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HAIR TRANSPLANT & REPLACEMENT SURGERY



A review of two major types of Surgical Hair Transplant and Replacement Surgery procedures: Follicular Unit Transplantation and Mini-Micrografting.


MINI-MICROGRAFTING

THE UPSIDE

Mini-micrografting is the most common type of hair transplantation procedure performed today and, until recently, the procedure that produced the most natural results. Mini-micrografting depends upon the use of larger grafts (mini-grafts) to create density and smaller grafts (micro-grafts) to produce naturalness. The mini-grafts (which are smaller than the old plugs) are generally used in the central part of the scalp where they give "bulk" to the transplant, but on their own don't look completely natural. Smaller micro-grafts are then placed in front of, and around, these larger grafts to produce a more natural, soft hairline and overall appearance.

In mini-micrografting, the donor tissue is removed with a multi-bladed knife that produces long thin strips of donor tissue.

A multi-bladed knife used in Mini-micrografting| Cutting grafts "to size" in Mini-micrografting


The thin strips are then cut into smaller pieces depending upon the desired size. Those that contain 1-2 hairs are referred to as micro-grafts and those that have 3-6(+) hairs are called mini-grafts. Often the mini-grafts produced by this technique contain considerably more than 6 hairs.

A more accurate term for the procedure is "Mini-micro-grafts cut to size," since the grafts are cut to a predetermined size rather than dissected the way they naturally grow.

THE DOWNSIDE

Critics of this technique point out that achieving maximum density at the expense of naturalness is not a desirable goal and feel that the same density can be better achieved by newer techniques. The major concerns with mini-micrografting are
  • That damage to the hair follicles caused by the multi-bladed knife will impair full hair growth
  • The lack of preservation of the natural hair groupings in the scalp (called follicular units) will produce less than natural results, and...
  • The larger wounds needed for mini-grafts take longer to heal and may result in permanent changes in the surface of the scalp.
  • In Mini-micrografting, neither preserving follicular units nor even keeping hair follicles intact are felt to be particularly important. Rather, the speed and economics of the procedure are the driving factors.
FOLLICULAR UNIT TRANSPLANTATION

Follicular Unit Transplantation is the newest technique of permanent surgical hair restoration in which hair is transplanted from the permanent zone in the back of the scalp into areas affected by genetic balding, using only one's own naturally occurring, individual follicular units. This procedure differs from other forms of hair restoration surgery in the microscopically controlled preparation of the grafts, the most efficient use of the donor supply and the total naturalness of the results.

WHAT ARE FOLLICULAR UNITS?

The hair in every person's scalp grows in tiny groups called Follicular Units. Although scientists had recognized this for some time, physicians performing hair restoration surgery largely ignored their existence. The Follicular Unit of the adult human scalp consists of 1-4 terminal (full thickness) hair follicles.

The Follicular Unit is very small and can only be identified under magnification. The instrument commonly used to measure these naturally occurring groups is called a Densitometer. It is a simple tool that is placed on a small area of scalp whose hair has been clipped closed to the skin surface. Its use should be an integral part of your hair loss evaluation. Follicular Units are best viewed under a microscope, where they are seen as well-formed structures in the skin.

Follicular Units seen under densitometry| A histologic cross-section of FU's within the dermis


HOW IS FOLLICULAR UNIT TRANSPLANTATION PERFORMED?

The key to Follicular Unit Transplantation is to transfer intact Follicular Units from the permanent donor zone in the back of the scalp to the recipient (balding) areas. In order to remove Follicular Units from the back of the scalp without damaging them, the donor tissue must be removed in one piece. This technique is called "Single Strip Harvesting." It is an essential component of Follicular Unit Transplantation as it not only preserves the follicular units, but also it prevents damage (transection) to the individual hair follicles and insures maximum growth. It differs dramatically from the mini-micrografting technique of using a multi-bladed knife that breaks up follicular units and causes unacceptable levels of transection of hair follicles.


Dissecting stereo-microscopes used in Follicular Unit transplantation



The second essential component of Follicular Unit Transplantation is "Microscopic Dissection." In this step, the donor tissue (obtained with single-strip harvesting) is carefully subdivided into individual, naturally occurring Follicular Units under the careful control of a Dissecting Stereo-microscope. In the process, the non-hair bearing (bald) skin surrounding each Follicular Unit is carefully removed producing a tiny, compact graft, while avoiding damage to the hair follicles.

Complete stereo-microscopic dissection has been shown to produce an increased yield of both the absolute number of follicular units, as well as the total amount of hair, in upward of 25% when compared to other techniques.

A major advantage of Follicular Unit Transplantation (besides preserving follicular units and maximizing growth) is the ability to use small recipient sites. Grafts comprised of individual follicular units are small because Follicular Units are themselves small, but also because the surrounding non-hair bearing tissue is removed under the microscope and doesn't need to be transplanted. Follicular unit grafts can be inserted into tiny sites in the recipient area, which heal in just a few days, without leaving any marks.

The very small sites permit many follicular unit grafts to be safely transplanted in a single procedure allowing the entire hair restoration process to be completed as quickly as possible. When performed by a skilled surgical team, Follicular Unit Transplantation can provide a totally natural looking result in one or two sessions.

A Norwood class 6 patient with position of new hairline marked just prior to surgeryResults after 2 sessions of Follicular Unit transplantation. Note the natural hair line.


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