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Many veteran hair transplant patients are familiar with the term “follicular unit grafting” and have come to know this as the today’s “Gold Standard” in surgical hair restoration.  What many don’t know however, is that a “follicular unit” falls under a particular category of “micrograft” – a term often wrongfully associated with a much less favorable and also misconstrued term “minigraft“.

Believe it or not even some of the leading hair loss doctors in the hair transplant profession today use some “minigrafts” when appropriate for the patient. But what exactly is a “minigraft”? Are they really as bad as some have perceived them to be?

Unfortunately, the terms for the various types of grafts have been misunderstood and misconstrued in our hair loss forum community for a long time.

Recently, Coalition member Dr. Ron Shapiro wrote an article to help hair loss sufferers understand the differences and appropriate use of various types of grafts.

I encourage you to read through Understanding Hair Transplant “Graft” Terminology to learn the various graft types and how they’re appropriately used. You are also encouraged to give your feedback on this hair loss forum topic discussing graft types.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair transplant, hair restoration, follicular unit, micrograft, minigraft, hair loss doctors, minigrafts, hair loss

Given the number of impressive hair transplant results presented in the “Results Posted by Leading Hair Transplant Clinics” forum, Coalition member Dr. Jean Devroye has quickly become recognized as a leading hair transplant surgeon in Europe.

In an attempt to improve the quality of results patients can achieve with follicular unit extraction (FUE), Dr. Devroye designed and has been using for 6 months a unique powered instrument (prototype) for FUE hair replacement procedures. This prototype was designed to improve the speed of the follicular unit extraction procedure while maintaining the same effectiveness as when performed manually by a skilled surgeon.

This new powered FUE device works by spinning alternatively with a low angular motion.  This allows for fast and effective penetration of the scalp and extraction of the follicle while keeping the risks of damage to the follicles virtually nonexistant.  It’s speed is controlled by a foot treadle allowing for better hand control of the device.

While Dr. Devroye believes his FUE tool prototype helps to increase the speed of the hair restoration procedure, he admits it doesn’t reduce the already very low transection rates he achieves while performing follicular unit extraction with a manual tool. Dr. Devroye’s powered FUE instrument has allowed him to increase the number of follicular unit grafts he can transplant daily via FUE from approximately 1200 to 1500 per day.

This hair loss question was answered by Dr. Glenn Charles of Florida who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

One thing I never really understood is when people say that the hairline will soften during the period 6-18 months after a hair transplant.  I thought that hairs initially grew thin and thickened up during this same period.  If hairs are getting thicker how can the hairline get softer? What does softening of the hairline actually mean?

Creating a soft and natural hairline with surgical hair restoration should be addressed by the hair replacement surgeon during the procedure.

It is critical that the thinner/finer hairs be used in the hairline. Thick/coarse hairs will most likely have a similar look and feel no matter where it is placed.  It is true that sometimes transplanted hairs will be more brittle and kinky during its first hair growth cycle. After repeated hair growth cycles and hair cuts those same hairs might begin to look and feel softer, but are probably just finally returning to their original state.

 Dr. Glenn Charles, D.O.

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Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair loss, hair transplant, hair restoration, hair replacement, transplanted hairs, hair growth

Today’s top hair restoration surgeons will create tiny incisions with small tools to maximize dense packing and reduce trauma to the scalp during a hair transplant procedure. The cutting tools however, vary from surgeon to surgeon.

The discussion on whether custom cut flat blades or pre-fabricated needles is optimal for making incisions has come up from time to time on our hair loss forum. While some clinics believe custom cut blades reduces trauma to the scalp and allows for packing hair more closely together, other clinics believe that by pushing the hair apart, sharp point needles can actually reduce the risk of shock loss.

In this hair loss forum discussion thread, read views by leading hair restoration clinics like Coalition members Hasson and Wong, Dr. Jerry Cooley, and Shapiro Medical Group. Feel free to offer your own input on this important topic.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair restoration, dense packing, hair transplant, hair loss, shock loss, Hasson and Wong, Dr. Jerry Cooley, Shapiro Medical

This insightful article was written by a Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians.

Over the past few years Bill Seemiller (Falceros) and Pat Hennessey have asked me to share with the reading audience my rationale for using multi follicular unit grafts (MFU) grafts (multi-follicular grafts, 4-6 hairs each) in the hair transplant planning for some patients. I will try to do so here.

First of all, in order to get our terminology straight, the difference between a “minigraft” and a MFU Graft, is that the minigraft is cut with less magnification, usually with “loupes” and are “cut to size” and often have a little transection in the cutting process. A MFU graft is cut, at least in our practice, under a 10x stereoscopic microscope and the nurse in our practice who specializes in cutting them each case that we use them, under high magnification dissects out a graft that encompasses two (or sometimes three) follicular units (FUs) that are in close proximity to each other. Incidentally, MFU grafts can be placed into either a small slit (usually made in what we call a “parallel” orientation) or into a small, round hole (usually 1-1.3mm in diameter; about the size of pencil lead)

ADVANTAGES:

1) In most research studies performed on hair growth / survival in follicles within MFU grafts, the survival has been 100%. It is presumed that this is because of the fact that they are buffered and protected by the surrounding tissue around and thus are less susceptible to trauma and drying. Also, hidden “telogen” stage (hibernation) hairs are often present and grow out later, which with FU dissection might be stripped away.

This hair loss article was written by Dr. Ron Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians. 

When Hair Restoration Surgery (HRS) was first popularized by Orentreich, the primary graft used was the “standard” 4 mm round punch graft.  However, over the past 10 years we have seen the introduction of much more diversity with respect to the size and shape of grafts. Grafts used today vary significantly and can be described with respect to a number of different variables including:

• Number of hairs
• Number of follicular units (FU’s) per graft
• Graft shape (linear, rectangular, round, chubby, skinny)  
• Size and type of the recipient site used (i.e. slit, slot or punch incisions).  Although technically this last variable refers to the recipient site and not the graft, in clinical practice, grafts are often described in this manner. 
• Process of graft production (i.e. cut “to size” vs. deliberately cut to contain a specific “number of hairs (or FU’s)”.

The reality of the situation was that for a long time a great deal of inconsistency and lack of specificity existed  when grafts were  described in the literature or at conferences.   Often in the past all that was stated was  that “Micrografts” or “Minigrafts” were  used.  This lack of specificity contributed to much of the confusion that existed when trying to compare different techniques that have developed over the years. 

This insightful hair transplant article was written by Dr. Bernardino Arocha of Houston, TX – an elite member of the Coalition of Independent Hair Restoration Physicians.

Hair characteristics, caliber, presence of curl, color, angle of emergence, and sheen play a pivotal role in the outcome of hair restoration surgeries. If your hair genie offered one of two wishes:

1) To double the amount of your hair;
2) To increase the diameter of your hair from thin to coarse.

Which of the wishes would be your choice? Well wish number one is quite simple by doubling the amount of hair you increase the volume by two, but what about the other option? If we go from fine hair with a diameter of 40 microns to coarse hair with a diameter of 80 microns, the area covered increases TWELVE fold since hair shaft is a circle the area is ∏r2 hence  (3.14)(2)2= 3.14x 4≥12. 

The other characteristics have a significant influence on the cosmetic impact of the hair transplant result, but to a lesser degree. The presence of curl can have a great impact on the volume; hence very curly. African-American hair covers a greater volume and more than compensates for the lower hair density in this race. The color or rather the amount of contrast between the color of the hair and the complexion is also important. Black hair looks thinner on the fair skinned individuals, while fuller on a tanned or darker individual. Similarly, a fair skinned individual with black hair who is transplanted will appear to get thicker hair as he ages and his hair turns grey. It is all attributed to the decrease in contrast.

I’ve noticed that some hair transplant surgeons use .7mm custom blades while others use .9mm to 1mm custom blades. Is it logical to follow the intuition of “the smaller the better”?

A doctor’s skill always reigns paramount when discussing something like this, or loupes verses microscopes. But assuming the hair restoration physicians are of equal ability, is there any reason why smaller blades/incisions are not optimal? Are there actual attributes for using the larger blades I referenced, other than that it’s easier for a doctor?

This hair loss question was answered on our hair restoration forum by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

The answer to your question is that sometimes smaller blades are more optimal, and sometimes not. It depends on many factors. What is more important then the size of the blade is how the follicular unit (FU) fits in the incision. The graft should fit snugly, but not too tight to cause compression. Also, the incision size should be such that the follicular unit grafts can be planted into the skin with as little trauma as possible. The texture and thickness of ones skin and the size of the graft determine what size blade should be used to make the incisions. Some patients have tough, non-forgiving skin that does not have much stretch to it.  In these hair transplant patients I would usually cut my blades a bit larger. Some patients have follicular units which splay at the bottom. I find they get squashed a bit if the incision size is too small and I have to use larger incisions for this type of follicular unit. A person who has thin blond hair will have much smaller follicular units then a person who has thick, black hair. Persons with very curly or kinky hair will have a curve to the follicular unit and will need larger incisions. Also, a FU with 4 hairs will be larger then a one hair FU and will need a larger incision to fit properly.

Have you ever wondered why so many actors have a full head of hair? Though it may appear that Hollywood is immune to male pattern baldness, many may have restored their hair with today’s revolutionary hair transplant procedures.

Thanks to the online collaboration between educated patients and quality physicians, today’s surgical hair restoration procedures can produce results so natural that even your hair stylist can’t detect them.

Ultra refined follicular unit grafting has raised the bar for physicians and their staff. Today, clinics dedicated to this revolutionary procedure can perform larger densely packed sessions when appropriate for the patient. A hair transplant surgeon must have a large and experienced enough staff to carefully trim all follicular units under microscopes and pack them closely together into tiny incisions carefully and timely. Only experienced and delicate hands can properly place grafts into small and densely packed incisions without damaging the grafts.

Thankfully, a handful of surgeons, such as members of the Coalition of Independent Hair Restoration Physicians have mastered this technique and regularly perform it with excellent results. Below we’ve provided a few recent examples provided by real patients sharing their stories and hair transplant photos with us. You are encouraged to offer your input on their hair loss blogs.

The concept of hair transplant surgeons giving varying estimates on the number of grafts needed to meet a patient’s hair restoration goals has concerned prospective patient members of our hair loss forum for years. Where one surgeon may estimate only 2500 grafts are needed, another may suggest 4000. But how many will a patient need to get a great hair transplant result?

The topic of splitting grafts has been heavily discussed on our patient hair loss forum for a long time. Where most if not all clinics will subdivide larger grafts into singles for hairline reconstruction, which clinics (if any) will cut smaller grafts and split true follicular units? What are the benefits and drawbacks to cutting smaller grafts?

Forum member “Reptile” was told by a doctor he consulted with that no hair transplant clinic can do sessions larger than 4000 grafts unless their splitting true follicular units. View this thread to read others and offer your own input on whether or not what this doctor saying has any validity.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair transplant, hair restoration, hair loss, follicular units