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Advances in Aesthetic Hair Restoration
Background: Great advances have taken place in recent years in hair transplantation for both aesthetic and reconstructive purposes. However, there are still cases in which results do not appear entirely natural. This may be a result of slight clumps caused by grafts that contain too many follicles, scarring, and hair lines that are too straight, too low, too thin, or otherwise artificial. Furthermore, too many surgical sessions (4, 5, or more) are often required for an aesthetically pleasing result.
Objective: A procedure for achieving natural and aesthetically pleasing hair restoration in 1 or 2 sessions through the use of large numbers of follicular micrografts and minigrafts is described.
Methods: Between March 1994 and March 2002, more than 400 consecutive patients underwent hair restoration with 2000 to 2500 micrografts and minigrafts. A horizontal ellipse of skin was harvested from the occipital area and dissected into 2-mm strips by the surgeon. The strips were further dissected into individual micrografts or minigrafts by surgical technicians. The grafts were inserted with the use of a technique in which scalp slits were made by the surgeon using a 22.5 Sharpoint (Surgical Specialties Corp, Reading, PA) blade and an assistant immediately inserted the graft by sliding it along the side of the blade. This process was repeated until all grafts were inserted and densely packed, about 1.5 mm apart.
Results: Satisfactory results with few complications were obtained predictably in 1 session. Further enhancement was obtained with a second session.
Conclusions: Natural-looking, aesthetically pleasing hair restoration without detectable scars and with reasonable hair density can be obtained in just 1 or 2 sessions through the use of large numbers of follicular micrografts and minigrafts.
(Aesthetic Surg J 2003;23:259-264.)
Nordstrom1 and, later, Marrit2 described the use of micrografts (1 or 2 hair grafts) for the frontal hairline to camouflage scars from plugs or previous hair transplantations and to provide a transition zone and a natural-looking front hairline. However, the use of such small grafts was time-consuming and, at the time, appeared impractical for treating large areas of baldness.
The use of micrografts and minigrafts (3 or 4 hair grafts) in combinations of more than 1000 grafts per session (megasessions) to cover the entire area of baldness was originally described in the mid-1980’s by Uebel.3,4 Headington5 studied the transverse microscopy of the scalp and found that hair grows in follicular units – that is, in groups of 1, 2, 3, or 4 hairs, with each group containing and independent neurovascular bundle, sebaceous glands, sweat glands, and piloerectile muscle, all surrounded by a fine circumferential sheath of collagen. These units appear, to some degree, to be true physiologic entities, so that maintaining them as intact as possible improves hair survival and ultimate hair growth (Figure 1). Skeletonizing the grafts to the bare hair shaft jeopardizes their survival.
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