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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 cosmetically acceptable.

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These are the original, standard, out-of-date pluggy-looking grafts.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 head.

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.

Scalp Reduction

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.

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