Hair Loss: Procedures to Avoid
Linear or Line Grafts
A three- to four-mm linear strip of donor hair is removed from the side or
back of the head and instead of dividing the strip into follicular unit grafts,
the entire strip or large parts of it are transplanted.
Since this large graft can't be placed in tiny recipient sites, a trench
must be surgically cut into the bald area and the large graft is placed into
the trench. As hair grows, it looks like a manmade line of hair that is not
Round or Square Grafts
These are the original, standard, out-of-date pluggy-looking grafts. Each
three- to five-mm graft is made with a hole punch device, resulting in a plug
of hair about the size of a pencil eraser. Whether round or square, these large
grafts are too large and do not resemble the way hair grows naturally from the
When transplanted, because the grafts are so large and therefore compromise
the blood supply, hair in the middle of the graft often does not grow, leaving
the patient with a doughnut effect. These large grafts are responsible for what
looks like doll hair -- a pluggy look of islands of hair in an ocean, as they
are now described. Cobble-stoning, a common scalp deformity in hair restoration
patients, is caused by this procedure.
Even the more recently developed smaller version of the grafts -- the mini
grafts and micro grafts -- can give a less-than-natural appearance, which is
why transplants should be made up of naturally occurring grafts called
follicular units comprised of one to four hairs.
Also known as alopecia reduction (AR), galeoplasty (GP), or male pattern
reduction (MPR), scalp reductions can result in an unattractive appearance.
Performed in the doctor's office under local anesthesia, the bald part of the
scalp at the top or crown of the head is cut away, and the edges of the nearby
hair bearing skin are sewn together, bringing the hair-bearing scalp from
either side to meet in the middle. In some cases a scar results, commonly know
as a "dog ear" scar.
Scalp reduction problems also include:
- Accelerated hair loss, more than the natural course your hair would take.
This hair loss can occur within just weeks or months and often doesn't
- An unnatural appearance because the direction of hair growth is
- Hemorrhaging and hematoma (blood pooling)
- Stretch back, a problem in almost 100% of scalp reduction cases. The
stretched part of the hair-bearing scalp that has been stitched together loses
its tightness and stretches out partially or totally, leaving a visible bald
area created by the stretching. The dog ear scar is not only unattractive; it
is extremely difficult to repair.
- Suture reaction, in which the stitches in the deep layers below the skin
can cause pain and swelling. The body can reject the sutures, causing holes in
the scalp at the suture sites.
- Loss of hair for future transplants. Scalp reductions do not preserve hair
for later use, as some physicians may try to claim. The same wreath of
permanent hair is stretched to cover the wider area in the crown, thereby
thinning the permanent hair that would normally be used as donor hair for