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Follicular Unit Grafting in McLean, Richmond and Virginia Beach

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.

Hair Grafting at Virginia Surgical Center

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.

Hair Grafting results in McLean, VA


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.


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.

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