Transplantation techniques

In the 80's the mini-and micro graft method was introduced by Marrit. It was developed from the original "skin islet" method by Okuda/Ohrentreich. A mini transplant has a diameter of 1,0 to 1,2 mm and contains 3-6 hairs. A micro transplant has a diameter of 0,7 to 0,9 and contains 1-2 hairs. Hair transplantation makes it possible to increase the hair density of the recipient area, at the expense of the donor area. That means that many, but certainly not all of the patient's expectations can be met.

In order to attain the greatest possible patient satisfaction, his or her expectations have to be evaluated in a detailed interview. For instance, if the bald area is larger than the donor area it is generally impossible to obtain "youthful" hair density. The face shape as well as density, structure and colour of the donor area furthermore determine the possibilities and limits of hair transplantation with mini-and micro grafts. Each individual's hair plays the deciding role in estimating donor capacity. The most unfavourable conceivable course of continued hair loss has to be anticipated. As a consequence, the most important pre-requisit for a long term successful hair transplantation is a consistent therapy plan - which considers both the general aging process and the individual's form of baldness. This plan has to include a sufficient hair reserve from the start, so possible further advancing hair loss can be corrected by successive treatments.

We exclusively practice mini-and micro transplants. Critical areas are the anterior frontal line or the back vertical area. In these areas we exclusively use micro transplants. The hair needs to grow in the direction nature intended it to. The density should not be too unequal, but rather should be as homogeneous as possible. The hair line has to match with the proportions of face, brow and shape of the head.

Indications

The application of mini-and micro grafts are suited to androgenetic alopecia, innate alopecia and scaring alopecia after accidents, operations and radiotherapy as well as eyebrow reconstruction.(pic.2)

Technical procedure

The extraction of donor skin from the back of the head is done under local anaesthetisation. The extraction area is primarily closed with stitches. The extracted skin strip is carefully prepared under the microscope prior to being implanted. The goal is to obtain mini grafts with one to two hairs and micro grafts with three to six hairs.
Next, the receiving area is locally anaesthetized and the mini- and micro grafts are inserted into perforations, made with an electrical hollow drill. A different method is the stitch-incision technique. Here the mini-and micro grafts are inserted, with or without epidermis, into stitch-incisions made with a scalpel. This technique is methodically easier, but in comparison with the drill technique, has following disadvantages: the direction of growth cannot be exactly determined, because the transplants aren't fixed firmly inside the stitch-incisions. In addition a "palm tree effect" can occur, because the hairs could be pressed together. A palm tree effect is the grouping of the hair shafts along the coarser epidermis. The result is a fan-like growth of the hair. Also, the bald skin is only pushed aside, whereas in the hollow drill technique it is removed. An experienced team can transplant up to 1500 mini-and micro transplants per session and cover even bigger baldness in two to three sessions.

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