4 - 12 months afterwards.



Visible results:

Please be patient. It will take about 12 months for the results of an FUT to become fully visible and meaningful. Make a personal appointment with Dr. Feriduni for a check-up, as he is the only one in a position to assess the results. Some 4 - 8 months after an FUT, post-operation tests can be performed. 
Process of growth

No two people are alike. This also applies to the growth of the grafts - in some people they grow faster, in others slower. In the field of hair surgery one speaks of fast growers and slow growers. What this means is that some patients will already start seeing results after just 6 months, whilst others may have to wait more than 12 months.
The natural healing process after a hair transplant involves thin scabs developing over the small incisions, as well as over the scar in the donor area. These scabs drop off by themselves in the course of the healing process. In the second or third week after the FUT, most of the transplanted hairs fall out. This is due to the reduced intake of oxygen and nutrients, leading to follicles being rejected. This weakening of the hair roots is not to be confused with their destruction - new strong hair growth will set in after 3 - 6 months.

In certain cases, for instance when dense packing has been performed, there is a possibility of not just the donor hairs falling out, but also neighbouring hairs. These will also grow again once this hair loss period has ended. This so-called shock loss is a phenomenon occurring in certain patients, probably triggered by operation stress.
The new hair roots start producing new hairs immediately after being transplanted. In the first three months, these are very thin, akin to flax. Afterwards the hairs get thicker and stronger and after about a year the end result is very visible. All transplanted follicles generally produce new hairs, although there are certain exceptions. These are fairly seldom. 

Mega Dense Packing and the One-Session Philosophy

Natural hair density does not just vary from one person to the next, but also from one area of the head to another. This is an important aspect needing to be taken into consideration if a hair transplant is to look as natural and aesthetical as possible. The logical consequence of this knowledge is that the success of an FUT is to a great extent dependent on how hair density is dealt with. The number of implanted FUs is not necessarily the primary factor here - of greater importance is an aesthetic and harmonious appearance. Dense Packing is the term used to refer implanting FUs in a certain recipient area in a certain density: medium or high/maximum-density.

The surgeon plays around with hair density, implanting donor hairs as sensibly as possible and doing his best to achieve a result looking as natural as possible. This attempt to mirror natural hair as far as possible is very patient-dependent, taking three factors into account:

  • The possibilities available under the circumstances and the availability of donor hair.
  • Future age-related hair loss - the recipient area should remain looking pleasing and natural in the long term.
  • The overall concept determined beforehand.

Donor hair is not always available in sufficient quantities to satisfy a patient's wishes. Using the right technique, an experienced hair surgeon will be able to create the optical illusion of high density with just a few hairs, using donor hairs as efficiently as possible.



Mega Dense Packing & the One Session philosophy: the best technique for optimal results

Modern techniques of extracting and implanting hair follicles allow results to look very natural and pleasing to the eye. Successfully transplanted individual hair roots and hair groups help to achieve this natural look. Hair density plays an important role here, offering the opportunity of achieving such naturalness. But there are also other factors such as hair thickness, hair structure, the number of hairs in a single follicle and the quantity of donor hair available determining the success of an FUT.
Mega Dense Packing is the term used to refer to implanting follicular units in a certain density in a certain recipient area. Such packing is done in just one session and has no negative effects on the patient's future appearance. In contrast to earlier hair transplantation techniques, Follicular Unit Transplantation allows well-prepared individual FUs to be inserted into tiny openings (incisions) very close together. In doing so, a high follicle density can be achieved in one or just a few sessions. This means that much more natural-looking hair density can be achieved without having to subject the patient to several operations.
 


The advantages of the One Session philosophy:

  • A large number of hairs can be extracted in just one treatment session.
  • Improved growth prospects for the transplanted FUs
  • Shorter healing times for patients
  • Less scarring in the donor area
  • A result very pleasing to the eye
Customized blades

Customized blades – custom-built for patients

In an FUT, the extracted FUs are prepared and then implanted in tiny incisions. These can be formed by one of two possible incision techniques:
  • sagital (top-down/parallel)
  • lateral (sideways/perpendicular)
These incisions are generally made using fine needles, scalpels or special blades, with either pin-pricks or tiny slits being made. The rule here is that the smaller the needles / blades are, the more accurately the follicular units can be placed. This in turn improves overall naturalness and harmony, contributing to the success of an FUT.



Customized blades – sharp, exact and custom-made

Customized blades are particularly advantageous, as they can be individually adapted to a patient's follicles and tissue structure. As with modern needles and scalpels, they ensure top results, as damage to tissue and the skin is kept to an absolute minimum. This in turn is the basis allowing implants to best take root.

Customized blades offer further advantages:
  • They can be produced in the clinic in any size needed (including intermediate sizes), meaning that they are always available as needed.
  • They are sharper and cut more accurately, which benefits the subsequent healing process.
  • Bleeding occurs less often.
  • Damage to the skin is reduced even more, having a positive influence on scarring (micro-scars)
  • The possibility of skin rashes occurring is minimised
 

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