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With the patient’s head turned to the left, I harvested the right half of the ellipse and immediately dissected it under 3.5x loupe magnification into 2-mm-thick slices (Fig 3). These slices were then dissected into individual follicular units (micrografts or minigrafts) by 2 or 3 surgical technicians, usually also under 3.5x loupe magnification (Fig. 4). Sometimes a 10x microscope was used, especially if the hair was gray or very light in color, because this made the dissection easier and safer. As the grafts were dissected, I closed the right side of the ellipse by performing a single-layer closure with 3-0 Prolene, (Ethicon, Inc., Somerville, NJ) or nylon. Once closure was complete, the patient’s head was turned to the right and the procedure was repeated. Conservative underminig was performed as needed, although the donor site was not infrequently closed without the need for undermining.

I inserted the grafts with the use of a “slit-and-slide” technique, in which the slit was made with a 22.5 Sharpoint blade (Surgical Specialties Corp, Reading, PA) (Fig. 5) and an assistant immediately inserted the graft by sliding it along the side of the blade. To keep grafts from “popping out,” they were initially inserted 5 mm apart. After 20 to 30 minutes, when the fibrinogen had converted to fibrin and the grafts were a bit more stable, I made slits about 2.5 mm apart, again working anteriorly to posteriorly. This process was repeated until all the grafts were inserted ad densely packed, 1 to 1.5 mm apart. Greater emphasis was placed on the anterior scalp rather than the posterior because the anterior is more important in framing the face and the hair can always be combed back to help cover the posterior scalp.



(Fig. 3). A view of the initial strips. Dissection into the individual follicular micrografts and minigrafts was performed at this point.		(Fig. 4). A 22.5 Sharpoint blade was used to insert grafts at the front hairline because its sharpness and small size prevent detectable scarring.

(Fig. 5). A 22.5 Sharpoint blade was used to insert grafts at the front hairline because its sharpness and small size prevent detectable scarring.

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