Hair Graft Dissection
Hair Graft dissection refers to the stage during hair restoration in which the harvested donor hair from the back of the head are trimmed and cut into individual grafts to be later inserted into the recipient sites. Excellent graft dissection is an integral part to the overall success of every hair restoration procedure. This tutorial is intended to underscore the salient points necessary to achieve consistently excellent dissected graft quality.
Three major objectives during hair graft dissection:
- Preservation of follicular-unit integrity: Follicular units refer to the natural groupings of 1 to 5 hairs that occur on one’s head. Preserving these natural groupings of hair can increase the survivability of the transplanted hair. As the distribution and spacing of different follicular units are random, proper training is needed to examine actual scalp and donor tissue to visualize the appropriate path of dissection. It takes time and practice for someone to recognize individual follicular units. The accompanying video in this section shows these follicular units with close-up macro photography.
- Preservation of graft viability through proper handling: Grafts that are traumatically handled or left out to dessicate will invariably lead to poor or unnatural growth of transplanted hair. Proper graft handling is discussed both in this section and in the graft placement section.
- Maintain consistency in graft size and shape: Although dissecting along the natural cleavage planes that divide follicular units is important, deciding how much surrounding tissue for each graft is equally so. Depending on the end objective, grafts can be trimmed with little surrounding tissue (“skinny”) or with additional tissue (“chubby”). Each dissected graft must be made to conform to a consistent shape and size that will accommodate a specifically created recipient site. Without consistency in graft dissection, the dissected grafts simply will not fit into the created recipient site. For example, if the grafts are made too small relative to the created recipient site, they will fall into the site and create pitting. If they are made too large, they will be inserted traumatically and cause kinky hair growth, poor growth, or no growth at all if the grafts remain too high relative to the surrounding scalp.
Dr. Lam maintains quality control by keeping his hair-transplant dissection team with him full time. He does not outsource or use agency help. In the past when he did, he recognized that outside help simply could not deliver the quality of graft dissection that his own team who have been trained by his hair-transplant coordinator, Emina Karamanovski, could offer. Furthermore, all dissection is carried out in the immediate vicinity of Dr. Lam’s site creation (i.e., adjacent to the patient) not in another room where the hair-transplant team leader would have no guidance on the successful dissection of grafts. Every time that Dr. Lam creates a new type of recipient site, the site is checked for graft to site fit before continuing with the procedure. Therefore, quality control is continually monitored at every step of the procedure.