Hairs Per Graft........ Is It Important? What is Transection?

When people speak of a hair transplant and asked "how many did you have?" they always refer to "grafts", a graft can simply be a piece of tissue with hair, it does not always represent reality of what your donor can give.

In essence and in true form a graft should represent a "FU" or Follicular Unit, a group of hairs that grow together and can range from 1-4 hairs. Different areas of the scalp or donor area will have different concentrations of hair numbers, for example more 1 and 2 hairs around the sides and more 3 and 4 hair units around the back.

When designing a hair transplant it is important for a varied mix of each hair grouping, for example single hair units for the hair line and larger groupings to add the thickness, so it is important when harvesting the follicular units they are removed intact. Splitting of hair groups can occur with either Strip or FUE, but we will discuss FUE as in the pure form it does mean "Follicular Unit Extraction". When the FUE punch encompasses the hair unit the diameter of the punch must be large enough to house the entire unit and a little fatty tissue around but also small enough to not over lap surrounding hair units.

There can be a number of negative effects if a hair unit is compromised, or "transected", this is when the hair unit is split, for example a 3 hair unit is split into 2 and 1 hair, this would then make up 2 "grafts" instead of 1, same amount of hair though, this means if the patient is paying per graft he will be paying more than required for the same amount of hair. Transection can also kill the hair, damage the follicular unit. By splitting follicular units vital aspects of the unit are damaged or lost, protective fatty tissue around the unit, muscle receptors and other glands maybe missing or damaged. Leaving a partial follicular unit in the donor has no real benefit to the operation or the patient, if an educated extraction pattern is thought out the donor will not be over harvested or obviously lower density, and as the trauma of the splitting can damage the hair unit anyway there is a good chance the hair will miniaturise anyway or worse actually die.

There is no reason to split the graft with FUE as by the nature of the technique the hair units can be cherry picked from around the scalp and enough single hair units for example can be found for hair line work, splitting and leaving hair in the donor can be detrimental and of no benefit and also reduces the hair count per graft so the patient loses out on their natural number groupings. Removing and using an intact follicular unit requires skilled extraction with an FUE punch, the diameter of the punch has to be correct and a very good understanding of the skin anatomy is required to understand angle and directional changes under the skin surface to ensure there is no accidental or purpose splitting of the hair units.