What they are | Benefits
| Risks | Variations
| Candidates | Treatment
What Follicular Unit Micrografts Are
Clusters of hair follicles: Hairs
on the scalp grow naturally from as one, two, three or
more tight clusters hair follicles, called follicular
units by hair restoration surgeons. Microdissection
follicular unit micrografts preserve these clusters in
graft form. Only the excess tissue around the follicular
unit is trimmed away, and the follicular units are left
largely intact. Follicular unit micrografts typically
measure 1/2mm to 1 mm across, which is much smaller than
a grain of rice. Follicular unit micrografting
is now the current state-of-the-art surgical hair restoration
technique, and is the method Dr. Panagotacos uses.
Old Style Micrografting:
Up until the mid 1990's some other hair restoration surgeons
performed micrograft procedures with single hair grafts
in an attempt to achieve the widest possible distribution
of the donor hair follicles. Others simply mapped
out a plan for the number of single-hair, two-hair, and
three-hair grafts they needed, and instructed their assistants
to make the grafts to fit the plan. But the cutting of
single hair grafts from follicular units containing two
or more hair follicles increased the risk of graft failure,
and the end result of using only single-hair grafts was
a sort of thin fuzzy coverage that did not look natural.
New style Follicular
Unit Micrografting: By the mid 1990's follicular
unit micrografting became the favored technique.
With follicular unit micrografting, the surgeon places
the grafts based on how they naturally occur, rather than
making them fit a pre-designed plan. It is a subtle
distinction, but follicular unit micrografting produces
a more natural result with the hands of a skilled and
artistic surgeon.
Advances in
Equipment : Dr. Panagotacos helped lead the shift
toward follicular unit micrografting by using the most
advanced graft preparation equipment possible, and when
necessary inventing his own modifications
to achieve the best possible results. His team of
surgical assistants use powerful stereo microscopes to
prepare grafts, which are placed in special chilled and
backlit cutting trays designed by Dr. Panagotacos.
The stereo microscopes improve resolution and reduce the
risk of graft transection, while reducing eye strain.
Backlighting
and Chilling: Backlighting helps to better illuminate
hair follicles that are approaching the telogen or resting
phase, and may otherwise be overlooked during graft preparation.
Also, backlighting helps to better define follicles producing
light colored hairs, including blonde and gray hair.
The chilled trays increase graft survival during the preparation
process. Advances in equipment such as stereo microscopes
and backlit and chilled cutting trays help Dr. Panagotacos
achieve graft survival rates approaching 100%.
Advances in
Training: In addition to advances in equipment, Dr.
Panagotacos has a highly trained and skilled surgical
preparation team, who are able to determine which hair
follicles should be used for single hair grafts, and which
ones are better suited to follicular unit micrografts
of two or more hairs.
Internationally
Recognized: In addition to training in the office
and gaining the benefits of Dr. Panagotacos' 30 years
of hair restoration surgery experience, the members of
Dr. Panagotacos' surgical preparation team have trained
at national and international workshops, and have presented
lectures and live demonstrations on the techniques they
use both nationally and internationally as well.
It is hard work, requiring great concentration and steady
hands, but the team knows that the goal it to achieve
the highest yield from the donor tissue and the most natural
results possible.
Each
Procedure Stands Alone: Follicular unit micrograft
procedures are designed to stand alone and look natural
after surgery, regardless of when any additional procedures
are performed, if ever. In the distant past, when hair
transplant procedures were performed exclusively with
larger full-size hair grafts, patients had an "under
construction" look until the last procedure was completed.
Exclusive use of full-size grafts required four or more
procedures to achieve a natural look, and in the time
between procedures the hair transplants looked half-finished.
Follicular unit micrografting has largely eliminated this
problem, as each procedure is designed to look natural
upon completion. With follicular unit micrografting, each
procedure stands alone. Additional procedures can be done
to increase hair density, as desired by the patient.
One
Procedure May Do It: Most hair transplant patients
express a desire for hair density that would require two
or sometimes three follicular unit micrografting procedures.
However, many patients are satisfied with the density
achieved from just a single session. There are increased
risks when trying to place too many grafts in a single
session. Dr. Panagotacos takes each patient's needs and
desires into consideration when designing a treatment
program. His years of experience has taught him to plan
each procedure to stand alone, and appear natural if no
further procedures are performed.
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Dr.
Panagotacos does follicular unit micrograft hair
transplants on women as well as men:
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"People think
of hair loss as only a man's problem, but it can
affect women, too. The day I walked into Dr. Panagotacos
office was one of the best days of my life!"
(Registered Nurse, Berkeley, CA)
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Immediately
after surgery
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Five
months after
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Combination of sizes: In most hair transplant
procedures a combination
of single hair micrografts and multi-hair follicular
unit micrografts are used. The smallest grafts are
used for the hairline because they are less detectable,
while the larger follicular unit micrografts are used
to thicken areas on the top and back of the head.
| Dr.
Panagotacos is an expert at using single hair micrografts
to create a diffuse and natural looking hairline
zone: |
Day
of surgery
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11
months after
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Number of grafts:
The number of grafts placed in a hair transplant micrografting
session can range from a few hundred to a few thousand.
Some surgeons boast of performing "massive megasessions"
of 3,000 and even 4,000 single-hair grafts in a single session.
Dr. Panagotacos does not do "massive megasessions".
While more grafts placed in a single session may seem
to provide greater density in a shorter period of time,
the opposite result can occur if many of the additional
grafts fail to survive. And once these failed grafts are
gone, they are gone forever. Also, it is important
to consider the actual number of hairs placed,
rather than just the number of grafts. 2,500
single hair grafts will not provide as much density as
1,500 grafts with many containing two or more hairs.
A variety of factors affect the number of grafts placed,
including the size of the individual grafts, the size
of the area needing coverage, the density of hair follicles
in the patient's donor site, the patient's budget, and
perhaps most importantly the surgeon's judgment. Many
experienced surgeons, including Dr. Panagotacos, choose
to not take excessive risks with their patient's donor
hair follicles, as there are only a very limited number
of these hairs, and if they fail to survive a transplant
procedure, they are gone forever. If 4,000 grafts are
required for a particular patient, Dr. Panagotacos will
design a hair restoration program consisting of two or
more procedures, in order to achieve the maximum survival
of the transplanted hair follicles, and ultimately do
the best job for the patient.
| Dr. Panagotacos places
follicular unit micrografts on the top of the head
in between existing hairs, while single hair micrografts
are used to reconstruct a natural hairline in a
single procedure: |
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Day
of surgery
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9
months after
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Strips of
donor tissue: The tissue for the grafts is removed
from a donor site on the back of the same person's head.
Each patient is their own "donor" for hair transplants.
The donor material is removed in the form of a long strip
of tissue. Grafts are individually prepared from the strip
by a team of medical assistants during the micrografting
procedure. As grafts become ready, the surgeon places
them into individually prepared recipient sites at the
top and front of the scalp in a way that best assures
their survival and mimics the natural growth pattern of
hair follicles.
Nearly undetectable: The main
benefit of follicular unit micrografting is that the final
results are nearly undetectable as transplants. The relocated
hair follicles grow new hairs just as they had done in
their previous location, and with expert placement of
the grafts, the new hairs grow out in a natural way.
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Dr.
Panagotacos uses a fine surgical blade to make
tiny slits between existing hairs for micrografts.
The incisions heal rapidly.
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Immediately
after surgery
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Three
days after
(with antibiotic ointment)
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Seven
days later
(no ointment)
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One
year after
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Convincing hairlines: Micrografts are especially
effective for constructing convincing hairlines, with
a zone of hairs becoming increasingly thicker away from
the face and toward the top of the head. Hairlines frame
the face, and natural looking hairlines are critically
important to appearance.
Efficiency: Hair transplants with follicular
unit micrografts are an efficient way to achieve a full
head of hair look with only a limited quantity of donor
hair. Although more than one session may be required to
achieve the ultimate desired density, just one session
of micrografting will result in a natural-appearing look
of having more hair.
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Just one session
of micrografting will result in a
natural-appearing look of having more hair.
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The individual small grafts can be placed in a way that
mimics natural hair growth more easily than would be possible
using old style full-size grafts alone. Many people who
would in the past not be considered good candidates for
full size grafts because the area requiring coverage is
too large to be adequately covered with the limited amount
of donor follicles available, are good candidates for follicular
unit micrografting. With expert placement of the grafts,
micrografting allows the look of more coverage, with less
donor hairs.
Any hairstyle: Micrografts grow real growing
hairs, and these hairs look and style just like naturally
occurring hairs. With an adequate number of transplanted
hairs, any hairstyle can be worn, even cut short or combed
straight back.
Add density: Micrografts can be individually
placed between other growing hairs, adding density to
thin areas, before these areas become completely bald.
Men just beginning to experience receding hairlines, and
women just starting to have overall thinning, can both
benefit from follicular unit micrografting procedures
before their hair loss becomes more apparent. Micrografts
are also placed between hairs growing from previously
transplanted micrografts, thereby allowing hair density
to increase with each additional transplant procedure.
Unlike old style full size grafts, existing growing hairs
are not sacrificed to make room for micrografts. Micrografts
even grow well in scar tissue, and are can be placed after
other cosmetic surgery procedures such as face lifts to
hide scars that may otherwise appear on the scalp.
Enhance Past Procedures: Micrografts are also
used to enhance the appearance of past hair transplantation
procedures, especially at the hair line. For example,
Dr. Panagotacos has further improved the appearance of
patients who had full-size graft transplants performed
decades earlier by performing an additional micrografting
procedure to enhance their hairlines.
No bandages: Micrografts are placed with very
minor injury to the scalp, and accordingly they heal very
rapidly. The grafts can be relatively unnoticeable within
just a few days of surgery. Dr. Panagotacos' patients
leave the office without any bandages on their grafts,
and frequently without any bandages at all. Even when
bandages are used, only a single small pad is placed over
the donor site on the back of the head,
and this is only for one day. Within just a few days after
a micrografting procedure there is little evidence to
a casual observer that the surgery had even taken place.
No one has to know: The relocated hair follicles
begin growing new hairs within 3-5 months after surgery,
and the result is a gradual thickening of one's hair.
Because there is no sudden change to appearance after
surgery, no one has to know about the procedures being
performed.
Finished look in between: Patients in between
procedures may have a thin-hair look, but they will still
have thicker hair than when they started. Micrograft hair
transplant patients can schedule additional procedures
as their time and budget allows, without concern for appearing
"under construction". With additional micrografting
sessions, their hair will gain the look of even greater
density.
Risks and Disadvantages
of Micrografts
Limited Results: When compared
to hair replacement "systems" (hairpieces),
only limited results are possible with micrografting because
no new hair is added. Hairs from one part of the scalp
are simply moved to where they have greater visual impact.
The goal of micrograft procedures, like all surgical treatments
for hair loss, is only to create the illusion
of having more hair, by expertly relocating live growing
hair follicles. The results can appear thin when a limited
number of grafts are distributed over a large bald area,
although the final density achieved depends upon the number
of grafts per session, number of sessions, hair density,
hair color and contrast with skin, hair curl, and hair
shaft width. In most surgical hair restoration procedures
the illusion of more hair is very effective.
Delayed Results: Hairs in the newly transplanted
follicles are typically shed shortly after surgery, and
3-5 months later new hairs begin to grow out from the
transplanted follicles. This is because surgery typically
causes the transplanted hair follicles to enter the telogen
or "resting" phase of the hair growth cycle,
during which the hair follicles reestablish their connections
to the blood supply in the scalp. At the end of the telogen
phase, the new hairs grow for a normal period of about
five years before the next resting phase starts the growth
process over again.
Additional Procedures: One follicular unit micrografting
session may not adequate for some patients seeking to
restore their lost hair. Only a limited amount of grafts
can safely be transplanted in a single micrografting
session, and additional procedures may be required to
add the density desired by some hair transplant patients.
Also, as hair loss progresses over the years, additional
procedures may be desired in the future.
Six to Nine Month Intervals: A micrografting
treatment program does not produce instant results. Most
micrografting treatment programs are designed with 2 or
sometimes 3 treatment sessions, with each session separated
by 6 to 9months. Separating the micrografting sessions
allows the grafts placed in the previous session to grow
out and provide coverage for the new grafts. Allowing
adequate time between micrograft sessions also helps to
achieve the greatest survival rate for the transplanted
grafts. Placing too many grafts too close together, all
in a single session, increases the risk that individual
grafts may not get adequate nourishment, and may fail
to survive. Typically 6-9 months are allowed between sessions
to allow the newly transplanted grafts to reestablish
connections to the blood supply, a process known as recapilarization.
Cost: Micrografting seems expensive initially,
however the up-front cost can be financed with modest
payments over time. The total cost of micrografting
is still less costly than many cosmetic alternatives such
as hair replacement "systems", when the continuing
cost of hair replacement system maintenance and repairs
over many years are also considered. After micrografting
surgery, there is no extra cost for maintenance and repairs
- except for maybe some hair cuts periodically! And
that's a maintenance cost most people with hair loss are
pleased to pay!
Pain: Prior to surgery, all patients are given
a "cocktail" consisting of a tranquilizer, a
short-acting sleeping pill, and the pain kill. Most patients
fall asleep within 15 minutes and wake up near the end
of the procedure. The same "ccocktail" is given
to the patient for the first night at home to assure a
restful night. During surgery the scalp is numbed with
local anesthetics. On the first night after surgery, after
the local anesthetics have worn off, there can be some
discomfort at the donor area at the back of the head.
There is no pain in the area where the grafts were placed.
Pain medications are prescribed for micrograft patients,
however many patients find that they do not need them.
Micrograft procedures generally involve only a minor amount
of tissue cutting in comparison to other more extensive
cosmetic surgical procedures, so there is little tissue
swelling or discomfort after surgery. If there is any
discomfort at all, the discomfort is with the donor area,
not the area where the grafts are placed.
Permanent loss: Like all hair restoration surgical
procedures, micrografting surgery includes a risk of permanent
loss of some or all of the transplanted donor follicles,
where the transplanted grafts do not survive after surgery.
Typically the yield of transplanted micrografts is greater
than 95%, and usually approaches 100%. Lower yields can
occur, especially if a scalp infection occurs and is not
properly treated, or in "massive megasessions"
involving the transplantation of thousands of grafts in
a single session. As a Board Certified Dermatologist trained
to treat skin and hair conditions, Dr. Panagotacos can
easily recognize possible scalp infections at their earliest
stages and treat them effectively. And he simply does
not perform risky "massive megasessions".
Hair loss continues: Micrograft procedures have
no effect on one's genetic program for losing hair. After
a hair transplant, hair loss due to inherited genetics
will continue, and continued loss of hair may cause dense
hair on the back, sides and especially the top of the
head to become thin. In anticipation of future hair loss,
Dr. Panagotacos designs each of his micrografting procedures
to "stand alone", so that anticipated future
hair loss will not result in unnatural appearing "islands"
of transplanted hair. The capability of micrografting
procedures to "stand alone" is a significant
advantage of micrografting over other more extensive surgical
hair restoration procedures, where the risk of future
hair loss can dramatically alter the effect of surgical
results many years after the surgery, if hair loss progresses
beyond what was anticipated. (The risk of future hair
loss can also be addressed with medications such as Rogaine
and Propecia).
Unnatural Appearance Immediately After Surgery:
Micrograft procedures typically result in a slightly unnatural
look immediately following surgery. While individual patients
heal at different rates, there usually are some crusts
from dried blood that can affect one's appearance for
a day or two or more after the procedure.
Usually these wash out after a few days of healing, and
then the micrografts become practically unnoticeable.
Immediately after surgery, existing hair can be combed
over the micrografts, or a hat, cap, or hairpiece can
be worn temporarily. Some patients simply choose to take
a few days off of work, until the micrografts are not
evident.
Possible Complications: There are risks of complications
relating to any surgery. Micrograft procedures involve
minor cutting of skin tissues. There is a risk of temporary
numbness, and sometimes but rarely, permanent partial
loss of sensation on the scalp following surgery, although
in over 30 years of performing surgical hair restoration
Dr. Panagotacos has never had a patient experience this
complication.
Variations of Micrografts (Older Techniques)
There are many variations in minigrafting procedures,
but most fall into one of four categories. The first
includes variations in the size and preparation
of grafts used. The second includes various methods
used to prepare the recipient sites and place the
grafts. The third category includes the pattern
of placement of the grafts, and the fourth is the
quantity of grafts placed in each session. Often
surgeons and clinics give procedures special names
to highlight these differences, which can be confusing
to patients. Furthermore, different variations from
each of these categories may be combined into a
single procedure, adding to the confusion.
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Variations by graft size and preparation:
Dr. Panagotacos' recommended procedure is Follicular Unit
micrografting. This procedure is used on everyone, men,
women, new patients, and old patients seeking enhancements
or repairs of grafts placed by other doctors.
The following procedures are not recommended.
"Bare follicle" grafts: Some surgeons
specially prepare single-hair "monografts" by
separating follicular units and then trimming away from
the individual follicles all excess fat and scalp tissue
in an effort to promote fast revascularization. This additional
handling may actually reduce the survival rate of the
grafts, and Dr. Panagotacos considers this to be a risky
and unacceptable technique.
Machine cut grafts: Some procedures use machines
to separate donor material into individual grafts, achieving
great savings in time and labor. Sometimes these savings
are passed on to patients in the form of cheaper hair
transplant quotes. But these graft cutting machines are
guillotine like devices with multiple blades, and do not
identify individual follicles within each graft, so while
every graft is uniform in size and there is less handling
of each graft, there is also substantially more transection,
or "cutting-in-half" of the follicles themselves.
Although many transected follicles will still survive
and grow normal hairs, skilled surgeons prefer the higher
yield and whole follicles that result from individually
hand cut grafts. Dr. Panagotacos believes that there is
no substitute for the graft-cutting judgment and surgical
skill of a physician or experienced team of medical assistants.
Variations by recipient site preparation and
graft placement:
Slits: The standard procedure for placing Follicular
Unit micrografts is small slits in the scalp, made with
slender flat-bladed surgical instruments. Dr. Panagotacos
uses an especially fine blade called an MIS67, which was
designed for use in eye surgery. Slits allow grafts
to be placed between growing hairs and transplanted hairs,
with less risk of damage to the adjacent hairs, thereby
increasing hair density. Slits also hold the grafts securely
during the healing process, and the slits heal very rapidly.
With some patients however, the slits may compress the
tissue around the new hairs and cause them to grow together
as a tuft, with all of the hairs from a graft appearing
to come out of a single hole. For this reason, slit grafting
is usually done only with follicular unit micrografts
having three hairs or less, so that the risk of graft
compression is minimal.
Holes: Holes for larger minigrafts of 5-6 hairs
used to be made with a circular punch called a trephine,
however this size graft is rarely used at present. The
trephine removes a tiny plug of scalp tissue to make a
hole. The plugs are smaller than a grain of rice, but
when they are all added up, they reduce the amount of
bald scalp and thereby increase hair density. Holes have
somewhat less of a tendency to compress grafts, but slightly
increase the risk of grafts becoming loose before they
have completely healed.
Laser transplants: "Laser transplants"
use a cosmetic surgery laser to vaporize scalp tissue
to make narrow recipient slots for placing micrografts
and sometimes larger minigrafts. The laser slots are slightly
wider than slits made with a metal blade, and may reduce
graft compression with some patients. Laser slots have
the potential to combine the advantages of both slits
and holes, by allowing speedy graft placement between
existing hairs, while also reducing bald scalp area and
graft compression. Lasers however, also have some additional
disadvantages.
The main disadvantage of lasers is that they cause some
degree of thermal damage to the tissue in the recipient
site for the graft, slowing the rate of healing, delaying
the appearance of new hairs, and causing considerably
more crusting at the graft site. The crusting associated
with laser slots can sometimes still be visible 2 to 4
weeks after surgery, in comparison to the 2 to 4 days
that is typical for with slits made with a metal blade.
In addition, lasers are very expensive surgical instruments,
and their cost must be passed on to the patients. Finally,
laser use in hair transplantation is still relatively
new, and improvements such as computer-controlled hand
pieces programmed with pre-set scanning patterns and shorter
burst durations to limit thermal damage are still being
refined. At this time, Dr. Panagotacos believes that the
expense, risks, and disadvantages of laser use for preparing
micrograft sites is not worth it to the patient.
Variations in graft placement pattern:
A wide range of graft placement patterns exist, and
most are custom tailored to each individual for each session.
In general, micrografts are placed so that even with future
hair loss, they will look natural. Some surgeons use a
grid, or a grid pattern, to assure that individual grafts
do not crowd other hairs and threaten their survival.
Others place the grafts in a more random pattern, while
taking care to allow adequate space between grafts. Calling
on his experience performing hair restoration surgery
for more than 30 years, Dr. Panagotacos selects the best
graft placement method for each patient, for each procedure.
Among the factors taken into consideration are the size
of the grafts to be placed, the amount of existing hair
on the scalp, the color contrast between the skin and
hair, and the number of procedures to be performed as
part of each patient's complete treatment program.
Special Location Transplants: These are micrograft
transplants to locations other than the scalp, such as
the eyebrows, sideburns, mustache, and even eyelash areas.
Often patients need special location micrografts to correct
flaws from vehicle accidents, burns, or other surgical
procedures. Others may need to cover scars from cosmetic
surgery procedures, and some simply want to enhance their
facial hair. Special location transplants require
great care in the placement of each graft so that the
angle and direction of the transplanted hairs mimic the
natural pattern of hairs growing in those areas.
Dense packing: Dense packing is a variation of
micrografting where specially prepared grafts are placed
very close together, usually at the hairline, in a single
transplant session, rather than over a few sessions. This
technique has its advantages for some patients.
Variations by quantity of grafts placed:
Mega-sessions: Mega-sessions are micrografting
procedures where over 2,000 specially prepared micrografts
are placed in a single session, now a fairly routine procedure
for experienced hair restoration surgeons such as Dr.
Panagotacos. Megasession procedures usually are performed
on patients with more extensive hair loss, allowing the
larger quantity of grafts to be placed over a larger area,
without crowding the grafts too close together and risking
lower graft yield. Dr. Panagotacos cautions that every
patient is NOT a candidate for a megasession.
Candidates for Follicular Unit Grafts:
For Almost Anyone With Hair Loss: Candidates
for Follicular Unit micrografts can have male or female
pattern hair loss, with or without clear bald spots. The
only real limitation is that there has to be adequate
donor hair on the back of the head for redistribution
to the top and sides. Follicular Unit micrografting allows
maximum flexibility in placing hair follicles, so more
people are good candidates for micrografting procedures
than most any other surgical hair restoration technique.
Adequate health: Adequate health for surgery
is required, with no conditions restricting surgery such
as pregnancy or severe cardiovascular problems. While
nearly everyone has adequate health for micrografting,
it is important to discuss your health conditions with
your surgeon during the initial consultation, including
discussing any and all medications you have been taking,
and any known allergies to medications.
Realistic expectations: Candidates must have
realistic expectations for the results achievable with
this treatment method. All surgical hair restoration techniques
redistribute the patient's own hairs to locations where
they will have greater visual impact. The idea is to fool
the eye into thinking that there is more hair. The results
of micrografting treatment can be very effective, however
no new hair is added, and as a result there are limits
to the density achievable.
Follow through: Candidates for Follicular Unit
micrografting must be motivated to follow through with
the entire set of procedures recommended, and to follow
the surgeon's instructions for care following surgery.
Of course most patients are very eager to help their "new
hairs" grow in, and they carefully follow the doctor's
instructions for post-surgical care. Once the new hairs
grow in following the first procedure, the motivation
of patients to follow the surgeon's instructions increases
further!
Dense, curly hair: Those with dense hair at the
donor site will achieve a greater visual impact than those
with less dense donor hair. Curly hair will look denser
than straight hair. Light colored or "salt-and-pepper"
hair will look more natural after the first procedure
than darker hair.
Not scar readily: Those with skin that does not
scar readily, or form bumps, will have better cosmetic
results than those who do. Skin tone with less contrast
with the hair color (dark hair and dark skin, or light
hair and light skin), will look more natural during the
intermediate stages than skin that contrasts with the
hair color.
Micrograft Treatment
Described:
Schedule an appointment:
After becoming well educated and consulting with the surgeon,
you will schedule an appointment for surgery. A $1,500 operating
room fee is paid at the time that a procedure is scheduled,
as the surgeon will commit the surgical room, their own
time, and their medical assistant's time for your appointment.
Fill Prescriptions: After scheduling the appointment,
medications may be prescribed for use after, and sometimes
before surgery. It is advisable to fill the prescriptions
before the scheduled surgery, as you may not feel like
waiting in a pharmacy after surgery.
No Aspirin: For ten days prior to surgery, do
not take any aspirin.
Eat Something: On the day of surgery it is courteous
to call the doctor's office or leave a message and confirm
your arrival. Shower and wash your hair, but do not use
any conditioners or styling products on your hair. If
you plan to pay for your surgery with a check, be sure
to bring your checkbook. Generally it is good to eat a
light meal prior to surgery so that medications provided
just before surgery are not taken on an empty stomach,
unless advised otherwise by your doctor. Fruit such as
grapes, bananas, or apples are good choices. Avoid drinking
excessive quantities of liquids, and avoid stimulants
such as caffeine and nicotine.
Warm Comfortable Clothes: Select warm comfortable
clothes for the surgery. Loose-fitting pants, and a shirt
that does not pull over your head are recommended. Jogging
outfits with zippered tops are ideal. Warm clothing is
recommended as operating rooms are often very cool, and
you will be lying in one place without moving much for
an extended period of time. Wear a few layers, and consider
bringing a warm pair of socks as well.
Get a Ride: Get a ride to the doctor's office,
as you will be medicated after surgery and your reaction
time may be slightly impaired. Arrange in advance for
a ride or a "designated driver" to pick you
up after surgery.
Medication: At the office you will change into
a surgical top, and receive medication for the surgery.
You will receive a short-acting sleeping pill, a tranquilizer,
and medication to reduce pain and swelling may be administered
at this time. This is a good time to use the bathroom,
even if you think that you don't feel like it. The surgeon
will reconfirm the surgical plan, and may mark the area
for treatment directly on your scalp. The donor and recipient
sites on your scalp will be cleaned with antiseptic and
then numbed with injections of anesthetic medication.
There will be a pin-prick sting with the first injection,
and shortly after that your scalp will feel "frozen"
for several hours.
Removing Donor Tissue: The scalp at the back
of your head will be measured, some hair trimmed slightly,
and the donor area will be injected with a saline solution.
The saline injection swells the donor site and makes harvesting
strips of tissue easier. With a single or multi-bladed
scalpel, the surgeon will remove strips of donor tissue.
The open area is then closed with sutures and possibly
surgical staples. A bandage is placed over the wound,
and pressure is applied to reduce bleeding, often with
a head band.
Graft Preparation: While the donor site is being
closed, the donor tissue will be cooled and trimmed to
form micrografts by the surgeon's medical assistants.
Typically a team of assistants work with the chilled donor
tissue under magnification to prepare the individual grafts
according to the requirements outlined by the surgeon.
The natural pattern of hair follicle clusters within the
donor scalp tissue is an important consideration in graft
preparation. Naturally occurring clusters of 1-4 hair
follicles will typically become Follicular Unit grafts,
while individual follicles or pairs of follicles will
be trimmed to become micrografts.
Recipient Site Preparation: While the grafts
are being prepared, the surgeon will prepare some of the
recipient sites for the grafts. Great care is taken in
making the recipient sites to assure that the grafts will
grow out in a natural direction and pattern. Also, care
is taken to avoid damage to existing hair follicles, and
to assure that there is adequate space between each graft.
Typically a small metal blade is used to make the slits.
Graft Placement: As the individual grafts become
ready, they are placed into the recipient sites according
to the surgical plan. The surgeon and staff may work together
at this time. As the recipient sites are filled with grafts,
the surgeon will prepare additional sites. Placing the
individual grafts may take a couple to several hours,
depending upon the quantity of grafts prepared.
Clean Up: After placing all of the grafts, your
scalp is gently cleaned up, so that the grafts are barely
visible. Most of Dr. Panagotacos' patients leave the office
without any bandages. Typically you will be given some
water or fruit juice after surgery. You will also be given
some medications, to reduce discomfort and swelling after
the local anesthetic wears off. Photographs may be taken.
If you need to call for a ride home, this is a good time
to make that call. Before leaving, you will pay for your
surgery. The surgeon and staff will ask you questions
and observe you, for your own safety, to assure that you
are OK to leave.
Home: At home you should avoid vigorous activity
and excessive exposure to the sun, which may injure the
grafts. Follow the surgeon's instructions for care and
cleaning your scalp during the healing period. If any
complications occur, including excessive swelling, redness,
bumps, or bleeding, contact your surgeon and be prepared
to go into the office that day. Most micrograft patients
choose to go back to work one to five days after surgery.
Sutures Out: After about a week, you will return
to the surgeon's office for the removal of sutures and/or
staples at the donor site. This takes only a couple of
minutes, and is painless. Dr. Panagotacos will inspect
your scalp to assure that everything is healing well,
and may take more pictures. Possibly you may meet other
prospective patients in the office who will ask you about
your micrografting experience.
New Hairs: Within a week the transplanted hair
follicles will appear to be growing new hairs. Actually
these are the hairs that they had been growing before
they were transplanted. Usually these old hairs fall out,
as the transplanted follicles usually go into the telogen
or "resting" stage after transplantation. After
about 4-6 months they will begin
to grow new hairs.
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