Punch grafting is a method, in which a 4 mm punch was used to remove a cylinder of hair-bearing skin, i.e. punch graft, containing 12 to 30 hairs, from the donor area, which was then placed in a slightly smaller punched out cylinder in the recipient area. The bald skin removed from the recipient area, was discarded, and the holes in the donor area were left to heal by themselves. This was the method of hair transplantation that was used for 25 years. This allowed growth of hair in formerly bald areas, but compression of the grafts after the skin healed, often led to a “pluggy” look that got better after two or three more sessions in the same area; but the hairline still looked abrupt. Even after 4 sessions, the hairline could still look “pluggy”, especially with coarse or dark hair. “Shotgun” scarring in the donor area was also a problem and donor hair could be depleted rapidly. Some surgeons became very skilled at punch grafting but punch grafting was eventually abandoned as newer, better methods were developed.
Mini grafts are generally prepared after one or more strips of skin are excised from the donor area. The opening in the donor area is either sutured or stapled closed and the incision heals to form a narrow scar. Mini grafts are placed into slits in the recipient area made with a scalpel, needle, or a similar device. Mini grafts are cut to fit into the recipient sites, but on an average, mini grafts contain 3 to 8 hairs. Micro grafts usually contain one to four hairs and are either prepared intentionally or are prepared as a by-product when mini grafts are trimmed to size. Most surgeons who perform mini grafting and/or micro grafting prepare the grafts with simple magnification or with the naked eye but do not use microscopes.
To avoid overwhelming the circulation, the slits must be spaced out. Two to four sessions of mini grafting are required to complete an area. While the transplanted hair does not look nearly as pluggy with mini grafting as it did with punch grafting, it still, does not bear close inspection the way follicular unit hair transplantation does, especially after the beginning stages.
The majority of hair transplant surgeons still use micro grafts in the hairline and mini grafts behind them. This method is less demanding and less time-consuming than follicular unit hair transplantation. Almost all agree that the results of follicular unit hair transplantation are more natural looking but the proponents of mini/micro grafting say their results are good enough. At the Seager Hair Transplant Center, we don’t feel that quality should be sacrificed to make the procedure less demanding for the surgeon.
Scalp reduction is a procedure in which an area of bald skin is excised (cut out and removed) usually from the top and back of the scalp. The resulting gap is then stitched closed. Rarely used as an individual treatment to reduce baldness, it is used by some surgeons as an aid to hair transplanting, since scalp reduction also reduces the size of the area requiring transplantation.
However, these days, scalp reduction is not performed nearly as frequently as it used to be. There are four main reasons. Multiple, painful procedures are required. A phenomenon known as “stretch-back” leads to a loss of effect overtime. As baldness progresses, a formerly bald crown will again become a bald crown but there will also be an unnatural scar. Finally, stretching of the skin leads to spreading out of the donor hair, which means that less donor hair can be moved to the most cosmetically important frontal area at one time or possibly forever. For these, amongst other reasons, the majority of the world’s surgical hair restoration facilities, which used to frequently perform scalp reductions, now rarely, if ever do so. However, there still remain a handful of hair restoration surgeons in the world who routinely perform varying types of scalp reductions.
Moving a flap of hair bearing skin from the side of the head to across the top of the forehead is occasionally done in the United States, South America, and elsewhere. It is considered a major surgery, and more pain and complications are associated with it. Some of the complications can be permanently disfiguring. In the opinion of Dr. Simmons and Dr. McKenzie, the results of flap surgery rarely, if ever, look as natural as a good hair transplant and represent inefficient use of a limited donor area. Flaps do, however, have the advantage of giving immediate hair coverage.
Considered an extensive major surgery, they are primarily performed by a handful of highly trained surgeons around the world. These operations are, again, more major and invasive and are associated with more complications and pain than other forms of scalp surgery.
At the time of the construction of this web site, Dr. Simmons and Dr. McKenzie does not recommend them.
In September 1995, the Seager Hair Transplant Centre obtained the most expensive “state of the art” Coherent Ultra pulse LASER. This was in keeping with Dr. Seager’s ongoing commitment to bring the latest and best techniques used in hair transplantation to his patients, so that, he could offer a complete range of all effective modalities of hair replacement surgery.
At that time, laser hair transplantation was being touted as the “Way of the Future” in hair transplantation, and certain experts claimed that the laser produced a more natural look.
Dr. Seager was a pioneer in the use of laser in hair transplantation, and was initially enthusiastic. However, after one year of using the laser, he found that, his results and the laser-assisted hair transplantation results of other experts with even more laser experience looked no more natural than his own advanced techniques, using conventional “cold steel”.
The clinic discontinued the use of laser, because of the limitations described by Dr. Seager and as reported by others. The laser method gave poorer yield with apparent permanent loss of hair, prolonged scabbing and crusting, and the inability to place the grafts as closely together as with the “cold steel” techniques.BACK