Last updated: 11/24/2009

The donor area is the area on the scalp selected for having hair follicles that are DHT-resistant, and will likely continue growing new hairs for the individual’s lifetime. The donor area is typically the back of the scalp, and the sides extending...

behind the ears which are unlikely to lose hair during the progression of “pattern baldness.” Immediately after the donor hair is removed from the patient, it is immersed in cold saline solution to bring down the temperature of the hair follicles, and thereby increases skin graft survival. A few hours can elapse from the time the donor tissue is removed to when a particular hair follicle is placed into the scalp, and keeping the follicles cool and moist helps them survive better during this time. After the grafts are cut they are placed onto surgical pads moistened with saline solution, and these pads are placed into trays that are chilled as well.

The use of stereomicroscopes to cut the donor material into grafts is another standard component of follicular unit micrografting. In the early stages of micrografting, eye loupes and magnifying glasses were commonly used to aid the process of cutting donor tissue into strips and pieces, and eventually into individual grafts; however, a considerable number of hair follicles were cut due to poor visibility even under high magnification.

Stereomicroscopes have separate eyepieces for each eye, which allows for a three-dimensional view of the donor tissue. Stereomicroscopes require additional training for the team of medical assistants who cut the grafts; however, their use results in less graft damage and transected follicles (split hairs).

The most significant of all micrografting refinements, and the concept that gives the follicular unit procedure its name, is the preservation of the naturally occurring clusters of hair follicles during graft preparation. Transplant surgeons have observed that many hair follicles on the scalp occur in pairs or bundles of three or four follicles, which are called follicular units. Preserving follicular units as micrografts reduces the risk of inadvertently cutting follicles occurring close together, which results in grafts growing more viable hairs, and also produces grafts that grow hairs in more natural looking clusters.

With follicular unit transplant procedures, the medical assistants prepare the grafts using their judgment to identify and cut around follicular units, producing grafts containing one, two, or three hairs according to how many follicular units naturally occur in the donor tissue.

Finally, the follicular unit micrografts are placed into tiny slits made in the scalp with a miniature scalpel. The slits are made in a slightly irregular manner, to avoid creating a pattern of rows as the grafts begin to grow new hairs. In the early days of micrografting, surgeons were careful to allow adequate space between each graft, and a variation of a grid pattern was used to make recipient sites. With follicular unit micrografting, adequate space is allowed between grafts; however, the grafts are placed in a more random and natural looking manner to avoid the “doll’s hair” appearance common to earlier surgical approaches.