About Hair Loss

Fortunately for balding men, one’s hair can be divided into permanent hair-bearing regions (the donor area) and also the region I which hair loss is prone to take place in (recipient area). In summary, hair transplants involve transferring the ‘hardy’ hair follicles to the hair loss region. After the transplant has been carried out, the transferred hair will then grow for a long as it would have in the donor region.

The Figure below shows a standard location for a donor area:


source: hairlossblackbook.com

Source: hairlossblackbook.com

More about the onset of hair loss:


Hair loss areas are commonly divided into the following zones:

  • Frontal area
  • Mid-scalp area
  • Crown area

Normally one procedure will normally treat just one area; multiple treatments are required for a full solution.

Follicular Units and Hair Transplants

15% Follicular units contain 4 or 5 hairs

15% Follicular units contain 1 hair

The rest of Follicular units contain 2 or 3 hairs

Most modern hairs transplant procedures us FUs as the building blocks of the process.

Groups of FUs are typically extracted by “sectioning”. This involves taking an 8 – 10mm strip of skin from the donor are. By the end the procedure, the donor are is closed, leaving  thin scar which normally heals within 7 – 10 days.

Transferring the Follicular Units

Using the 8 – 10mm strip of skin removed from the donor area, individual Follicular Unit are extracted using a dissecting stereomicroscope. The recipient area is prepared by making small incisions into the scalp using small bore needles or blades. In order to replicate the hair that wold have been originally present in the recipient area, the incisions are made at angles which orientates the FUs appropriately.

DO NOT PANIC – it is normal for all of the hair on the transferred hair follicles to fall out within 2 – 3 weeks after the procedure. After a further 2-3 months the patient will experience regrowth on the transferred FUs in the recipient area.

A relatively new procedure – Follicular Unit Extraction (FUE)

This technique skips the removal of whole strips of skin by removing individual FUs from the donor area and transferring them to the recipient area. A small round punch is used to excise individual FUs, similar to the process of using a cookie cutter! However this process has advantages as well as considerable disadvantages relative to excising strips from the donor area:


  • No linear scar
  • Good for tight scalps
  • Good for people who have the tendency to scar easily
  • Good for body to scalp transplants


  • Less time-efficient
  • More expensive
  • Can result in the lower survival rate of FUs



The final result of a hair transplant is dependent on the nature of the grafts that are transferred. The best results occur when the FUs are placed as close as possible together. For example, a follicular implant (shown in the Figure B above) covers 2/3s of the area in comparison to using a micrograph containing 2 FUs: 1 X 1-hair follicular unit and 1 X 2-hair follicular unit.

Ensuring that the recipient sites for the individual grafts are as close together as possible has the following advantages:

  • More recipient sites can added per unit area in on session while ensuring –
    • No scalp damage
    • No adverse effect on blood supply

Ensuring that the FUs are used containing multiple hairs have the following advantages:

  • Increased look of fullness of hair
  • Natural looking hair, without looking ‘pluggy’. However, grafts must still be skilfully inserted in the correct direction

It is also worth noting that if the individual graphs that are inserted into each recipient site are larger than the FUs this will compromise the naturalness of the of final crop.

30/11/2014 – Main Reference: Hair loss for dummies. Images from burnstein publications

Graft sizes have been classified into 4 size categories:

  • Traditional Graft – 3 – 4 mm in diameter   + images for each type of graft
  • Minigraft – 12 – 2.5 mm in diameter
  • Micrograft – 1 – 1.5 mm in diameter
  • Follicular Unit Graft – 1 – 4 hair follicles

So why not just use big grafts and fewer of them?

Firstly, using large grafts results in skin deformity, which shows up almost immediately after the procedure and makes the grafts more visible.

Secondly the grafts themselves will contract over time as healing occurs. As the grafts contract the hair density within th graft will increase. This forms a pluggy look. This is especially the case when the hair density within the graft appears more dense than the donor region. + images showing the contraction of a graft.

Worst of all – because hair follicles have a high metabolic rate and require a lot a oxygen and nutrients. Grafts which are too large can lead to a doughnut effect, where hair follicles in the centre of the graft die before they are able to obtain oxygen and nutrients. (Look into the budding of caparies + how long this takes)

+ images showing the doughnut

Disadvantages of having small grafts:

  •  Surgeons require more time to use tiny grafts
  • Small grafts require many grafts in total to form a full appearance of hair

If the surgeon decided to go to micrgrafts, there is also the added complication of loss of pigment in the skin. This is particularly problematic if you have darker skin.

In addition micro and minigrafts still have to following disadvantages:

  • clumpy appearance
  • Many of the follicles get destroyed in the preparation of the grafts as a knife is used to cut the donor strip into minigrafts or micro grafts

For these reasons the recommended hair transplant procedure is  FUT. link