How many follicular unit grafts on average are lost doing the trichophytic closure hair transplant donor closure technique?
The trichophytic part of the closure should not cause any loss of any grafts.
From the surface downward, the layers of the skin are the epidermis, the dermis, and the fat layer. We are only trimming off the epidermis or surface layer of the skin and the tips of the hairs. The trimmed hairs will keep growing.
We are not affecting the stem cells in the hair follicle bulge area in the dermis layer or the dermal papilla stem cells in the fat layer. The hair follicles will therefore be able to keep producing new hairs every 2 to 6 years for the rest of your life.
Avoiding tension is most important to keep donor scars narrow. First and foremost we have to avoid taking a wider strip than the scalp laxity allows. We can further reduce surface suture tension by using deep dissolving sutures or by undermining the skin edges.
Not doing a trichophytic closure allows me to make the donor strip 1 mm wider than if I do a trichophytic closure and that could yield another 250-300 grafts. Some patients prefer getting more grafts than having a trichophytic closure but most don’t.
We do a trichophytic closure almost all the time but avoid it if the skin edges do not come together easily before undermining or using deep sutures. I would rather create a narrow scar with no hair in it than a wide scar with hair growing through it. Of course, a narrow donor scar with hair growing through it is best of all.
On subsequent hair restoration sessions, it may take a bit longer to dissect the follicular units out from the old scar than from virgin skin but careful microscopic dissection can still preserve the grafts.
In summary, unless a patient prefers a non-trichophytic closure or their skin is tighter than I would like, we do trichophytic closures routinely.
Dr. Cam Simmons