Follicular Unit Grafting in McLean, Richmond and Virginia Beach
Hair Grafting Microscopic Follicular Dissection & Grafting
In recent years great change has occurred in the way our surgeons perform
hair grafting. Our clinic has adapted the use of the dissecting microscope
to create hair grafts of the smallest possible size that still retain
the natural characteristics of hair growth.
By natural characteristics of hair growth, we mean the pattern of hair
follicles as they grow out from the skin. If one looks at the scalp with
5-10 powers of magnification, one can see that hair grows out of the skin
in units of one, two, three, or four hairs.
The human scalp averages one follicular unit per 1 mm and each unit averages
2.2 hairs. Therefore a strip of scalp 1 cm in height and 10 cm in length
could yield 1000 follicular unit grafts (2200 hairs). This is the way
nature grows hair. We move hair in these follicular units, cutting away
the non-hair bearing skin between them, and then transplant them into
tiny slits on the top of the head. By keeping hair grafts as small as
possible, yet keeping the follicular units intact, one can create a totally
Only one or two graft sessions are necessary to give complete results and,
if the goals are limited, one session will work. Because male-female pattern
baldness is progressive, it is best to distribute the hair grafts so that
coverage creates a natural and undetectable look.
When performing large sessions of hair grafts, it is necessary to have
a team of physicians, nurses, and technicians who can do the labor-intensive
task of cutting the donor hair under microscopes into hundreds (or even
thousands) of these small grafts and then insert them into the micro-slits
that the surgeon makes into the scalp. In our clinic, we have up to five
assistants working on a case. The skill and experience of these assistants
is crucial to efficient and successful modern-day hair grafting.
We perform these procedures under local anesthesia only. This allows the
patient to be fully alert through the procedure and able to drive himself
or herself home afterwards. The operation is painless once the scalp is
We do not use a post-operative dressing; However, we encourage each patient
twenty four hours after the procedure, to use a saline spray on the scalp
every 2-3 hours.
This technique seems to lessen the amount of crusting and sometimes causes
the hair to grow a bit more rapidly.
Every patient returns to the clinic the day after for a gentle scalp cleansing
and, if they have sufficient hair to comb over, can style it. The second
day after surgery, we gently shampoo again and, on the third day, you
may use your usual hair styling methods. The stitches used for closure
in the back of the head are removed in ten days.
A minor problem can occur following a hair grafting procedure. Swelling
of the forehead is possible, which can occur within the first two days
of surgery. The swelling, if it occurs, is temporary. We can employ certain
measures during surgery that lessen the incidence of swelling. We see
this phenomenon in perhaps one out of ten cases. In your follow-up shampoo
treatment, we can spot early detection of swelling and address it immediately.
A common occurrence after large sessions of grafts is the hairs will fall
out along with the little crusts that form around the grafts. The hair
will go through a premature phase of hair growth cycle where the hair
falls out and then re-grows.
IT SHOULD BE EMPHASIZED THAT HAIRS, WHEN THEY ARE TRANSPLANTED, TAKE AN
AVERAGE OF TWO TO THREE MONTHS BEFORE THEY APPEAR ABOVE THE SURFACE OF
THE SKIN AND THE GROWTH PROCESS BEGINS.
In the “old days” hair grafting was done with larger grafts
which have essentially been abandoned for the smaller grafts described
in this writing. These older style grafts, often referred to as “plugs,”
frequently resulted in a “corn row” or “doll’s
hair” look. This was due to large grafts standing out by themselves.
By dividing the donor tissue into smaller grafts, we spread the hair around
more diffusely and, therefore, get a natural look. We strive for a totally
natural undetectable look. We can also correct the old “plug”
procedures and obtain the same natural result.
Judgment, experience, and a sense of artistry are required by the surgeon
in order to achieve optimal results with each patient. There are a great
variety of balding patterns, hair textures, densities, colors, and scalp
laxity–all of which are factors that require modification to get
an optimal result. We always emphasize that hair transplantation is not,
in our opinion, an assembly line type of procedure where one can recommend
the same technique for all patients. We feel it is our responsibility
to personally educate each patient and devise a plan based on our knowledge