Follicular Unit Micro Grafting

Introduction

Follicular unit micrografting is a method of hair transplantation. This is considered as most evolved procedure in the field of hair transplantation.

The benefits of this technique are as follows:

1. This method maximizes the yield and survival of the limited number of donor hair follicles during the surgery.

2. This surgery gives the most natural-looking appearance of hair among all methods.

Procedure

The follicular unit micrografting procedure differs from conventional micrografting in planning to avoid unnecessary harvesting of too many grafts for a single transplant session. Although the surgeon can create the desired hair density in one session by placing a large number of micrografts very close to each other, a follicular unit micrograft surgeon harvests and transplants only about 1,000 to 2,000 grafts in a single session. This is because too much density can lead to graft failure.

The donor material harvesting method is a new refinement in the follicular unit micrografting. In the past, many surgeons utilized a multi-bladed scalpel to remove the donor tissue from the back of the scalp. All the blades in this surgical instrument were parallel, and were about three millimeters apart from each other. With a multi-bladed knife, the donor material was removed already cut into longstrips, and individual grafts were then cut from the strips. This method caused many hair follicles to be cut by the scalpel blades, and many of these cut follicles did not survive. In follicular unit micrografting, the surgeons use a single-blade scalpel for retrieval of donor tissue from the scalp and then they cut the donor tissue into grafts by guidance of high magnification. This avoids cutting the hair follicles.

The donor material is immersed in cold saline solution in surgical pads or trays to bring down the temperature of the follicles immediately after their removal from donor area. This also increases the graft survival. The follicles are kept cool and moist which helps them survive better during the time period of retrieval and grafting.

The use of stereomicroscopes to cut the donor material is another standard component of follicular unit micrografting. Previously, eye loupes and magnifying glasses were commonly used to guide the process of cutting donor tissue into strips and pieces, and finally into the individual grafts. But their drawback is that a significant number of hair follicles were cut due to poor visibility under this level of magnification. Stereomicroscopes provide separate eyepieces for each eye, which gives a three-dimensional view of the donor tissue. This leads to less follicle severing and avoids split in future hairs. However, the use of stereomicroscopes requires additional training for the medical assistants who cut the grafts.

The slits are made in a slightly random fashion to avoid creating a specific pattern of rows after the growth of new hairs.

Use of cool fluorescent light panels in graft preparation microscopes has improved visibility and keeps the temperature of grafts low. His method illuminates the grafts from underneath. This lighting technique is called as transillumination. This helps in preventing the heat damage and provides better visualization of small dormant follicles as well as follicles containing very fine light-colored hairs.

The most significant feature of this procedure is the preservation of the naturally occurring clusters of hair follicles during the graft preparation. Surgeons have observed that many hair follicles on the scalp occur in pairs or bundles of three or four follicles, which are called as follicular units. They are anatomical as well as functional units. Preserving follicular units as micrografts has benefits like:

1. Reduction of the risk of cutting the follicles which are very close together

2. This gives more viable tuft of hairs

3. The grafts so produced grow hairs in more natural groups.

In the follicular unit transplant procedures, the medical assistants prepare the grafts using their judgment to identify and cut individual follicular units. This produces grafts containing one, two, or three hairs depending on number of follicular units in the donor tissue which are naturally present.

Finally, the follicular unit micrografts are placed into preformed tiny slits in the scalp with the help of a miniature scalpel. The slits are made in a slightly random fashion to avoid creating a specific pattern of rows after the growth of new hairs. In follicular unit micrografting, adequate space is allowed between the grafts; although the grafts are placed in amore random and natural looking manner.