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Old Style Hair Plugs New Follicular Units

What separates a good transplant from a bad one? Several factors are very important, the skill of the physician and assisting staff [see how to choose the right doctor], a person who is a good candidate [see who are the best candidates], but most importantly its the technique that's used.

Even a skilled doctor cannot make a natural looking hair line using hair grafts that don't look natural to begin with. Unfortunately hair transplantation started with doll hair type plugs and this unacceptable looking technology persisted for many years. Fortunately transplant doctors did eventually make progress by using mini and micro grafts to create a more realistic looking hair line, but even these are flawed and don't look perfectly natural. The reason is simple, to have something look completely natural you have to duplicate it perfectly as it exists in nature.

In nature every hair in a person´s scalp grows in tiny bundles called follicular units. Although this had been recognized for some time by histologists (doctors who study human tissue), the existence of follicular units was largely ignored by physicians performing hair restoration surgery.

The follicular unit in an adult is comprised of 1-4 terminal (full thickness) hair follicles. In addition to the full terminal hairs, the follicular unit contains 1-2 fine (vellus) hairs, sebaceous (oil) glands, a small muscle, tiny nerves and blood vessels, and a fine band of collagen surrounding the unit (called the perifolliculum). The follicular unit is thus the hair bearing structure of the skin and should be kept intact to insure both maximum growth and natural appearance.

In Follicular Unit Transplantation, the surgical technicians cutting the grafts out of the donor tissue use microscopes to ensure that these units are not split up and are maintained in their original and natural state.

How is Follicular Unit Transplantation different from Mini-micrografting?

In Follicular Unit Transplantation the graft sizes are determined by nature, in mini-micrografting the graft sizes are arbitrarily determined by the surgical technicians who cuts the donor tissue into the size pieces that the doctor has requested. Another name for this technique is mini-micrografts "cut to size."

The NHI team performing stereo-microscopic dissection.

In mini-micrografting, neither preserving follicular units nor even keeping hair follicles intact are felt to be that important. Rather, the speed and economics of the procedure are the deciding factors. Mini-micrografters use a multi-bladed knife to quickly generate thin strips of tissue and then use direct visualization (rather than microscopic control) to cut the tissue. The resulting grafts are generally larger than follicular units and since the excess skin is not trimmed away the donor sites are also larger.

Perfectly intact 1-, 2-, 3-, and 4-hair Follicular Units removed from the donor strip using a dissecting stereo-microscope.

A major advantage of follicular unit transplantation, (besides preserving follicular units and maximizing growth) is the ability to use small recipient sites. Grafts comprised of individual follicular units are small because Follicular Units are themselves small, but also because the surrounding non-hair bearing tissue is removed under the microscope and doesn´t need to be transplanted. Follicular unit grafts can be inserted into tiny needle-sized sites in the recipient area, which heal in just a few days without leaving any marks.

When performed by a skilled surgical team, Follicular Unit Transplantation can provide totally natural looking hair transplants that make the full use of the patient´s donor supply to give the best possible cosmetic results in the fewest possible sessions.

If its so much better why is it not performed by all doctors?

The simple answer is cost. It takes longer to cut the follicles into follicular units and requires that the staff are better trained. Also many doctors are reluctant to upgrade their facilities while mini micro-grafting gives reasonable results. If you are shopping by price and are looking for the lowest price per graft, you will most likely end up with micrografts and not follicular units.