Bernstein Medical - Center for Hair Restoration - Dissection Phase of Hair Transplant

Dissection Phase of Hair Transplant

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Q: I went to a hair transplant doctor for a consultation for my hair loss and he said that it was not that important to use microscopes for hair transplants. I had heard that it was. What’s the deal? — V.F., Hell’s Kitchen, N.Y.

A: It is extremely important to use microscopes when performing hair transplants. It is the only way that follicular units, the naturally occurring groups of hair follicles, can be isolated from the donor tissue without damaging them.

Other techniques, such as magnifying loops and back-lighting are not as precise. Using microscopically dissected follicular units in hair transplants has been the main advance that has allowed doctors to move away from the older mini-micrografting hair restoration techniques to the current procedure that can produce totally natural results.

See the Graft Dissection page.

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Q I had a hair transplant 15 months ago at a well known clinic in Manhattan. There were about 1000 grafts transplanted in the front hair line. At this point I am upset with my results. My guess is that only about 50 new hairs have grown. My question is what would cause this to happen? It seems to me that the hair transplant took longer than expected and my grafts died before they were placed! Please help! — B.E., Ithaca, N.Y.

A There are many factors that can contribute to poor growth during the hair restoration process including grafts that are left out of the holding solution too long or kept under the microscope for a prolonged period of time where they dry out.

Grafts can be injured in the dissection process or can be traumatized during the placing – if they are grasped too tightly or manipulated too much.

If properly hydrated, grafts can survive outside the body for many hours, so this in itself is generally not a problem.

There is no way to really tell what the exact problem(s) may be without watching the entire hair restoration procedure, since so many steps are involved that can affect the survival of the grafts. All of these steps must be carefully controlled to insure optimal growth.

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Q: Why are strips used so much in a hair transplant when there is now Follicular Unit Extraction (FUE)? — E.N., Long Island, N.Y.

A: Strip harvesting is used in the majority of hair transplant procedures because it allows the surgeon the ability to perform hair transplant sessions using large numbers of grafts while minimizing injury to the patient’s hair follicles.

This is possible because once a strip is removed from the back of the scalp, the tissue can be placed under a stereomicroscope where dissection is accomplished using direct visualization of the follicular units. This allows the grafts to be dissected with minimal trauma.

This degree of accuracy is not possible with other hair restoration techniques, such as FUE, where the separation of follicular unit grafts from the surrounding tissue is accomplished “in vivo” (directly from the scalp).

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Q: Why can donor hair become frizzy and dry once transplanted? — G.F., Stamford, C.T.

A: Frizzing and kinkiness is a temporary phenomenon that is part of the normal healing process after a follicular unit hair transplant. During the healing process, the new collagen that forms around the grafts can alter their growth. Over time, usually within a year, this collagen matures and the hair quality usually returns to normal. If grafts have been excessively traumatized or grafts larger than follicular units have been used, these changes are more likely to be permanent.

Dry hair is felt to be caused in part by trimming follicular units too closely and thus removing the sebaceous glands which normally provide an oily film to the surface of the hair and skin. With grafts smaller than follicular units (i.e. with closely trimmed micro-grafts) the risk is even greater.

To prevent this, in the dissection phase of the hair transplant, one should isolate intact follicular units from the donor tissue and trim away excess skin, but not trim the follicular units “to the quick.” Excess trimming, besides removing the sebaceous glands, also makes the grafts more subject to drying, warming and mechanical trauma (particularly during graft placing).

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