The success of hair transplant surgery depends upon accuracy of hair transplant procedures

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Standard Hair Transplant Procedures for Hair Transplant Surgery

Hair Transplant Procedure: Graft Creation Technique

The success of any hair transplant surgery largely depends upon hair transplantation procedures adopted during the hair restoration surgery. With the emergence of single follicular hair transplant as the standard unit for hair transplant surgery, the hair transplant procedures have now become more or less standardized. A good hair restoration surgeon, irrespective of which hair restoration center he belongs to, now follows these standard hair transplant procedures in order to achieve aesthetically superior results.

A brief round up of these standard hair transplant procedures is givne below to help you understand the nut and bolts of a hair restoration surgery.

A long string of hair transplant procedures for hair transplant surgery start with the harvesting of the donor hair. The procedure starts with the excision of a 1 cm wide and 20 cm long strip of hair from the donor site. The strip is tapering at ends to facilitate easy removal.

Dissection of strips

As soon as the fusi-form strip is excised from the donor site, it is handed over to surgical assistants who with the use of a stereoscopic microscope cut the strip into many fine strips, which are one follicular unit in width. The hair transplant procedure of dissecting the donor strip into many fine strips is technically known as silvering.

Cutting of the strip into silvers is an extremely difficult hair transplant procedure. Earlier, most of the hair restoration surgeons were using multi-blade knife for the job. But with the introduction of stereoscopic dissection microscope in 1987, the use of single blade has gained wider acceptance. Though the above said microscopic hair transplant procedure takes more time to perform or requires more assistants, it requires 20% less donor strip for obtaining the same number of well-trimmed follicular units. If donor tissue is in short supply, stereoscopic microscope dissection is the method of choice. There are reports, which have shown a positive correlation between the microscopic dissection procedures and the better and faster growth rate of the transplanted hair follicles.

Dissection of grafts

Once the hair transplant procedure of slicing up of very thin slivers from the fusi-form strip is completed, the assistants proceed on the next hair transplant procedure, which involves the dissecting of these silvers into the following 6 categories of the grafts again with the use of dissection microscope.

• One-haired follicular units (follicular unit graft)
• Two-haired follicular units (micro graft)
• Three-haired follicular units (mini grafts)
• Four-haired follicular units (mini grafts)
• Three-haired follicular groupings
• Four-haired follicular groupings

  • A one-haired follicular unit is obviously a single hair follicle consisting of a single hair coming out from one pore or the opening on the scalp.
  • A two hair follicular unit is hair follicle consisting of a pair of hairs emerging from the scalp through a single opening, generally referred to as micro-graft.
  • Similarly a three-haired follicular unit consists of bundle of three hairs coming out from the scalp through one opening.
  • And a four-haired follicular unit consists of bundle of four hairs emerging out from the scalp through one opening.

It is important to note these follicular units are not as equally distributed in our skin. Sometimes two follicular units are much closer to each other than the other surrounding follicular units. In such cases it is advisable not to separate these units but dissect them as one group to avoid iatrogenic injury caused to them.

  • A three-haired follicular grouping is made when a two haired follicular unit and a one-haired follicular unit are naturally placed very close to each other.
  • A four-haired follicular grouping is formed when either a two-haired follicular unit is placed very close to another two-haired follicular unit, or a three-haired follicular unit and a one-haired follicular unit are extremely close to each other.
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After the micro-grafts, mini grafts and the follicular unit hair transplants are dissected, the next hair transplant procedure consists in making slits on the recipient site. This procedure is highly important hair transplant procedure being performed by the hair transplant surgeon and his assistants. As already discussed, the natural direction of the hair is of much importance to a hair restoration surgeon, so any slit which is made on the recipient scalp has to be closely guarded with the incision made only in direction of the natural hair growth. Apart from the direction, size of the slit is also of much importance as a standard hair transplant procedure. The size of the slit made by the hair transplant surgeon has to be exactly same as the size of the graft to be transplanted. The standard hair transplant procedure consists in making use of different kind of blades for different sizes of the follicular units (one-haired, two-haired and four-haired) and groups of follicles.

Stereo-microscopic graft dissection of slivers into naturally occurring groups has dramatically increased the skills of the hair transplant surgeon and his/her staff to perform a hair transplant surgery.

The hair transplant procedure of using natural groups for the hair transplant surgery has many advantages:

1. It results in much quicker hair transplant procedure as it saves time for separating each follicular unit and less time is required for their placement.

2. Hair transplant procedure prevents iatrogenic injury to follicular units during the dissection phase.

3. It lessens iatrogenic injury during placement phase because follicular groupings are not as fragile as follicular units because of more tissue attached to them.

4. As this hair transplant procedure proceeds at a faster rate, it allows the grafts to be left out of the body for a shorter period of time and increases their survival rates.

5. The last but not the least important advantage of this hair transplant procedure is that it reduces the cost of hair transplant surgery.

Use of follicular groups provides a much higher density to the recipient sites and allows more hair follicular units being left for defining the hairline or for gradation at transition zone. Since a hair transplant surgeon has already done a diagrammatic planning for the hair transplant surgery to be performed, he knows exactly where to implant a single haired unit follicles or/and groups of 2-4 hair follicles. By judicious use of single hair follicles, micro and mini grafts and groups of hair follicles, an expert hair restoration surgeon through the much skilled hair restoration surgery tries to give a natural look to the restored hair. And it is this is hair transplant procedure, which introduces an element of art in the science of hair restoration surgery.


Dominic A. Brandy, MD: 'The The Art of Mixing Follicular Units and Follicular Groups In Hair Restoration Surgery', Dermatol Surg 30:6:June 2004, 846-856

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