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Follicular Unit Transplantation is a technique, in which hair is transplanted from the permanent zone in the back of the scalp into areas affected by genetic balding (and some other types of hair loss), using only the naturally occurring, individual follicular units. In order to remove follicular units from the back of the scalp without damaging them, the donor tissue must be removed in one piece. This technique, "single strip harvesting," is an essential component of follicular unit transplantation as it not only preserves the follicular units, but also prevents damage (transection) to the individual hair follicles. It differs dramatically from the minigrafting and micrografting technique of using a multi-bladed knife that breaks up follicular units and causes unacceptable levels of transection of hair follicles.
illustration of the dissected follicular units |
actual follicular units used in hair restoration surgery |
A very important component of Follicular Unit Transplantation is "stereomicroscopic dissection." In this technique all of the follicular units are removed from the donor tissue under total microscopic control to avoid damage. Complete stereomicroscopic dissection has been shown to produce an increased yield (as much as 30%) of both the absolute number of follicular units, as well as the total amount of hair. (This procedure differs from minigrafting and micrografting in which grafts are cut using minimal or no magnification.)
Over the years as we increased the number of microscopes and power of magnification it was noticed the number of grafts from a strip increased. Follicular units dissected without any magnification can look as good, identical, or even better than one cut with magnification. But that's not the criteria which should be used, an increase in the number of preserved follicles is. What is being lost isn't being seen because it can't be seen without higher powers of magnification and it's in the garbage. If one believes these studies and the experience of those who have seen the light, by not using higher powers of magnification one is committing follicular homicide. This is not in the best interest of the patient regardless of cost to the physician and patient in money and/or time. If the past one could argue that not using magnification didn't really make a difference because we didn't know. That is no longer true so there is no excuse in my opinion. There are ways to magnify without microscopes but I found increased grafts numbers going from loupes to 6X magnification and even more from 6X to 10X magnification. I refer to cutting slivers and the grafts from the slivers with magnification, either/or doesn't count. No assistant has 6X eyes regardless of gender or ethnicity.
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