Combination Grafting - Is it a good approach?

[jimdee]

I'm not entirely schooled on hair transplantation techniques but I had heard that some surgeons like to do combination grafting where they use follicular units in the bare or very thin areas and double follicular units where the hair is thinning but not as barren. This method supposedly reduces costs but also provides for better coverage in the long term. Any thoughts or comments? Pat, have you heard this from any surgeons?

[jimdee]

I'm not entirely schooled on hair transplantation techniques but I had heard that some surgeons like to do combination grafting where they use follicular units in the bare or very thin areas and double follicular units where the hair is thinning but not as barren. This method supposedly reduces costs but also provides for better coverage in the long term. Any thoughts or comments? Pat, have you heard this from any surgeons?

[Bill - Seemiller]

jimdee,

 

Good question:

 

Firstly, I recommend that you read the entire thread of discussion posted in the link below between many members and Paul Shapiro who uses DFUs on some patients when appropriate.

 

http://hair-restoration-info.com/eve/forums/a/tpc/f/746...751082382#7751082382

 

Just IMO, I believe, as Dr. Paul Shapiro does, that DFUs can be beneficial at times, however, should not be used in over abundance. Using an over-abundant supply of DFUs will most likely cause a pluggy look. I believe Dr. Paul Shapiro uses these artistically, however, there are other doctors that have been discussed (I believe Dr. Chang was one) where it seems his over-abundant use of what he called Muliti-grafts (essentially the same thing as a Double Follicular Unit) produced a less natural look and minimized/eliminated the possibility of dense packing.

 

Bill

[Jotronic]

One way to reduce the chance of a pluggy look is to simply not use dfu's. If one uses blades that are small enough then two double hair fu's placed closely enough together should do the trick. DFU's, in my opinion, are no different than mini grafts.

[Bill - Seemiller]

Jotronic,

 

I think DFU's in it as themselves would be very similar if not the same as mini-grafts, however, I think Paul Shapiro validates pretty well that they can be used in small quantities to produce quality results. Now comparing one DFU to 2 FUs packed closely together...is there a difference? I'm not fully convinced that there is one, however, Paul Shapiro does make some good points in the thread above worth considering. IMO, however, I don't hold a strong opinion either way as long as DFUS are not used in over abundance potentially creating a pluggy look like mini-grafting.

 

It's probably a case of 6 and 1/2 a dozen in the other the way Dr. Paul does it...however, the benefits for use of a few DFUs here and there (potentially less trauma to the scalp - less incisions and a lower price if the doctor charges the same price for a DFU as he would an FU).

 

Bill

 

Bill

[HK500]

Fascinating discussion, nice going guys.

[the B spot]

This is an interesting discussion!

 

Anyway, my opinion is this--- if used properly DFU's can help creat the illusion of more coverage, without being pluggy.

 

The 2 immediate benefits that I see is

 

fewer incisions and lower cost-----

So if 2-2 hair grafts placed in close proximity create the same result as a 4 hair DFU, what is the difference?

 

In the hands of a top Doc a properly trimmed 3-4 hair graft is advantgeous to helping present the illusion of greater density.

 

Also, I think it is pretty obvious that a 4 hair DFU that requires an incision of 1-1.1mm takes up less space than 2-2hair grafts spaced .5-.6mm apart, with each 2 hair graft requiring .6-.7mm incisions.

That is a total area of 1.1 mm for the DFU and a total area of 1.7-2mm for 2-2hair grafts.

 

Even if the DFU required a slightly larger incision, the fact is we cannot get 2- 2hair grafts closer than mother nature can.

 

Less area and more hair? Oh, and I don't get charged for extra "grafts?"

 

Of course, this leads into actual density using all 1's and 2's versus using 3's and 4's in addition to 1's and 2's.

 

I think it comes to down to choice/philosophy on a Dr. by Dr. case and it is the responsibility of the INFORMED patient to assess this and move forward.

 

Joe is right about one thing--- in the hands of the wrong Dr. a DFU would look pluggy or odd.

The good thing here is that we are talking about some of the best Dr's.

 

Patients SHOULD know the difference.

[nobuzz4me]

Just my two cents from a guy who has gotten plugs in the past, I would avoid this approach if you can afford to do so.

 

If this is a cost issue, than it might make some sense, but I personaly would not want this done. (I am by no means comparing this to plugs, just having suffered with them, this sounds scary to me)

 

I think that 2 / 2 hair fu's placed in the same incision is different from two seperate closely aligned incisions.

 

This approach to me seems like a step backwards in Ultra - Refined HT.

 

If a guy's donor is heavy with 1 and 2 hair fu's, he has limited donor density anyway and may never acheive full coveage. This method may give more density in some areas but not full coverage. Patients choice here though.

 

Make the extra incision and place the extra graft, whats the big deal, to save a few $$$, in the hands of the wrong Doctors this could method may turn out bad for some unsuspecting newbies.

 

Good discussion, I would like to know if this method is being used at Bosely or MHR?????

[jimdee]

Thank you boys. Some really great insights!! I appreciate the thoughtful responses. I've got two consultations coming up. I'll let you know what I decide -- and the results!