Micrograft and Minigraft Megasession Hair Transplantation Results after a Single Session

The purpose of this article is to share observations made after performing 90 consecutive micrograft and minigraft megasessions for the treatment of male pattern baldness. Micrograft means grafts with I or 2 hairs, mini grafts are those with 3 or 4 hairs, and a megasession is a procedure in which more than 1000 micrografts and mini grafts are inserted in a single session. Between March of 1994 and June of 1996, the author performed 90 consecutive micrograft and minigraft, megasessions on 86 men and 4 women ranging from 21 to 67 years of age (average age, 42 years). The surgical team consisted of three surgical assistants and a plastic surgeon. Today, usually between 1500 and 2000 grafts per session are performed in about 4 to 6 hours, with up to 2495 grafts done in a single session. All procedures were done under intravenous sedation and local anesthesia. A donor horizontal ellipse of scalp is harvested from the occipital area; the grafts are made out of it and then inserted through small slits. The procedure has been found to he safe, and predictable with natural and aesthetically pleasing results, and there were no serious complications. The Only complication found in this group was self-resolving Inclusion cysts (ingrown hairs) occurring in 9 of 90 patients (10 percent). Even through the hair density achieved in a single megasession is limited, there is a high level of patient satisfaction: 83 of 85 patients were satisfied (97.65 percent). (Plast. Resonstr. Surg. 100:1524, 1997.)

For many years, multiple procedures have been available for the treatment of male pattern baldness. These include punch grafts,1-2 strip grafts,3 scalp flaps, 4-6 scalp reductions, 7-10 tissue expansion, 11-13 combination of tissue expansion and flap advancement,14 transposition,14 and, more recently, the use of scalp extenders.15 For the most part, these techniques tend to require too many sessions. The punch graft technique, as well as the temporoparieto-occipital flaps and the scalp reductions, typically takes four surgical procedures, leaving noticeable scarring and a result that looks unnatural.

The tissue expansion and combination of expansion and flaps typically take two sessions and often require additional touch ups. Also, there is the inconvenience of significant deformity during the 2 to 3 months of expansion, and patients often end up with a visible scar at the front hairline.

The use of single hair grafts was initially reported by Tamura in 1943 for reconstruction of pubic hair16 and in 1953 for reconstruction of eyebrows.17 In 1980, single hair grafts as eyelashes were reported by Marritt.18 Nordstrom 19 and Marritt 20 introduced in 1981 and 1984, respectively, the use of single hair grafts (micrografts) to improve the frontal hair line after hair transplantation as an attempt to provide a natural appearance. Subsequently, Uebel 21,22 introduced the concept of micrografts (I to 2 hairs/graft) and minigrafts (3 to 4 hairs/graft) in large numbers to cover the entire affected area while obtaining excellent results without visible scars.

Inspired by the work of Uebel, I started performing micrograft and minigraft megasessions in 1994, making a special effort within the bounds of reason and safety to gradually increase the number of grafts per session and trying to accomplish the best possible results in one session. This report includes my personal experience with 90 consecutive micrograft and minigraft megasessions.
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