Trichophytic closure of the donor area is currently the norm in FUT hair transplant surgery and is my preferred method of closure. In conventional closure, the scar can be visible especially when the hair is kept relatively short which can be unsightly. Frequently, when the closure is not done properly or the patient has weak connective tissues, the scar can be particularly wide. These problems can be addressed using the trichophytic closure technique.
In trichophytic closure the scar is modified in such a way that hair follicles actually grow through the scar making it nearly imperceptible when done properly. I try to achieve double trichophytic closure in all of my patients because this produces the best results. However, this entails removing additional removal of dermis and subdermis which might therefore entail additional tension on the closure. To counter this, there are some things that require attention.
First of all, the scalp tightness varies from patient to patient. In some patients the scalp can be so tight that even after harvesting a narrow strip there can be tension on the closure and in others the mobility is excessive posing no problems whatsoever in achieving the trichophytic closure. Therefore, assessment of scalp laxity is imperative when dealing with a hair transplant patient. In those patients who have a tight scalp, scalp massaging on a regular basis actually softens the scalp and makes closure easy. This should be demonstrated to the patients and should be done diligently by the patients for a couple of days prior to the hair transplant.
The commitment towards trichophytic closure should be made after apposition of the deeper layer using permanent sutures. There should be no tension on the suture line for trichophytic closure to take its full effect. Done in this fashion, this can be an invaluable method of hair transplant which can be performed in most if not all patients.