Procedures adopted by Hair Transplant Surgeons

As follicular unit transplantation evolved over the years, it has also led to an evolving philosophy that a hair transplant surgeon should use nothing larger than a follicular unit for the hair transplantation surgery. The basis of this philosophy was the fact that a typical spindle-shaped donor strip consists of nearly 50% of non-hair bearing skin. And because of this the skin has more chances of being included in any graft larger than a sinle hair follicular unit. It is this unwanted skin which negatively affects the aesthetics of the surgical hair restoration. And as a hair transplant surgeon should always transplant hair follicles with a minimum amount of skin attached, the follicular hair transplant received much credence as the basic unit for use in any hair transplant procedure.

As discussed earlier, apart from the actual hair transplantation surgery procedure, there is much in the hands of a hair transplant surgeon! Besides being a skilled hair transplant surgeon, your hair transplant doctor also needs to have an aesthetic vision. Through the creative mixing of state-of-the-art hair transplant procedures, his experience in the field of surgical hair restoration and his aesthetic vision, a hair transplant surgeon can perform a number of successful hair restoration surgeries. Creative planning, mainly of the anterior hair line, accounts much for the success of hair transplant surgery performed by any average hair transplant surgeon.

Hairline planning is something which a hair transplant surgeon has to do ideally through consultation and the agreement of the patient. A hairline provides a frame to the face and, depending on the success hair restoration surgery, it can either enhance or mar the looks of the patient.

Hair Follicular Units - As Physiological Units

Hair restoration surgery made a major leap in 1981 when a hair transplant surgeon, Dr Nordstrom, with his colleagues introduced the idea of utilizing three-to-six-haired grafts at the anterior edge of the hairline. Later, in 1984, hair transplant surgeon Dr Bradshaw introduced the idea of utilizing smaller six-to-eight-haired quarter grafts over the entire head. Although the acceptance for the single follicle as the hair transplant surgery unit had already gained momentum, an article written by the well-known hair transplant surgeon Dr Headington was instrumental in enlightening the 'Surgical Hair Restoration' medical community about the use of follicular unit transplants.

The definition helped hair transplant surgeons to understand that the follicular unit was not only an anatomic unit, but was more importantly a physiologic one. And this was the reason why the follicular unit should be left intact and not to be broken apart. In 1987, Dr Limmer was the firs hair transplant surgeon to use stereoscopic microscopes to dissect follicular units for surgical hair restoration.

Hair Follicular Units Vs Single Hair Micrografts

Experiments performed by the hair transplant surgeon Dr Seager in 1996 gave significant credence to Dr Hedington's theory. He demonstrated that the single-hair micrografts had an 82% survival rate, compared to the 113% survival rate of intact follicular units.

Although the results of surgical hair restoration with the use of follicular unit transplants were sound and aesthetically pleasing, this form of hair transplant surgery suffered from drawback of requiring a long time period (6-8 hr) to complete a transplant session. It involved teams of highly skilled assistants for the hair transplant procedure of separating the follicular units. And as it required much time and skills the procedure was proving to be very costly to the patient. The surgical damage caused to the follicle when two follicular units extremely close together were dissected apart, had also started to affect the results of Hair Restoration Surgery.

A reduced success in follicular unit transplantation was more frequent in hair restoration surgeries that were being performed by hair transplant surgeons undertaking follicular unit transplant surgery only infrequently. The fact was of much concern to the professional hair transplant surgeon. The primary reason for a reduced success rate was that the assistants of the hair transplantation surgeon lacked the expertise and experience in correctly isolating single follicular units and dissecting them at a fast pace. Ensuring that the follicular unit remains intact and is dissected and implanted into the scalp in the shortest possible time is essential for inreasing the chances of the hair follicles surviving the process and growing. And when this important aspect was ignored, it affected the results.

Three and four-haired follicular groupings

For the above mentioned reasons, a technique that leaves the follicular unit intact, but at the same time advocates the use of three and four-haired follicular groupings for surgical hair restoration was evolved by the innovative hair transplant surgeons. This procedure was found to have many advantages over follicular unit transplantation.

A single hair follicular unit does not necessarily comprise a single hair and may contain 2-4 hairs in a single hole. When the follicular units are found very close to each other in the donor skin sample it is not advisable to separate them as it can cause iatrogenic damage to them. Advantage of this fact is taken to form three-and four-haired groupings when 2 two-haired follicular units or a three haired unit and one-haired unit are naturally placed very close to each other. A group (of 1-4 follicular units naturally placed close to each other) transplanted as a single graft results in superior hair growth and at the same time lessens the surgical damage and trauma to the recipient site. The procedure also saves a lot of time in separating each follicular unit and in turn is more affordable to the patient.

Besides the above mentioned advantages, the technique of grouping of hair follicles can serve as a crucial tool in an expert hair transplant surgeon's hands to create wonders through the hair restoration surgery! Success and a natural looking hair transplant requires strategic planning! The grouping technique does not undermine the importance of a unit follicular hair transplant but actually compliments it by conserving more single-haired follicular units for the defining the hair line. The 2-haired follicular groups can be used for gradation in the area immediately posterior to the hair line and use of denser, but not bigger, 3 haired groups to provide the hair-density to the bald scalp behind. Besides saving the hair in the donor area for the future hair transplants this innovative technique of hair restoration surgery provides you the results which are just wondrous! And to you, your hair transplant surgeon is nothing less than a magician with a magic wand in his hand!

1. Dominic A. Brandy, MD: ‘The Art of Mixing Follicular Units and Follicular Groupings in Hair Restoration Surgery’, Dermatol Surg, 30:6:June 2004, 846-856

2. Jeffery S. Epstein: ‘FollicularUnit Grafting: state-of-art Surgical Technique’, Arch Facial Plastic Surgery, Vol 5, Sept-Oct 2003, 439-444

A hair transplant surgeon uses his aesthetic vision during hair restoration procedures

Some standard hair restoration procedures adopted by Hair Transplant Surgeons

Hair Follicular Units - As Hair Transplant Units

Hair Follicular Units - As Physiological Units

Hair Follicular Units Vs Single Hair Micrografts

Three and four-haired follicular groupings