Small versus large hair grafts

To meet the demand for natural-looking hairlines, doctors began decreasing the size of hair grafts in the 1980s, because of the following large graft disadvantages:

Large hair grafts are more visible during the transition period after transplantation before the hair grows in. Skin deformities show up almost immediately after the hair transplant.
Large hair grafts placed in a frontal hairline look pluggy and unnatural when the hair is combed back or to the side. Patients were forced to comb their hair forward and down to hide their hairlines.
When large hair grafts are placed behind the hairline or in the crown, they look like patchy clumps of hair (even in the most gifted surgical hands) and these are very difficult to disguise or camouflage.
As healing occurs in three to four mm hair grafts, the grafts contract, pushing the hairs in the graft together and increasing the density of the hair within the graft. The hair density within these larger grafts often exceeds the hair density in the donor area, contributing to the pluggy, stalk-like appearance of traditional grafts.
Larger hair graft repairs force the patient to undergo multiple transplant sessions in the quest for natural-looking results, and the patient’s appearance can be strikingly unnatural until the work is completed.

It takes four to six days for the buds of new capillary blood vessels to grow into the hair grafts from the surrounding tissue. Until these new blood vessels grow into the graft, the graft’s cells depend upon the surrounding tissue to bring the needed oxygen and nutrients for their survival.

Hair follicle cells have a very high metabolic rate, and they require more oxygen and nutrients than other cells. If the graft is too large, the cells of the follicles in the center of the graft may die before sufficient oxygen and nutrients can reach the center of the graft. The follicles at the periphery of the graft survive because they’re close to the body’s nourishing oxygen and fluids.

When hair finally grows from larger grafts, those in the center die and this creates a doughnut configuration, with hair at the edges and a bald central area of skin. This is one of the numerous reasons why many doctors have changed to the use of exclusively smaller grafts.

Small hair grafts also have some disadvantages.

The amount of time and work needed to place tiny grafts is greater than what’s needed with larger grafts.
Smaller hair grafts produce a thinner hair appearance, so many more graft units are needed to produce a natural look.

1. Follicular unit extraction allows the surgeon to remove individual follicular units
Follicular unit extraction Follicular unit extraction (FUE) allows the surgeon to remove individual follicular units without making a linear donor incision and ...

2. Single strip harvesting removes the donor tissue as a single strip
Harvesting Your Hair There are five common methods of harvesting donor grafts, but only two methods — single strip harvesting and follicular unit extracti...

3. Follicular unit transplantation
Follicular unit transplantation Follicular unit transplantation (FUT) was the most significant advance in hair restoration since hair transplants were introduced ...

4. Minigrafts and micrografts consist of multiple follicular units
Minis, micros, and more Minigrafts and micrografts consist of multiple (partial or complete) follicular units along with the intervening skin. This technique so...

5. Avoiding the hair transplant look
Avoiding the “hair transplant” look A bad hair transplant is easy to spot. The uneven, patchy effect of large, pluggy grafts occurs when a surgeon use...

6. A hair transplant that relied entirely on the use of micrografts
Finding ways to produce more natural results In spite of many missteps, the drive to develop better surgical techniques to move hair around the head led to proced...

7. Scalp reduction techniques
This procedure had the following advantages: The results were instantaneous. Other than the time between the first surgery to create the flap and the second ...

Small versus large hair grafts

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