Avoiding Follicle Transection?

[Guest]

The merit of strip excision is that fewer hair follicles are damaged. It has been stated that one of the primary goals of HT surgeons is to protect the limited number of donor hairs.

 

I remember reading that when "chubby" grafts are placed, that regrowth is sometimes over 100% because of latent hair follicles that were not originally counted. This leads me to believe that not all hairs are "visible" when the strips are being dissected into grafts.

 

Likewise, if a follicle is not visible within a FU, then it stands to reason that there are (other) follicles that are not visible which may be damaged or discarded during the process of creating grafts.

 

When grafts are cut, how do doctors MAKE SURE that follicles are not transected and/or discarded? What is the estimated % of hairs lost during graft creation?

 

Also, might this explain the perceived density advantages of strategically placed micro grafts (i.e. They is less transection going on therefore more hair grows in)?

 

Someone please explain this for me.

 

Thanks!

[Guest]

The merit of strip excision is that fewer hair follicles are damaged. It has been stated that one of the primary goals of HT surgeons is to protect the limited number of donor hairs.

 

I remember reading that when "chubby" grafts are placed, that regrowth is sometimes over 100% because of latent hair follicles that were not originally counted. This leads me to believe that not all hairs are "visible" when the strips are being dissected into grafts.

 

Likewise, if a follicle is not visible within a FU, then it stands to reason that there are (other) follicles that are not visible which may be damaged or discarded during the process of creating grafts.

 

When grafts are cut, how do doctors MAKE SURE that follicles are not transected and/or discarded? What is the estimated % of hairs lost during graft creation?

 

Also, might this explain the perceived density advantages of strategically placed micro grafts (i.e. They is less transection going on therefore more hair grows in)?

 

Someone please explain this for me.

 

Thanks!

[Guest]

[arfy]

This is a tough question!

 

Because the FU supporters (which I consider myself to be, by the way) tend to use the "no transection" argument as one of the more important benefits of FU use.

 

FUs are by definition trimmed under microscopes. The trimming of the FU means that they look the most natural emerging from the recipient sites. This trimming is not done to a Minigraft, so they do not look as natural. The excess tissue around the follicles can be noticeable.

 

A "plump" graft is not trimmed as closely. However, if "plump" grafts do result in more hair yield, that makes the "trimming issue" a little more complicated. It's no longer so obvious that closely trimming FUs is always the best approach.

 

Nobody asked my opinion, but I'd rather sacrifice a small percentage of yield, in order to have a more natural look. I will be interested in reading the doctors' take on this question.

[Guest]

I've been researching HT for the past 5 years and understand that this is not an easy question to answer. I agree that sacrificing some % yield for natural results makes sense. Even a large % loss of hairs would not invalidate some of the excellent work thats being done. However, while I have been sceptical of the "Woods technique" -- its stated downfall being the unnecessary transection of follicles -- this got me thinking about transection during strip excision and traditional microscopic dissection. Perhaps a large number of hairs are lost here too.

 

I'm sure this has been asked of HT surgeons before and I hope its not the "dirty little secret" of the HT industry. Imagine having to report that some large percentage of hairs are damaged/discarded during graft creation. I certainly hope thats not the case. In any event, the skill and strategy employed for graft creation could have a big effect of final density and hair count.

[Dr. William Parsley]

Sharp, the question you ask is very legitimate and certainly is not a dark secret among transplanters. It is debated at every meeting. As you know hairs grow from the scalp in clusters known as follicular units. The units may contain 1-5 hairs. FU grafting usually means a single blade created strip from the back of the scalp followed by microscopic preparation of the strip which means removing the considerable amount of "hairless" skin in between them.

Here are the numbers. About 20% of the hairs in the donor area are single hairs. If resting or empty follicles are part of a follicular unit (FU) then they will almost certainly be moved with the FU graft. So we are mainly concerned about the single hair units. Anagen (growing) hairs are very visible and would not be overlooked. 10% of hairs will be in a resting phase, where they are retracted up to the skin and lose pigment in the bulb, at any given time. With the micrsocope they can be seen and transplanted. So this involves 2% of the grafts and less than 1% of the total hairs because, even though 20% of the grafts are single hairs they only represents 8% of the the total hairs - FU's generally average 2.5 hairs. So 10% of 8% is 0,8%. Now if the hairs has been shed from follicle, the follicle is an "empty" follicle (exogen follicle). These will be missed and discarded but fortunately probably represent 0.1 % of the hairs. This % will vary with the skill and conscientiousness of the assistant. There was a study by Dr. Kolasinski that reported significant growth in discarded skin. However, he did not use a microscope during the study so it is hard to know the significance. More work needs to be done. Some survival studies show as good or better survival from FU grafting vs minigrafting - the payoff is the naturalness.

The other controversy is transection. Some studies show that it is very detrimental to grafts and other show that is is not damaging. In my experience it is highly significant. There is always some transection with the strip excision, but is minimized with the single bladed knife. Very little occurs with the use of a micoscope to separate out follicular units.

One last thing. Bald epidermis (top layer of skin) is removed right up to the hair shaft with most FU grafting. With this technique, no bald skin is removed from the recipient area in creating sites. If the bald skin is left on the graft, you can't obtain the desired density because you are adding more bald skin to an area where none has been removed.