The modern hair transplant surgery largely depends upon the follicular hair transplant

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Some Recent Advances in Hair Transplant Surgery

Hair Transplant Surgery: Use of Micro and Mini-Grafts

As already discussed the introduction of micro-grafts (one- to two-hair grafts) and mini-grafts (three- to four hair grafts) was a significant advancement in the field of surgical hair restoration leading to aesthetically superior hair restoration surgeries.

Apart from the treatment of male and female pattern baldness hair loss, hair transplant surgery using micro and mini grafts are now widely used in hair transplant repair procedures and reconstructive surgical hair restoration procedures. Because of their small size, the micro and mini-grafts have lower metabolic requirement than the plug grafts and have better survival rate than the follicular units, which can be damaged during dissection. Since these grafts are able to successfully grow on burnt scalp or fibroid areas, they seem to hold a high promise for the reconstructive hair transplant surgeries. With the increased use of micro and mini grafts along with the single hair unit follicular transplants, the reconstructive hair transplant surgeries now account for approximately 8-10% of the total surgeries performed for hair loss restoration by hair restoration surgeons. The other part mostly includes hair transplant surgeries performed for the treatment of male pattern baldness and the hair restoration surgeries like the scalp flap and scalp reduction surgeries to a lesser extent.

Hair transplant surgery with micro and mini-grafts requires the patient to be under intravenous sedation and local anesthesia for creating occipital and supra-orbital nerve blocks. H air transplant surgery is always performed with the patient lying in supine position under the influence of a very mild sedation. A mild infusion of epinephrine for production of puffiness and temporary edema is a regular procedure for hair transplant surgery, which is intentionally performed to facilitate easy graft insertion.

Hair Transplant Surgery: Frontal Hair Transplantation

After a slit is made for the hair transplant surgery, the dissected mini and micro grafts are to be inserted into the scalp as fast as possible, as the transplanting of the grafts in the shortest possible time increases the chances of the hair follicles surviving the hair transplant procedures and actually grow into hair. To hasten up the above mentioned hair transplant surgery procedure, a hair transplant surgeon with a Sharpoint makes a slit, and an assistant with a fine curved jeweler's forceps immediately inserts a graft into the slit. Because these blades are so small and sharp, they leave almost no detectable scar and are therefore generally for the front 5 to 10 mm of the scalp.

But for the posterior regions of the scalp a hair transplant surgeon uses the no.11 feather blade for making the slits, the slits such made heal beautifully but occasionally leave slightly detectable scars due to pigment changes. A good hair restoration surgeon never uses the feather blade for the frontal hair transplantation.

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Hair Transplant Surgery: Hair Restoration on the Face

Hair transplant surgery procedure for hair restoration of the face (eyebrows, mustache, and sideburns) is more difficult and different. If a hair transplant surgeon makes slits near other grafts, the neighboring grafts tend to “pop out” of their corresponding slits. Hair transplant surgery in such cases makes the slits in a preliminary fashion, with the grafts inserted a few minutes later. The hair transplant surgeon uses a Nor Kor needle instead of the blade, the needle acting as a sort of dilator. The rest of Hair Transplant Surgery procedure is just the same, when the hair transplant surgeon withdraws his needle, an assistant implants the graft with a jeweler’s forceps. An experienced hair restoration surgeon always pays close attention to the natural direction of the growth while performing a reconstructive hair transplant surgery, and takes care to insert his blade or the needle at acute angle lateral to the eye brows.

For hair transplant surgery performed for restoration of beard and mustache, a hair transplant surgeon keeps his blade as flat as possible to the surface of lip so as to ensure the downward direction of growth.

On eyelids, the hair transplant procedure is more complicated because the eyelids are very thin, mobile and very adjacent to the eye. The most difficult aspect of the hair transplant surgery in this case is maintaining the direction of hair growth. Usually the eyebrow hair is used as the donor hair, and around 10-12 micro-grafts are inserted per eyelid in two separate sessions of hair restoration surgery performed with a gap of about 8-12 months between them. The use of a curved needle for the eyelid hair restoration is the new innovative technique that hair restoration surgeons have started making use for the ease of hair transplant surgery.

Hair Transplant Surgery: Some Standard Procedures

The state-of-the-art hair transplant procedure for dissection of micro and mini-grafts is described in the separate article. But it is important to make a note of the fact that the proper maintenance of these grafts thought out the hair transplant surgery is very crucial for these grafts to grow in to healthy hair. Throughout the course of hair transplant surgery the grafts are kept in Petri-plates filled with saline so as to keep them moist. During long procedures taking more than 3-4 hours, the Petri-dishes with these grafts in saline are stored over a basin filled with ice.

A procedure, which holds good for any hair transplant surgery, is the technique of inserting the grafts in way so as to leave the epidermis of the graft superficial to the epidermis of the recipient site. The aim of this hair transplant surgery procedure is to prevent the formation of inclusion cyst at the insertion points and also to prevent in-growth of hair. After any hair transplant surgery, the grafts look like bumps. After healing, the epidermis of the grafts starts turning into a crust and takes about 10 to 14 days to finally shed. The transplanted area now becomes smooth as before. The hair growth on the recipient area is seen only after 3 to 4 months. But once the growth becomes evident it continues to improve over the next few months.

Any reference to hair transplant surgery would not be complete without making a mention of the patient undergoing it. The positive attitude of the patient towards the hair transplant surgery is of much importance in this regard. Since it takes almost a year for the final results of the hair transplant surgery to be evident, the patient needs to bear with the long wait which has all reasons for showing successful results in the end. If the patient suffers from doubts and anxiety in anticipation of the results, it proves counter-productive. It is your faith in hair transplant surgery that not only leads to a better understanding between you and your hair restoration surgeon, it also helps you to develop a positive attitude.


Alfonso Barrera, M.D.: 'The Use of Micrografts and Minigrafts in the Aesthetic Reconstruction of the Face and Scalp', Plast Reconstr Surg, September 1, 2003.883-890

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