Micro-and Mini Grafts: Scope of Laser Hair Transplant
Since its inception in west in 1993, surgical hair restoration has come a long way both in terms of surgical hair restoration procedures and the aesthetic pursuits. The initial attempts of hair restoration surgery aimed only at hair loss restoration, but introduction of micro-grafts and mini-grafts in 1984 gave hair transplant surgery an aesthetic outlook with more natural and undetectable results. Besides hair loss restoration, the new hair transplant procedure showed great promise for reconstructive surgery and repair of bad hair transplants.
In 1990's Micro Grafts and Mini Grafts were widely used for hair transplant surgery as mega sessions to achieve acceptable density in one session of hair restoration surgery.
Micro and mini grafts as exclusive hair transplant procedures involved extensive graft preparation and handling along with tremendous assistant support. Teams of 8-10 surgical assistants worked with a hair transplant surgeon for 8-10 hours together. Though these mega-sessions resulted in aesthetically superior results, it was considered to be a highly demanding hair restoration procedure because of the long time taken by the hair transplant surgery.
Problems with Micro Grafts and Mini Grafts
Another problem associated with micro and mini-grafts is known as graft compression. In order to achieve the required density, many hair transplant surgeons use the hair transplant procedure of making slits into which 1-2 and 3-4 haired follicular grafts and follicle groups are inserted by their assistants. When thousands of grafts are closely placed together, the scalp pushes the hairs through the slits, making them appear as if they are growing from a single hole. This tufted hair effect is called the graft compression.
Sometimes the lateral compression and improper homeostasis during hair transplant surgery also led to graft elevation or graft exclusion. Hypertrophic scarring around the grafts and bleeding at the recipient site were some other problems of these grafts that were not unseen for.
As one would rightly think, graft compression can be avoided by unit hair follicular transplant, but most of hair restoration surgeons now use follicular hair transplant as hair transplant procedure for frontal hair transplantation and micro and mini hair transplants for the rest of the head.
Laser Hair Transplant: Some Initial Experiments
In the light of above mentioned facts, laser hair restoration was seen to have much potential in solving the graft compression problem associated with mini-grafts and micro-grafts. As a laser hair transplant procedure, it used laser beam to vaporize a narrow slot in the scalp for the implanting hair graft. By actually removing tissue, it was thought that laser hair transplant would reduce the risk of graft compression, and produce more natural results.
The first laser hair transplant procedure was performed by Dr. Unger and David in 1992 using the carbon dioxide laser. The subsequent laser hair restoration studies were undertaken with the hope to achieve a reduction in bleeding due to photocoagulation effect of laser. It was thought that laser hair restoration would lead to more natural hair restoration results due to consistent recipient channel depths produced by uniformly vaporized tissue. The proponents of laser hair transplant surgery had no doubts in its capability to transplant hundreds of grafts together to dramatically reduce the time of a hair transplant surgery due to increased homeostasis.
Modifications in Laser Hair Transplant
The histological and histo-chemical analysis in laser hair transplant experiments had a different story to tell. In all laser treated specimens, the damage to the tissue was more evident than seen with the standard punch technique. Thermal damage caused by the high energy of laser in all laser hair restoration studies was found to be statistically significant for both the connective tissue and the adnexal structures (hair follicle, sebaceous glands and eccrine).
Newer modifications in laser hair transplant surgery were aimed at reducing the lateral damage caused by the use of different laser settings. Flash scanned carbondioxide laser, ultra pulse laser, decrease in beam size and continuous movement of the beam via a computer scanner were some of the laser hair transplant surgery procedures, which were tried to improve results of the laser hair restoration surgery and study its medical implications.
But even with recent advances in laser hair transplant technology, there is not seen much possibility for laser hair transplant surgery to replace the conventional methods of hair transplant surgery, how much tedious and time consuming they may seem to be.
Laser Hair Transplant: A Note of Caution
For some people, the word laser surgery is synonymous wit the word "state-of the art". With laser surgery permeating almost any branch of surgery it is not very uncommon to think so. Since our site provides information about the various aspects of surgical hair restoration, a note of caution for such people with regards to the laser hair restoration is a must.
Not only is laser hair transplant inappropriate for Follicular Unit Transplantation, it is actually detrimental even with different modifications and variants of laser hair restoration procedure. Let’s see why?
The value of laser surgery lies in its properties of "selective photo-thermolysis" (this is the ability to destroy a specific target without injuring the surrounding tissue). Hair transplant surgery is different in this regard from other surgeries because of the lack of a target tissue. And when one is using laser hair transplant surgery for channel creation, it is actually making use of destructive properties of the laser. The laser hair restoration surgery literally burns a recipient hole in the skin. The tall claims made by laser companies for a new class of laser causing no thermal damage, is anything but true. Regardless of the source and the type, a laser is something which causes thermal damage by burning the tissue by its high energy. The laser hair restoration technique always leaves surface change and scarring. Not only this, high energy laser beams used for laser hair transplant may damage hairs existing near the implant site because of burning of the surrounding tissue .
There is another drawback of laser hair transplant surgery which is more critical. The high energy of laser beam leads to the closing of the blood vessels. This characteristic feature of the laser beam is useful in other type of surgery where it helps to close wounds and provides quick healing. But in case of hair transplant surgery, blood supply is very crucial for nourishing the grafts after they are transplanted. And this is the main concern about a laser hair transplant surgery. Laser assisted transplants either are not able to grow or heal more slowly to have unpredictable growth due to impaired blood flow.
The thermal damage caused by the laser hair restoration to the surrounding tissue destroys the collagen and weakens the elastic support around the newly transplanted grafts. It also increases the coagulum (clot) around the graft which, in turn, decreases oxygen perfusion and retards healing. The uniformly created channels created by laser hair transplant surgery lose all its promise when the laser "loosens" the "snug fit" between the transplanted graft and recipient site. And this is the reason why laser hair restoration results in unpredicted and slow growth of the hair follicle.
The advantage of laser towards decreasing bleeding at the recipient site is also of not much use. A hair transplantation surgeon can decrease bleeding more effectively by the use of precision instruments and better hair transplant procedures than using laser.
Regardless the hair transplant procedure a hair transplant doctor uses, maximizing the growth of a transplant is the one and only aim of any hair transplant surgery. And whatever is the type of implanted graft, whether it is a single follicular units or a group of follicular units, restoring the blood supply to the graft is of utmost importance. And since the laser hair transplant surgery fails to accomplish the vital function of restoring the blood flow, it is to be simply ignored as a hair transplant procedure.
1. Chu et al: 'Laser Assisted Hair Transplantation', Dermatol Surg, 27, 4 April, 2001, 335-342
2. Sadik et al: 'Comparative hair transplant surgery', Dermatol Surg, 27, 9 Septamber, 2001, 807-812