FU'S VS MINIGRAFTS

[thewizard]

I am somewhat confused by the great debate between minigrafts and Fu's. For months now I have been reading on this site how FU'S are superior to minigrafts. Some respected surgeons perform a blending technique where FU's are used for the hairline, crown and crease areas and some minigrafts that maintain the follicular families are used on the top of the head. I have read numerous times that this doesn't achieve natural results and that the FU'S are the only way to have a transplant.In April of this year Dr Beehner made a case for blend grafting to achieve density and still maintain naturalness. Many regular participants to this site stated that this is outdated and that FU'S are the best way to go. What disturbs me is that I now have read two threads from people who had transplants by prominent surgeons renowned for their work with FU'S only. In both cases the patients said that two one hair follicules were inserted into one site to achieve density, and in the other two two hair follicule units were inserted into one site to achieve density. Is that FU's or minigrafts? If its minigrafts then why are doctors saying they perform all FU' s when they are not. If you use minigrafts that maintain the follicular family and they are 2 to 4 hairs why is that different than inserting two one- hair or two two -hair follicules into one site. I would like to here some discussion on this issue. I am not paid by anyone or have any ties to any surgeon I am just trying to make a decision for my second HT but I always find information that is contradictory like this. If FU'S are so good then when you see pictures of patients why don't you ever see them with the top of the head showing In most cases its always the front. Is it a density issue? Evidently, it must be when surgeons using all FU's feel the need to put two grafts into one site. I made a mistake the first HT I don't want to make a second mistake but I feel like you can never make a decision because there are always hidden factors that are never mentioned at consultations. Like using multiple grafts in one site... opps I forgot they are FU's so that makes it different than mini's or does it. Let the debate begin!!!

[thewizard]

I am somewhat confused by the great debate between minigrafts and Fu's. For months now I have been reading on this site how FU'S are superior to minigrafts. Some respected surgeons perform a blending technique where FU's are used for the hairline, crown and crease areas and some minigrafts that maintain the follicular families are used on the top of the head. I have read numerous times that this doesn't achieve natural results and that the FU'S are the only way to have a transplant.In April of this year Dr Beehner made a case for blend grafting to achieve density and still maintain naturalness. Many regular participants to this site stated that this is outdated and that FU'S are the best way to go. What disturbs me is that I now have read two threads from people who had transplants by prominent surgeons renowned for their work with FU'S only. In both cases the patients said that two one hair follicules were inserted into one site to achieve density, and in the other two two hair follicule units were inserted into one site to achieve density. Is that FU's or minigrafts? If its minigrafts then why are doctors saying they perform all FU' s when they are not. If you use minigrafts that maintain the follicular family and they are 2 to 4 hairs why is that different than inserting two one- hair or two two -hair follicules into one site. I would like to here some discussion on this issue. I am not paid by anyone or have any ties to any surgeon I am just trying to make a decision for my second HT but I always find information that is contradictory like this. If FU'S are so good then when you see pictures of patients why don't you ever see them with the top of the head showing In most cases its always the front. Is it a density issue? Evidently, it must be when surgeons using all FU's feel the need to put two grafts into one site. I made a mistake the first HT I don't want to make a second mistake but I feel like you can never make a decision because there are always hidden factors that are never mentioned at consultations. Like using multiple grafts in one site... opps I forgot they are FU's so that makes it different than mini's or does it. Let the debate begin!!!

[NW]

Heya wizard,

 

Excellent questions!, Some prominent FU physicians do at times put 2 fu's in line with one another in the crown area including Dr Shapiro. I personally had some put way back on my "top-scalp" area during my 1st procedure....and admitadley I am happy with the placement and results.

 

But looking back, I feel I still would have chosen 2 all FU procedures. My 2nd procedure was all FU's only.

 

Do not let any Dr. do mini-grafting or double FU's anywhere near the front 1/3 of your scalp, the Dr's on this site would not do that anyway, but again I would still pick 2 all FU procedures if given the choice, you will get nice density if they place them tight and you are open to a 2nd follow-up HT ( assuming you are a good canidate). See "Wassup" and "Futzyhead" photo's both top quality work. If the office is lacking microscopes---pass em up.

 

Good Luck !!

NW

[arfy]

I would also recommend the "all-FU" approach. But like Wizard said, there are a few recommended doctors who now use a sprinkling of larger grafts. The key word being SPRINKLING. A good guesstimate would be UNDER 10% larger grafts. Bad clinics usually use something like 70% larger grafts... big difference there! A world of difference.

 

A true FU graft is carefully trimmed of excess tissue, using stereomicroscopes (and not "loops" which are headgear aka visors). A doctor who does mostly FU grafts but also includes a few larger grafts, will not suddenly shut off the microscopes, when it is time to create a few larger grafts. Th micrscope is still used for dissection. So definitely make sure your clinic uses microscopes, and not loops. (Good clinics do use loops to place the grafts, but NOT to dissect them).

 

These doctors who use a few larger grafts tend to refer to them as "coupled FUs". They are still trimmed more closely than Minigrafts.

[thewizard]

Now I am really confused...all the proponents of FU transplants are now saying 10 % is acceptable...who determines that cutoff....in a few months from now will someone say 70% fu and 30% larger grafts are acceptable ...as long as the larger grafts are cut under a microscope and the follicular familes are kept...I guess it all comes down to the basic concepts that

 

1) The doctor you choose cuts under a microscope

 

2) He / she is well respected in the Hair Transplant Community

 

3) HT is his only practice

 

4) The doctor uses a single blade to cut the donor area.

 

5) He is sincere and upfront with his evaluation

 

It seems to me the debate of some minigrafts with FU'S are a matter of opinion and up to the patient

to decide but one cannot bash another doctor for a different approach because that doctor chooses to use larger grafts sprinkled in with the FU'S as long as he meets the above criteria . Am I missing something here?

[arfy]

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR> ...all the proponents of FU transplants are now saying 10 % is acceptable...

No, not quite. There are still doctors who are "all-FU" and patients who want all FUs. What you decide is up to you.

 

Why is this so confusing to you? When most clinics (by far) don't use ANY FUs whatsoever. So you can immediately cross them off your list, in my opinion. But you are free to make up your own mind.

 

Then there are the clinics who use FUs in the hairline ONLY, and everything else behind the first few inches is a Minigraft. I wouldn't recommend those clinics either.

 

I already explained the difference between a coupled FU and a Minigraft, as I understand it... they are not the same thing. If a doctor uses 10% larger grafts in a 2000 graft session, only 200 grafts are not regular FUs. If you want an all-FU procedure, it is not hard to find the doctors who will do that.

 

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>in a few months from now will someone say 70% fu and 30% larger grafts are acceptable Somebody already DOES say that... Dr. Beehner I believe will sometimes transplant using those percentages. That's not what I would want for myself, but you should decide what YOU want.

 

I don't think it is that confusing. There's another thread here ("Scruffy or Sketchy?") where a fellow is wondering why his doctor stuck single FUs next to each other, to create a larger graft, but he still had to pay for each FU. This is an example of a case where the doctor thought single FUs would not do a good job. And think about it... a transplant of all single-hair FUs would not look good. By the same token, too many single FUs are not correct. So the doctor used "coupled FUs". They are not Minigrafts.

 

FUs are still the cornerstone of a good transplant. That is true no matter who your doctor is.

 

I am posting in the doctor's forum and I shouldn't be. Maybe a doctor who uses small amounts of coupled-FUs will answer any further questions...?

 

[This message was edited by arfy on November 20, 2002 at 07:26 AM.]

[Guest]

thewizard asked a question that remains in my head after months and months of research. What is the difference between a one hair micro graft and a single hair follicular unit graft ? Is it only the way the grafts are dissected under the microscope? What about their appearance ? Is the one hair micrograft any different from the follicular unit single hair ? How can you tell one from the other once it grows? I know ! dumb questions but I haven't been able to figure it out.

[NW]

MK

 

A 1 hair micrograft is:

 

A single hair micro-graft is cut away from its growing brothers of say a 2 or 3 hair cluster, when you dont use a microscope you must leave excess tissue around the base of this hair. So..you have to use a bigger incisions hole, which means less tight packing of hair.

 

1 hair Folliculler unit is:

 

A single hair that through looking under a higher power microscope..has always grown by itself...this guy never needs to be cut away from other hairs sharing the clump...or he has always exsisted as a "Loner" a "healthy & studly loner". Because of the use of high power microscpoes..Dr.s can see so well that they can trim the base more precisely and smaller, hence smaller incisions = tighter packing of hair...like mother nature did so well.

 

Some sub-par Dr's will try in vain to convince you..a 1 hair micro is the same as a 1 hair naturally growing folliculer unit.

 

Dont Buy the cheap talk

 

NW

[arfy]

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR> What is the difference between a one hair micro graft and a single hair follicular unit graft ? Is it only the way the grafts are dissected under the microscope?

Yes.

 

Technically, a FU graft is actually a specific type of Micrograft. The difference between a single follicle Micrograft, and a single follicle FU graft is the microscopic trimming.

 

Excess (untrimmed) tissue causes the grafts to be bigger than necessary. That means each graft disrupts the surface of your scalp more than it needs to. And peoples' eyes will be drawn to the grafts, because instead of appearing like your hair emerges from your scalp, like normal peoples' hair, it will appear to be growing from a graft.

 

The smaller the grafts are, the better, when it comes to scalp surface. That is, up until the point that you would start breaking up the natural groupings. The natural groupings must be kept intact. But trim all excess tissue. Clinics that use Micrografts do trim their grafts, but they don't use Microscopes, so it is typical that those grafts can't be trimmed as closely, without accidently damaging some grafts.

 

Also, in the case of FU procedures, the tech dissecting the grafts tells the doctor what kind of grafts the doc will be using. ("I've got 520 singles, 350 doubles..." etc). In the case of Minigrafts and Micrografts, the doctor tells the tech "we need more singles" and the tech splits up naturally occurring FU bundles, which is taboo in an FU procedure. Or the doc could say he needs some "fives and sixes" (bundles which do NOT occur naturally) and the tech will cut a graft that puts several different natural bundles together in the same graft. The tech creates combinations that are unnatural. Instead of cutting the natural groupings, the tech cuts the grafts "to doctor's orders". That too is also taboo in an FU procedure.

 

The difference between FUs and Minigrafts and Micrografts is probably more dramatic when discussing Minigrafts. Because a single hair graft is a single hair graft, as you said (besides the excess tissue). But Minigrafters combine multiple FU bundles into a single graft. Those grafts are too big, and they have too much excess tissue. Minigrafts can often lead to scalp surface irregularities like pitting and cobblestoning. Those problems are the KISS OF DEATH if you want a hair transplant that looks natural! If you want a hair transplant that looks like a hair transplant, you will get that if you have pitting and cobblestoning. Again, pitting and cobblestoning are scalp surface irregularities that result from using grafts that are too big... grafts that have not been trimmed under a high-powered microscope. From what I have read, pitting and cobblestoning are basically impossible when using true FU grafts.

 

So... how can you tell a single follicle Micrograft from a single follicle FU graft? Well, there are probably some cases where you'd have a hard time telling the difference. But in the cases where you CAN tell the difference, those guys are pretty seriously screwed! So the whole point is to avoid that in the first place. Don't even chance that happening, because that is a bad problem to have!!! To fix it, you have to typically remove the whole graft, and if you have hundreds (or thousands) of grafts with this problem you are SCREWED.

 

It's not that the microscopes are so expensive or so hard to use. It's that the clinics that trim grafts under microscopes have to spend more time per-patient, than the clinics who cut grafts by eye, or cut grafts less closely. Most FU clinics do one patient per day, whereas clinics who use Minis and Micros will typically do 3 or 4 patients per day. So even though FU grafts are cosmetically superior, most clinics prefer to go for the higher profits with Minis and Micros.

 

The differences between Micros/Minis and FU grafts are subtle, but it ultimately can make a HUGE difference in your results. The difference between a transplant that looks completely natural no matter which way the wind blows, and a hair transplant that makes you look like "a guy with a hair transplant".

 

It's up to you guys to decide which kind you want! Pick a clinic that puts superior results over high turnover and high profits!

 

[This message was edited by arfy on November 20, 2002 at 03:20 PM.]

[HotCreek]

Thewizard,

 

I think most posters to this site would agree that if you decide to have a transplant you will save yourself much grief by going to a physician who does ONLY FU transplants and INSISTING that he agree to put only one FU into each recipient site.

 

In my opinion properly cut FU's are ALWAYS better than mingrafts AND FU's with fewer hairs utilize each hair more efficiently than FU's (or any graft) with more hair.

 

First, any procedure which "bunches" hairs together into one graft runs a higher risk of producing a "clumpy" or "tufted" look than one which doesn't. And in some cases, bunching of any kind can make it difficult to insert the graft at the correct angle and orientation.

 

Second, a hair transplant procedure doesn't give you anything you don't already have. It only moves hair from one location to another. So the surgeon's job is to make those transplanted donor hairs (which are in limited supply) cover the underlying scap as efficiently as possible.

 

It would seem to me that a procedure using grafts with the FEWEST hairs utilizes each hair more efficiently than one using grafts with more hairs. The reason is simple: As hair grows you comb it over or it flops over on its own. In any case, hair which "layers" over other hair is NOT as preferrable as hair which covers scalp because it's scalp you want to cover, not other hair. And I would think that hairs in groups or bunches would tend to cover each other to a greater degree than they cover scalp; at least compared to hairs which are not planted in bunches.

 

Taking this logic a small step further, it is clear that the most efficient use of a single hair is a one-hair follicular unit; which is to say a graft with the smallest number of hairs.

 

However, there's a problem. Because there's a limit to the number of holes (recipient sites) a surgeon can poke into a given area of scalp, transplanting only single-hair FU's would reduce the overall number of hairs moved. Clearly, putting more hairs (larger grafts or multiple grafts)into each of a limited number of holes would move more hairs.

 

It may very well be that the best compromise between all single-hair FU's and larger multi-hair grafts is the FU as it naturally occurs on your own head.

 

Of course physicians love moving hairs in clusters or groups (larger grafts) because they get more "bang" per recipient site and the entire process from dissecting the donor strip to implanting is less work. Indeed, this is undoubtedly one reason why so many physicians still use minigrafts. Nonetheless, this practice almost always comromises cosmetic results. So you really have to choose your surgeon carefully.

 

[This message was edited by HotCreek on November 21, 2002 at 10:06 PM.]

[Dr. Michael Beehner]

I think there is some benefit to the general community that this topic of graft definitions has come up. These various terms describing particular types of grafts all evolved over the past 20-30 years, as the size and the means used to cut the graft changed over time.

For 30 years virtually the only graft used was the 4mm large "standard" graft popularized by Dr. Orentreich, which obviously looked quite "pluggy" and gave hair transplantation a bad name for many years. When these large grafts were later quadrisected into four quarters (first suggested by a Dr. Bradshaw of Australia), these became known as "minigrafts". They were a huge improvement on the so-called "standard" plug graft, but still were very detectable (and, in dark haired individuals, quite unsightly)if planted anywhere near the front hairline, crease, or crown area. Not too long after this (still in the 1980's) some doctors, Dr. Manny Marritt of Denver, CO among them, started breaking single hairs off of these mini's and large grafts and termed this even smaller graft a "micrograft". For many years hair surgeons accepted the definition of a "micrograft" to be one that consisted of 1-2 hairs, period. During these years most hair was harvested still using the electric rotary punch and punching out 4-5mm circles all over the donor area (this is how most of my own hair transplant was done in the early 1980's), usually leaving them to simply scar in. The magnification used was almost always some type of magnifying "loupe" mechanism, either attached to ones glasses, or in the form of the large circular prism that you see for sale in catalogues occasionally.

Then along came the microscope and a growing awareness of an entity called the "follicular unit" which was actually described by a researcher named Dr. Headington in the early 1980's. Dr. Uebel and Limmer were the first to use these types of grafts. Many others have come along to make contributions in how we use these grafts. In this era of stereoscopic microscopes,we thus now have the follicular unit graft, which is the naturally occurring 1-3 hair (rarely 4 or 5) graft that exists on the human scalp and in transplanting is isolated by cutting all around it to keep it intact. It is then placed in a tiny needle hole/slit in the scalp.

It should be pointed out that the term "minigraft" has now come to be described more in terms of the number of hairs in the graft, generally a graft of 4-6 hairs. If one uses no magnification or uses "loupes", then we usually describe these as being "cut-to-size minigrafts." If one uses the microscope to cut these grafts, as we have done for the last 7 years in our clinic, then these so-called "minigrafts" for the most part consist of small groups of intact follicular units that are adjacent to each other as either 2 FU's or perhaps even 3 FU's, depending on the size of the graft being made and the density of the patient's donor hair. In our clinic, in an extremely dense coarse donor area which has a lot of 4-5 hair FU's, we sometimes will actually carefully divide some of these into two smaller grafts, to avoid the detectability that can occur from that many hairs coming out of the same needle hole. Such a graft looks far more "pluggy" than a "paired FU graft" of two 2-hair FU's next to each other with a little intervening skin.

Oftentimes, in patients who have a very small number of 1-hair FU's or in eyebrow work (in which 1-hair grafts are preferred) it is often necessary to again divide the FU carefully into separate 1-hair "micrografts" in order to have enough 1-hair grafts to place at the front of the front hairline, temple area, or eyebrow where they are needed for naturalness.

I hope the above helps to clear up some of the confusion in the use of terminology in hair transplantation.

Mike Beehner, M.D.

[Guest]

Excellent definitions, explanations and history. I think this is the best page I have read in this forum. You were all very synoptic, simple and clear. Thank you.

[noreaster]

this guy panther5000 is asking every paient and doctor, on every different segment of this forum about his situation, dude why don't you go consult w/ another doc in the area, see what his assesment is, or count the grafts, you seem way to worried, without someone seeing you in person I dount anyone here will be able to help

[arfy]

Noreaster

Relax there, this is not the same question that has already been asked by Panther.

 

Panther is saying his techs dissected his grafts with no magnification whatsoever, which is a completely different issue.

 

If this is true, that is a BIG "no-no"...!

[noreaster]

arfy is right if that is true than that is wrong, was not trying to put anyone down or anything but you have been posting in quite a few places. Now after reading these you told us that your doc was dr charles, is he a shapiro guy? I think you would have a legitimate beef to be brought up w/ Pat, and Dr. Shapiro himself., or if I'm wrong about the group, how bout spencer??!!

[noreaster]

and also panther was it 6 months ago, or last week, make up your mind!!Doesn't really matter, we are here to help no matter when.

[Dr. Michael Beehner]

I must confess that I have come across a few assistants - all of them happen to have been female and of a younger age- , of nursing and other backgrounds, that had incredible eyesight. I have one that works for me presently who inserts her grafts without having to use an eye magnifier in front of her eyes (as I and the rest of my staff do). She does, however, use the scope to CUT grafts.

In answer to the question, I personally must come down on the side of saying that for it to be called true follicular units that are being dissected, one should use a dissecting microscope, at least a 6x power Mantis microscope, and probably preferably a 10x one of the standard variety. I will grant that an assistant with great eyesight, such as our Carol, could probably 9 times out of 10 cut true intact follicular units using the naked eye (or loupes), but there is so much that is missed when one doesn't use a microscope. It is like the difference between looking into the water while sitting on shore, versus getting in there with a snorkel and mask. You just see so much more. You see the tiny, dull germinal "bulge" that is around a third to halfway down the follicle (and should be preserved), down to the bulb itself, with its tiny, faint colored "dermal papilla" just beneath its underside, which also should also be preserved to get optimal and timely growth of the new hair. Even the act of accurately trimming the epidermis (skin) closely at the edge of the emerging hairs is best done with the advantage of the scope's magnification. I think most MD's and DO's that use a lot of FU's in their practice would agree with the above.

Mike Beehner, M.D.