f.units and old mini grafts?

[noreaster]

do many physicians use this technique, combining follicular units and then older mini grafts behind them for density? If so what are the pros/cons?

[noreaster]

do many physicians use this technique, combining follicular units and then older mini grafts behind them for density? If so what are the pros/cons?

[Dr. Alan Feller]

I really thought this issue was asked and answered a long time ago. There is no advantage, let me repeat, there is NO ADVANTAGE to inserting minigrafts. You can achieve MAXIMUM density using FUs just fine. Period.

 

Why mix? If you are already cutting FUs why bother to stop and switch to minigrafts???

You can't pack minigrafts as tight as FUs, therefore your density will simply go down.

 

Dr. Feller

[noreaster]

sorry if your getting repeat questions doc, you are always the 1st to respond, and sometimes the only one.thanks.

[TopJimmy]

Again after having 6 procedures now (20 days post-op) with probably 2500 mini's or more and now 1840 Fu's, next year will really let me see the difference.

 

Thanks

[arfy]

It's a good question, and the answer is important and bears repeating. Especially because there are new guys on the forums all the time.

 

FU grafts look the most natural. This is the #1 factor to keep in mind! Minigrafts and larger grafts need to be surrounded by FUs, in order not to look pluggy, in most cases.

 

Some clinics claim that larger grafts add density. Personally, I don't buy it. I have larger grafts and they contribute nothing except a pluggy look. There is an article in the Research Library section of the website here by Dr. Bernstein and Rassman called the Logic of Follicular Unit Grafting (I believe that's the name). In the article they prove mathematically, that Minigrafts can never add more density than FU grafts, that they are inefficient and can only lead to donor depletion or larger space between grafts. (There are a bunch of great articles in that section of the site, do yourself a favor and read them. Some of them get a little technical, but most guys should be able to figure out the bottom line message).

 

HOWEVER...there are a few "recommended" doctors who now use small amounts of larger grafts ("coupled FUs", supposedly similar to Minigrafts but trimmed under microscopes, unlike Minigrafts). Two examples of recommended docs who use limited amounts of larger grafts in specific cases are Dr. Shapiro and Dr. Parsley. I believe Dr. Parsely stated that something like 5% of his grafts in a megasession might sometimes be larger grafts, that he uses in some specific way. (Sorry, can't remember the exact figure, but I believe it was between 5 and 10%). In other words, if a patient has a 2000 graft procedure, Dr. Parsely might use 100 or so larger grafts. Here's the important thing to remember: The FU graft is still BY FAR the cornerstone of these doctors' approach! It is really important to understand how Dr. Shapiro might use a sprinkling of larger grafts, in comparison to a clinic like NuHart for example, where (guessing at their numbers here) 75% of THEIR grafts are big grafts, with a few smaller grafts placed in the hairline. Both clinics use "mixed grafts"... however there is NO COMPARISON between the two philosophies!

 

ASK your clinic if they use "all FU grafts" ONLY. If they say they use a combination, ask what the pecentages are. If the FU graft (microscopically dissected, of course) is not BY FAR the cornerstone of the procedure (and I mean like 90% should be FUs, with only a few larger grafts) in my opinion find another clinic!!!

 

Personally, I would only recommend the all-FU approach, however I believe Dr. Shapiro is a good surgeon (some say one of the best) and I would trust his judgement. But personally I would prefer FUs only. Also, there are a bunch of doctors who do FU grafts ONLY. And I bet if you asked someone like Dr. Shapiro to only use FUs, he would certainly consider your wishes.

 

Bottom line...ASK what kind of grafts your clinic uses. Don't go to a place that doesn't use microscopes. And make sure that almost all your grafts (or all your grafts, if you ask me) are definitely FU grafts.

 

[This message was edited by arfy on November 15, 2002 at 12:41 AM.]

[Guest]

Are mini graphs more than 4 hairs?

[noreaster]

thanks Arfy, very good explanation. When I put the question out, it was after reading about many of the recommended docs treatment plans and knowing the gold standard is follicular units they still prefer to use a minimal amount of mini grafts? I have to admit that i really did know the answer, but I was hoping that one of the docs still utilizing these older grafts would chime in and give their rationale, which i already know is density, but perhaps could expand a bit beyond..