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Ultra refined follicular unit hair transplantation is a term to describe the new “gold standard” of hair transplantation where hair restoration physicians are using smaller blades, making smaller incisions, and creating smaller “skinny” grafts. Making smaller incisions and trimming smaller grafts allows a hair transplant surgeon to “dense pack” follicular unit grafts much more closely together than that of standard follicular unit hair transplantation (almost twice as dense in many cases) and when done correctly, produces high hair growth yield and minimizes scalp trauma.

Determining what is “ultra refined” however can sometimes be a little tricky as blade and needle sizes vary and many hair transplant surgeons like to cut grafts somewhere in between “skinny” and “chubby”.

With a “chubby” graft, there is some extra potential that hairs in catagen (resting) contained within the graft will be rescued and thus produce greater hair growth yield.  However, in my opinion, cutting a graft too chubby will result in additional scalp trauma and a need for more than one pass to accomplish the same result.

On the flip side, cutting a graft to “skinny”, makes the graft more vulnerable, so physicians, nurses, and technicians must be extra careful with these ultra-skinny grafts to ensure they are not damaged.  I have found that most patients prefer ultra refined follicular unit grafting because it allows a hair transplant doctor to accomplish more in a single hair restoration surgery. Those who have mastered this technique, such as those members of the Coalition of Independent Hair Restoration Physicians have a proven track record of excellent and consistent patient results.

Technorati Tags: hair transplantation, hair restoration physicians, hair transplant surgeon, dense pack, follicular unit grafts, hair growth, hair transplant, hair growth yield, follicular unit grafting, hair transplant doctor, hair restoration

I have noticed that of hair transplant photos posted where needles are used instead of blades to make recipient sites for the transplanted hair, there appears to be MUCH more redness.  The redness also seems to last longer post-op.  Is this because the needle hair transplant doctor is transplanting hair at greater hair density or does the needle cause more scalp trauma?

This question was posed by a hair loss sufferer on our hair restoration forum and answered by Ailene, a member of our hair transplant community and personal assistant for Dr. Jerry Cooley of Charlotte, NC who is a member of the Coalition of Independent Hair Restoration Physicians.

Blades versus Needles in Creating Recipient Sites in the Balding Areas in order to Transplant Hair

Our hair transplant clinic has used both needles and blades for many years. In a large number of hair transplant patients, we have used both and see no difference in postoperative healing or redness. When patients come back in for followup when the hair is growing in, there is no difference in the appearance of the hair in blade areas compared to needle areas.

For hair grafting in hairless or shaved areas, we prefer the blades which we custom cut depending on the width and depth of the follicular unit grafts. Since most of our hair restoration patients do not want us to shave their heads and expect to be back at work in a week, we are often grafting into areas with significant amounts of natural hair. For this, we prefer the needles because the sharp point can be directed precisely and the larger caliber of the needle ‘pushes’ the hair apart, minimizing the risk of hair transplant shock loss. We use different size needles ranging in size from 19 gauge being the largest and 22g or 23g be the smallest.

Technorati Tags: hair transplant photos, transplanted hair, hair transplant doctor, transplanting hair, hair density, Balding, Transplant Hair, hair transplant clinic, hair transplant patient, hair grafting, follicular unit grafts, hair restoration, natural hair

I am a hair loss sufferer considering hair transplantation but I am confused.  I have been reading this hair restoration forum for some time and don’t understand what makes some hair transplant clinics better than others.  Hair replacement surgery seems like a simple process.  Why are some hair transplant surgeons better than others?

There are many ways to answer this question.

Firstly, I don’t think it’s fair to call hair transplantation a “simple” procedure.  It’s in fact a very delicate process and damaging the follicular unit grafts without the necessary and proper care is sadly more commonplace than not in the world of hair transplantation.

Keep in mind also that not all hair transplant doctors in the world utilize the latest techniques and technologies.  In fact, the majority of them are still using out of date techniques which is why only a handful of hair transplant clinics are recommended on the Hair Transplant Network.  Many hair restoration clinics, believe it or not, still refuse to use microscopes when slivering the follicular unit grafts from the strip.  Many clinics still use minigrafts.  Read more about the history of hair transplantation.  And even still, many hair replacement surgeons still use a triple + blade to harvest the strip, which significantly increases hair follicle transection rate.

Keep in mind also that there are variations in even the latest of techniques and technologies. 

Some hair transplant physicians prefer making recipient incisions with needles, some with precut flat blades, some with custom cut flat blades, etc.  I have personally heard of cases made for each of these hair transplant tools.

Technorati Tags: hair loss, hair transplantation, hair restoration, hair transplant clinic, Hair replacement, hair transplant surgeon, follicular unit grafts, hair transplant doctor, hair restoration clinics, hair follicle transection, hair transplant physician

I have a question regarding follicular unit graft placement in hair transplantation. In order to plant the hair graft at the right depth, is this the responsibility of the hair transplant doctor to make the incision the right depth or the hair transplant technicians to place it properly?  I am particularly concerned with avoiding cobblestoning and/or pitting. What if the follicular unit graft is too long for the incision?  Or, are all incisions cut deep enough so this is never an issue?

This insightful response was written by “the B Spot”, a well respected member of our Hair Restoration Discussion Forum and consultant of Shapiro Medical in Bloomington, MN 

Pitting and cobblestoning are terrible issues.  It is important to see hair restoration patients of a particular hair transplant doctor in order to make sure this is not happening.

Proper depth to avoid these issues depends on each hair transplant patient.  I would say that most hair transplant patients fall between 3.5-4.5mm deep, with hair restoration doctor using needles making the deepest incisions.

It is the hair transplant doctor’s responsibility to make sure each incision is properly made, which includes proper depth. This information is based on the information from the cutters as they prepare the grafts - a size for 1,2,3,4 hair grafts are measured and then customer blades are cut to size (for doctors that use custom blades).  I would imagine doctors using needles find the closest match.

Technorati Tags: follicular unit graft, hair transplantation, hair graft, hair transplant doctor, hair transplant technician, hair restoration, hair transplant patient, hair restoration doctor, custom blades

I would like to know the difference between the number of follicular unit graft and number of hairs transplanted.  For example: if a hair transplant patient had 2700 follicular unit grafts transplanted which amounted to 7900 hairs, did he get a better deal than hair transplant patient who received 3250 grafts with only 6800 hairs? 

A follicular unit graft is a bundle of hairs that can contain up to 4 and even 5 hairs as they grow naturally in the scalp.  An individual’s hair characteristics will ultimately determine how many 1, 2, 3, 4, and very rare 5 hair grafts are available for extraction.

The number of hairs per follicular unit graft will vary on a number of things including how the follicular units are cut. 

• Some hair restoration physicians will occasionally subdivide a follicular unit graft to create additional single hairs for the hairline to create a more natural look.  This is a perfectly acceptable approach but will ultimately impact the number of counted grafts - though some hair restoration clinics adhere to the original follicular unit graft count before any splitting, therefore, charging less than those who count the subdivided follicular unit grafts as a separate hair graft. 

Technorati Tags: follicular unit graft, hairs transplanted, hair transplant patient, hair transplant, hair grafts, hair restoration physicians

This question was posed by a hair loss sufferer on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

It was interesting reading Dr. Rose’s and my comments on this subject from several years ago. I thought I would try to update the readers on my thoughts concerning chubby grafts vs skinny grafts and also make a few additional comments regarding follicular unit graft survival.

There is no question that a greater yield, sometimes beyond 100%, is possible with “chubby” grafts. Most small studies of reasonably trimmed follicular units shows that survival around 90% can be expected. The survival rates over the years on follicular units have varied tremendously, all the way from 80% up to over 100%.

I believe the biggest factor in high survival of follicular unit grafts is that the hair transplant doctor or hair transplant technician placing the grafts have years of experience and are conscientious about their work. Four years ago at the ISHRS (International Society of Hair Restoration Surgery) meeting in New York City, Dr. Kim from Korea and myself both presented studies in which we looked at follicular unit survival rates and interestingly we both came up with an identical 90% survival in our two studies.

Technorati Tags: hair loss, chubby grafts, skinny grafts, follicular unit graft, follicular units, hair transplant doctor, hair transplant technician, ISHRS, International Society of Hair Restoration Surgery

Looking back through the history of hair transplantation, no wonder that follicular unit hair transplantation is the popular trend producing the most natural looking hair transplants to date!

In recent years however, a handful of hair transplant physicians such as those who are members of the Coalition of Independent Hair Restoration Surgeons have improved their techniques and tools used in order to perform regular larger sessions of ultra refined follicular unit hair transplantation.

Larger hair transplant megasessions give hair transplant surgeons the capability of restoring a hair transplant patient’s hair in only one or two hair transplant procedures. With ultra refined follicular unit hair transplantation, minimally invasive incisions made in the balding regions allow a hair restoration physician to dense pack transplanted hair very close together while minimizing surgical trauma to the scalp. A few recently posted examples from our hair restoration discussion forum are below.

This hair transplant patient received 3750 follicular unit grafts with Dr. Alan Feller of NY in a single session using ultra refined follicular unit grafting, significantly improving his cosmetic appearance in only one hair transplant procedure. Being that this hair loss patient is only at 5.5 months after hair restoration surgery, he will continue to see a lot of new hair growth and thickening of the transplanted hair. Notice how densely packed the transplanted hair is together in the immediately postoperative hair transplant pictures.

Technorati Tags: hair transplant, hair transplant physician, hair transplant megasession, hair transplant surgeon, hair transplant patient, hair transplant procedure, follicular unit hair transplantation, balding, hair restoration, dense pack, transplanted hair, follicular unit grafting, hair loss, hair restoration surgery, hair growth

This question was posed by a hair loss sufferer on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

Most of the factors that we think have to do with “shock loss” of native hair following a hair transplant procedure all take place at the time of hair restoration surgery. The two most important things are: one, the VULNERABILITY of the hairs that exist on top, and two, the AGGRESSIVENESS with which the recipient sites are made. If a large percentage of those remaining native hairs are “miniaturized” (limited length and decreased diameter; ie: “wispy”) they are much more likely to be shocked than a strong terminal hair is. When recipient sites are aggressively made, whether it is the closeness with which they are made or the width, depth, or length of the individual sites, native hairs can be lost either by taking a “direct hit” by the instrument used or simply as a “shock” reaction to having all these cumulative injuries occurring so close to them.

The THICKNESS OF THE SCALP is another key factor. The plexus of key arterial vessels that network to supply blood supply to the scalp lay deep in the scalp over the “galea” layer (the thick gristle at the bottom) deep in the subcutaneous fatty layer. It this subcut layer is nonexistent, then it is hard for the doctor to avoid injuring those deeper vessels, even with tumescence.

Technorati Tags: hair loss, shock loss, native hair, hair transplant, hair restoration, terminal hair, recipient sites

What is the greatest hair density that a hair transplant doctor can safely transplant into an area with existing natural hair without risking shock loss?

Rarely is there any answer that is cut and dry when it comes to hair transplantation.  The answer to this question really depends on a number of factors.

One such variable is the amount and density of the native hair that hair is being transplanted in between or around. The greater the density of the natural hair, the less dense transplanted hair should be packed in and around the native hairs.

It also depends on whether or not a physician is using chubby or skinny grafts.  The hair transplant surgeon’s use of chubby grafts creates a need for larger incisions than when using skinny grafts.  The use of chubby grafts may limit the hair restoration physician’s ability to densely pack follicular unit grafts in a single area when appropriate - especially when in and around existing native hair.  Larger hair grafts calls for larger recipient incisions which when packed more closely together can increase scalp trauma which may facilitate the risk of permanent shock loss of weaker vellus hairs.   Though terminal hairs (unless they are transected during hair transplant surgery) aren’t at risk for permanent shock loss, densely packing too many chubby grafts may hinder hair growth yield due to overtaxing the scalp’s blood supply.

Technorati Tags: hair density, hair transplant doctor, natural hair, hair transplantation, native hair, transplanted hair, hair transplant surgeon, chubby grafts, skinny grafts, hair restoration physician, follicular unit grafts, hair grafts, vellus hairs, terminal hairs, hair transplant surgery, hair growth

I recently had a hair transplant about 1 month ago.  The top of my scalp where the hair grafts were inserted is still a bit pink.  Is this normal?  How long will this last?

Thank you for your inquiry.

Yes, it is normal for the recipient area of the scalp to become discolored (red or pink) even up to several months after a hair transplant.  I have found that the length of time of postoperative redness is dependent on a number of factors including:

• Number of follicular unit grafts transplanted
• How densely packed is the transplanted hairs
• Patient physiology (healing time, skin characteristics, etc)
• Size (circumference) and type of cutting instrument (blades, needles, etc) used to make recipient sites by the hair restoration physician
• Depth of the incision made by the hair restoration physician

Everyone will heal at different rates and times based on the above variables.  I’ve seen some hair transplant patients heal entirely within a couple weeks while yet others are experiencing discoloration of the scalp for almost 5 months.

Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Technorati Tags: hair transplant, hair grafts, hair transplant, follicular unit grafts, transplanted hair, hair restoration, hair restoration physician, hair transplant patients