Follicular Unit Grafting in Richmond, McLean, &, Virginia Beach, VA
Follicular Unit Grafting
Hair Grafting Microscopic Follicular Dissection & Grafting
In recent years a great change has occurred in the way our surgeons perform hair grafting. Our clinic has adopted the use of the dissecting microscope to create hair grafts of the smallest possible size that still retain the natural characteristics of hair growth.
Natural Characteristics
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 the 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 natural appearance.
Hair Grafting Sessions
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 afterward. The operation is painless once the scalp is anesthetized.
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.
Follow-Up
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.
The Aftermath & Explanations
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.
In Conclusion
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 and experience.
FAQ
Hair naturally grows in small groups called follicular units. These groups usually contain between one and four strands of hair. Follicular unit grafting involves removing a strip of tissue from the back of the scalp where hair is densest. A specialized team then uses high-powered microscopes to dissect this tissue into individual grafts. This differs significantly from Follicular Unit Extraction (FUE). In FUE, the surgeon extracts follicles individually, directly from the scalp using a punch tool. The main difference lies in how the donor hair is harvested. Grafting allows for a high quantity of precise grafts in a single session. This method preserves the natural protective tissue around the hair bulb, ensuring the survival of the graft. Modern techniques have moved far past the old “plug” style associated with past decades. Ultra-refined follicular unit grafting focuses on using the smallest possible grafts that still hold the necessary hair structure. Surgeons use microscopes to trim away excess non-hair-bearing skin around the follicular unit hair grafts. This allows for tiny incisions in the recipient area. Smaller incisions mean the surgeon can place grafts closer together. This creates a denser, more natural appearance. Because the units remain intact, the hair maintains its natural growth pattern. Many patients seek hair restoration specifically to address a receding forehead or high hairline. Follicular unit grafting for lowering the hairline is an effective solution for this concern. The surgeon carefully selects single-hair grafts for the very front edge of the new hairline. This creates a soft, feathered transition that mimics nature. Two and three-hair units are placed behind this front row to build density gradually. This strategic placement prevents a harsh or artificial line. Lowering the hairline can dramatically frame the face and restore a more youthful balance to your features. The procedure relies heavily on the surgeon’s artistic judgment to match your facial structure and age, ensuring the new hairline looks appropriate. The recovery process is generally straightforward for most patients, who typically can return home the same day. You may need to spray the scalp with saline for the first twenty-four hours to keep the area moist and encourage healing. Any stitches used in the donor area are typically removed around day ten. Some minor swelling in the forehead might occur within the first two days. The transplanted hairs often shed along with small crusts after a few weeks. New growth typically becomes visible above the skin surface about two to three months later. Be sure to contact our team if you have any concerns over healing or the post-care steps to take.