Understanding Quality Work in Hair Restoration Part 2: The Role of the Team
Although it would seem that finding the right surgeon would qualify as the only thing that matters regarding hair transplantation, it is not the case. Finding the best team to do your work is equally important, as will be discussed in this article. Like building a first-class car, every person on the assembly line is crucial to the total impact of the result. In the first article in this two-part series we explored the critical role played by the surgeon in a hair-transplant procedure. In this article we explore the role of the hair-transplant assistant in their contribution to the final outcome. The two principal tasks that the hair-transplant assistant undertakes are graft dissection and graft placement.
Graft dissection is the first part of the graft preparation process which involves taking a harvested strip and then slivering (breadloafing) the strip into individual rows of hairs followed by graft dissection in which the rows are then separated into individual grafts. If grafts are manipulated poorly, left out to desiccate, or trimmed imprecisely, the results of the hair transplant will be suboptimal. For example, if the graft is left out to desiccate or dry the hair will not grow after transplantation. If the grafts are roughly handled, the grafts can grow out kinky, coarse and unnatural. If the grafts are improperly dissected, the grafts may not fit the site well and lead to either a compressed or pluggy look or create other problems that will be discussed in the next paragraph on graft placement. (View our hair graft dissection videos)
Graft placement can be an even more difficult art in the process of hair restoration. It takes a very special skill to be able to place dissected grafts into the scalp without trauma and with correct fit to the site as well as depth and direction. We will explore each of these actions and their consequences herein. As mentioned, if the graft is roughly manipulated or even if the hair shaft is squeezed during placement, the hair can grow out kinky and unnatural. If the graft does not fit the site well the graft can either be compressed if the graft is too large or fall into the hole resulting in pitting. The graft must be situated at the end of the case about 1 to 2 mm above the surrounding skin surface. If it is placed flush with the skin or slightly below the surrounding skin, the graft will become pitted in appearance. Conversely, if the graft is over 2 mm above vis-à-vis the surrounding skin, the skin surface can appear cobblestoned or the graft can die due to it drying out. Finally, grafts should be placed according to their natural curl, i.e., hairs grow with a curve in them and the curve should aim downward to the scalp rather than sideways or upwards, which can lead to compromised density and uncombability afterward. (View our hair graft placement videos)
Superior graft placement also involves another level of concern that is known as regional placement, a consideration that only involves the top echelon of transplant clinics. Rather than segregating hairs simply into 1-, 2-, 3-, and 4-hair grafts, which is very important, hairs are further selected based on their other qualities. For example, only the finest one-hair grafts are allocated for the frontal hairline, which creates the most natural-appearing hairline. Thicker 3- and 4-hair grafts are distributed in the cosmetically sensitive area known as the central forelock to provide maximal cosmetic hair density where it counts the most. White hairs that are harvested are allocated more to the temples and also more evenly spread out so that they do not unnaturally cluster on one side of the head. These finer points of graft placement and allocation truly separate the average from the superior clinics that perform surgical hair restoration.
I hope these two articles that only brush the surface of quality control helps a prospective consumer better understand the importance that quality plays in every hair-transplant procedure.