Micrografts and Minigraft Megasession Hair Transplantation: Review of 100 Consecutive Cases

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Exciting advances in hair transplantation have been introduced in recent years, particularly the use of a large number of micrografts (containing only one or two hairs) and minigrafts (containing three or four hairs) in a single hair transplantation megasession. A megasession consists of the placement of more than 1000 grafts in a single session.

This study includes data from 105 consecutive micrograft and minigraft megasessions performed between March 1994 and August 1996 in 100 patients, with a follow-up of 5 months to 33 months. The patients included 96 men and four women whose ages ranged from 21 to 67 years, with an average age of 42 years.

In this procedure a horizontal ellipse of scalp harvested from the donor's occipital area is used to make grafts under 3.5 loupe magnification. The grafts are inserted through slits in the recipient area, and the donor site is closed primarily. All of the procedures were done at my office surgical suite with the patients under intravenous sedation and local anesthesia. This procedure was found to be safe and predictable. The only complications encountered were a hypertrophic donor site scar in one patient (I %) and self resolving ingrown hairs (cysts) in nine patients (9%). Ninety-seven patients (97%) were satisfied with the results obtained after one session. Three patients (3%) who were dissatisfied with the results after one session were pleased with the results obtained after a second procedure.

For the most part the various procedures available over the years to treat male pattern baldness have tended to require too many sessions and leave too much scarring, and have yielded an unnatural result. In recent years the use of micrografts was introduced in an effort to obtain a more natural appearance in the front hairline after use of traditional hair transplantation techniques. (1-15)Micrografts were able to camouflage the front hairline by providing a transition zone of fine hairs before the wall of hair that begins abruptly with use of flaps; micrografts were also able to camouflage the "corn row" appearance of conventional round plugs. (16-18)More recently the use of a large number of micrografts and minigrafts to cover an entire area of baldness has opened up new possibilities for the treatment of male pattern baldness. Use of these grafts makes it possible to complete a hair transplantation in just one or two sessions without visible scarring and provides a natural result over the entire head.(19-21)

Between March 1994 and August 1996 I performed micrograft and minigraft megasessions in 113 patients. Thirteen patients were eliminated from this study because they were either lost to follow-up or had not been monitored for a long enough period. I performed 105 megasessions in the remaining 100 patients, all of whom were followed up closely from between 5 months to 33 months. Ninety-five patients underwent a single megasession, and five patients underwent two megasessions. The number of micrografts and minigrafts implanted in each patient per megasession ranged from 1000 to 2500. The majority of patients undergoing hair transplantation today receive approximately 2000 grafts.

As I have become more comfortable with this technique I have occasionally performed other aesthetic procedures at the same time as the hair transplantation procedure. These aesthetic procedures have included primarily upper eyelid blepharoplasty, upper and lower lid blepharoplasty, rhinoplasty, otoplasty, and liposuction. In addition, when performing a face lift I sometimes use the pieces of scalp that are normally discarded to make micrografts and minigrafts and insert them in areas where these grafts are needed.

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