Follicular Micrografting

Hair restoration surgeons began minigrafting as early as the 1990’s using grafts containing 3 to 5 hair follicles each.  Small holes in the transplant area were created on the scalp in which the minigrafts were inserted.  Due to this new procedure, minigrafted hair transplants had the potential of looking even more natural than their full size grafted counterparts, however initially the failure rates of the follicles were higher.

Through improved surgical techniques, surgeons were able to greatly increase the smaller grafts survival rates — soon transplanting grafts containing only a single follicle.  Additionally, new techniques were developed for removing the donor hair for the transplant by removing a strip of healthy hair from the lower, back of the head, then cutting these into smaller pieces.

The smaller pieces are then cut to 1,000 or more individual micrografts by teams of medical assistants, each graft containing between 1 to 3 follicles.  The amount of time needed to perform this operation can vary greatly from case to case but the results achieved from the micrograft procedure are certainly worth the extra time needed.  Today, the micrograft continues to be the most popular, and most natural looking hair transplant procedure available today.

Compared to the other surgical restoration techniques such as full-size grafts, scalp lifts and flaps, and scalp reductions, the micrografting technique advantages are numerous.  Among these benefits are a more natural looking head of hair, flexibility in placement of follicles and a relatively “safe” procedure where medical complications or poor results are extremely rare.

The obvious goal of the micrograft procedure from a cosmetic standpoint is a natural looking full head of hair.  The micrograft procedure gives both the patient and the surgeon the most flexibility in the placing of grafts, to achieve a natural look.  Micrografting can work for anyone, at nearly any stage of hair loss, from the individual with no hair on the top of his or her head, to the individual who is merely thinning or experiencing a reduced hairline.  The micograft allows the surgeon to place grafts between existing hairs, giving the individual a fuller looking head of hair.  The results for the individuals who have completely bald areas can change their appearance from bald to thinning in one session.  Follow up session can add thickness and density to the area, achieving the “full head of hair” that so many of us desire.

The time needed to heal from a micrograft procedure is very rapid compared to other hair restoration methods.  All of the incisions used in this procedure are made with a miniature surgical blade and heal quite quickly.  The donor area of the scalp is closed with a single line of sutures and remains very camouflaged by the thicker hair at the back of the head so literally no one can tell that any graft was removed.  Most micrograft patients are able to return to work within a day or two following the procedure.  This fact alone is reason enough to opt for micrografting as two weeks or more are required for healing in patients that have had full-size grafts, scalp lifts and flaps or scalp reductions.
By using micrografts, the surgeon is able to place hair follicles in a more natural pattern avoiding any type of “island of hair” or “dolls hair” effect for the individual.  Micrografting also allows the surgeon to place grafts in areas that future hair loss is likely to continue.  Additionally, micrografting is a procedure that can be performed more than one time — so if your hair loss continues in other areas, you will be able to replace the thinning areas with additional grafts from your own scalp.

It is also possible for micrografting procedures to enhance previously performed full-size grafts or to hide scarring caused from scalp reductions, lifts and flap procedures.

Micrografting is a safer alternative to other forms of hair replacement.  Micrografting requires only local anesthesia, so the individual remains awake during the entire procedure.  Conversely, other techniques such as full-size grafting, scalp reduction – lifts and flaps require general anesthesia dramatically increasing the risk of various medical complications.  Complications, while always a possibility with any surgical procedure are greatly reduced and rarely occur with micrografting.

From a cosmetic standpoint, micrografting produces a far superior outcome.  Micrograft procedure success ratios, from a results-driven perspective, are nearly always excellent or very good.  Even a poor micrograft transplant is typically acceptable and still maintains the ability to correct or enhance the overall appearance.  More elaborate scalp lifts and flap procedures, can produce remarkable outcomes as well with only one single session, but can also produce disastrous results resulting in large patches of dead scalp tissue combined with unsightly scarring.

Since 1990, there have been many variations of hair replacement procedures on the market, each claiming superiority over the others.  Included were monografting, megasessions, follicular unit micrografting and laser hair transplants. 

Monografting was eventually deemed unacceptable for many reasons, not the least of which was a high rate of follicular failure.  Isolating each hair follicle took too much time resulting in the loss of a number of donor follicles and a high graft failure rate.  Additionally, by isolating a single follicle and placing it on the scalp, the results seemed to produce an unnatural “fuzziness” look to the hair.

Megasessions are procedures whose intent was to finish an entire head in one session.  Each graft was divided into 1 and 2 follicle grafts, placing 2,000 to 3,000 or even more grafts in a single session.  Again due to the extensive cutting of the graft and the need to place each transplanted follicle so closely to one another, the risk of graft failure was again increased.  Also by placing so many grafts, so closely to one another, the recipient was not able to supply the adequate amount of nourishment from the blood supply to each individual graft.

Laser hair transplants also gained in popularity during the 90’s.  The donor material was harvested in the same manner as typical micrograft procedures, but all of the individuals' transplant areas were made with a laser.  It was later concluded that the damage caused by the laser to the surrounding tissue, caused a greatly increased healing time due to the lasers thermal damage to the recipient area and to the adjacent cells.

Finally, by the mid 1990’s micrografting had evolved to follicular unit micrografting, and is currently considered to be the state-of-the-art procedure used for hair replacement procedures.  The benefits to this refined procedure can be seen by the maximization, survival and overall yield of the limited supply of donor follicles.  This is achieved by careful planning, making sure that only the grafts needed for a single session are harvested.  It is important to place grafts at such at rate as to improve the odds of follicle survival.  By not placing each follicle graft too closely together during a single session, a greater number of surviving follicles can be achieved.  Additionally, surgeons will now use a single bladed scalpel under high magnification rather than the previous multi-bladed scalpel.  By doing so, the surgeon is able to save more of the follicles in the graft.  By using a single as opposed to the multi, fewer hair follicles will be damaged during the donor removal.  Despite the ability of the surgeon and the desire of the patient, a good micrograft surgeon will recommend a maximum of 1,000 to 2,000 grafts in a single session.

Once the donor graft is removed, it is immediately immersed in a cold saline solution to reduce the temperature of the follicles, and to increase the time of survival to the tissues.  This is so effective that a few hours can actually elapse from the time the donor material is removed until it is placed back into the scalp.

The ability to lessen the possibility of cutting a follicle was achieved. By using something called a stereomicroscope to cut the grafts into smaller pieces containing fewer follicles.