Are Single Follicular Units the Best Graft Size for You?
A. Hair transplantation has advanced due to the change in graft size. Since 1995, the New Hair Institute group introduced the concept of the follicular unit. Now when we discuss about the size of a graft, follicular units are the most popular and prominent term. Almost everyone believes that follicular units are the best size grafts for hair transplantation, but are follicular units really the most suitable size graft for the patient?
Some people use follicular units as a means for comparison between different clinics. Now, 8 years after the concept of follicular units was introduced, a lot of clinics even have to claim that they only perform 100% follicular units to help persuade patients. This paper will take a closer look to see if it really is in the best interest of a patient to do a 100% follicular unit procedure. First, let’s take a look at some of the claims why some doctors believe that follicular units are the best choice.
Claim #1: The wound size of individual follicular units can be kept to a minimum because larger wounds can make the healing process slower and often causes irregularities to the skin surface.
Claim #2: Multiple follicular units require the recipient skin to be removed via punch or laser.
Claim #3: Non-hair bearing skin consists of about 50% of the donor site. Removing the non-hair bearing skin will have a substantial effect upon the outcome of surgery.
Claim #4: Hair grafts larger than a single follicular unit will cause a pluggy, tufted look.
B. In our surgical center, we use 3 sizes of grafts: single hair grafts, follicular units, and modified follicular units. We use single hair grafts and follicular units for the hairline only, while modified follicular units are the basic size for the rest of the grafts. Why use modified follicular units instead of single follicular units? What are the advantages of it?
Response to Claim #1
To make slits for a single follicular unit, most physicians use an 18G needle with a diameter of 1.26mm. A few physicians use the 19G needle with a diameter of 1.08 mm. Therefore, 2 slits from the 19G needle would be 2.16 mm. In our clinic, however, we use the SP91 blade, which creates a slit length of 1.97mm, and also allows one slit to hold two follicular units (one modified follicular unit). Please compare below the length of wound size for a 1000 graft procedure.