Maximizing Graft Survival

The evolution of tiny 1-4 hair Follicular Unit (FU) grafts was a breakthrough in creating naturalness in hair transplantation. However, FU grafts created new problems in creating density. FU grafts are tiny and delicate and therefore susceptible to trauma and decreased survival. Cutting and placing large numbers of these delicate grafts very close together without trauma is technically difficult. There are many points throughout the procedure (i.e. donor harvesting, graft preparation, recipient site creation, and placing) where the grafts are vulnerable. It is important to overcome this vulnerability as there are only a limited number of donor hairs and each one is precious. Many modifications in techniques have been developed over the years to improve FU graft survival. A partial list of modifications is listed below. They are discussed in detail elsewhere on this website.

Taking the donor hair out in a single strip, rather than multiple thin strips, has helped limit transection and damage to hairs during this part of the procedure
The use of tumescence in the donor area to protect the blood vessels
The use of microscopes for dissection when creating grafts further limits damage to hairs
Improved physiologic graft holding solutions to protect grafts from dehydration after they are created
The use of tiny micro blades to make recipient site incisions to limit the amount of vascular trauma that occurs to the scalp
The use of custom blade cutters to create blades that perfectly match the size of grafts, making placing easier
The use of high magnification loops when making incisions and placing
The use of gentler placing techniques such as the “buddy “technique or the “stick and place” technique to limit trauma

SMG has lectured on, and been instrumental in developing, techniques to help maximize graft survival, especially with dense packing and mega sessions (see CV). With the use of these innovations, a skilled and experienced physician can achieve survival rates of above 90 percent.