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Hair transplant graft
placement represents the final stage during hair replacementin which
the carefully and meticulously dissected hair grafts are individually
inserted into the recipient sites prepared by the surgeon. The
success of graft placement is derived from excellent graft handling
prior to insertion and gentle and accurate handling of each graft during
graft placement. Of course, perfectly executed graft dissection
must be a precursor step that will affect every step thereafter.
With high-powered magnification and a dedicated in-house team, dissection
is never compromised at the Lam Institute.
Let’s discuss graft
handling before placement and during placement to understand the essential
dynamics that affect ultimately graft survival and proper growth.
During graft dissection and in preparation for graft placement, grafts
are always gently handled with forceps so that the follicles are never
compressed with forceps (i.e., “tweezers”) and kept well
hydrated through constant chilled ice baths immersed in a specially
prepared saline solution. The grafts are constantly rehydrated
with spray bottles and maintained at a constant chilled temperature
prior to placement.
Placing hair transplant grafts
may seem like an easy task and one that merits little attention.
However, this critical step can ensure consistently excellent graft
growth and avoid a host of possible problems, e.g., pubic hair appearing
grafts, spotty growth, pitting on the scalp, and compressed hairs that
can resemble the old “plugs”. Emina Karamanovski,
who is in charge of all the graft placement herself, has been a national
force of education for both surgeons and hair-transplant assistants
in delivering and maintaining quality control. (Watch Emina's video
on proper quality control in hair restoration: Quicktime
| Windows
Media.) She has presented both poster and oral presentations at
each Annual ISHRS meeting in order to help establish the primacy of
excellent graft handling and placement.
So what is involved with
great hair transplant graft placement? Here are the key maneuvers
that are demonstrated in the accompanying videos:
- As mentioned, all the
grafts must be kept wrapped and immersed in a controlled chilled saline
bath throughout the entire procedure.
- Each graft must be handled
with the minimum of forceps trauma, and the bulb and shaft should
never be touched or crushed by the forceps tines. Only the small
cuff of fat that surrounds each graft can be safely grasped.
With excessive trauma to the graft, the result can be a combination
of poor growth and/or pubic hair (“wiry’) looking growth.
- The correct graft must
fit the correct sized recipient site. If too large a graft is
placed into the wrong, smaller recipient site, the graft will either
not grow or grow out like a weed, i.e., compressed into a plug appearance.
- The graft should be placed
in the right direction so that the natural curl of the hair is maintained.
Graft orientation becomes paramount with combination grafts that hold
1 to 2 follicular units.
- The level that the graft
is placed relative to the surrounding scalp is the final quality check.
Besides placing each graft to the correct level, Emina returns at
the end of the procedure to verify that each and every single graft
has been placed at the right height relative to the surrounding scalp.
The graft should rest approximately 0.5 mm above the level of the
surrounding scalp. This disparity will even out when the surrounding
swelling dissipates and the grafts settle to the correct position.
If the grafts are placed too high, they will dry out and not survive.
If they are placed too deep relative to the scalp, they can appear
as unnatural pits, which is very hard to correct.
This patient is shown on the left following hair transplant elsewhere
in Dallas in which the grafts were mishandled forcibly leading to "pubic
hair" growth, i.e., a wiry and thick growth. In addition, growth
is overall very poor, the angles of the sites are too perpendicular
to the scalp, and the hairline is unnatural and appears zipped on. Without
removing his prior grafts, Dr. Lam and his team corrected the unnatural
result in only one session by overpowering the pre-existing work with
grafts that have been properly handled, well angled, tightly distributed,
with a natural appearing hairline that fits the patient's head shape
and face.
This patient is shown on the left after hair transplant elsewhere in
Dallas showing pitted grafts (the little holes that are apparent at
the insertion point of the grafts) that arose due to placement of grafts
too deep relative to the surrounding scalp at the time of hair transplant.
Also, there is poor visual hair density and an unnatural "zipped-on"
look to his hairline. In one session, Dr. Lam and his team were able
to correct the angle of the grafts, the shape of the hairline, and achieve
remarkable hair density without having to remove the grafts from the
previous work.
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