Once the “graft” has been extracted from the scalp donor the graft either has to be dissected into the individual follicular units with FUT or checked and cleaned if necessary with FUE. Skin tissue is delicate and requires great care when handling to not damage or traumatise the tissue, also the size of the tissue makes it difficult with the human eye to ensure the greatest accuracy and care is taken. To ensure this care is taken stereo-microscopes are utilised and this enables the surgical team to maintain the integrity of each follicular unit when either dissecting from the main tissue into the individual units or being checked and cleaned.

Under magnification it is possible to accurately ensure any directional changes of the hair in the tissue, sometimes the hair colour, especially grey or light blonde can make the depth and direction of the hair difficult to establish and without magnification the chance of transection or killing the graft is more likely. Therefore it is considered vital to generate a hair follicle that contains all the essential anatomic structures necessary for maximum survival and growth, therefore stereo magnification must always used.

A carefully dissected graft, trimmed of excess epidermis and fat has the flexibility to be inserted into the tiny opening made and placed at an angle almost flush with the skin. The recipient sites are made in close proximity to each other, the angle and direction decided dependent on the site position as well as the size of the site dependent on the number of hairs in place in the graft. When the grafts are placed the angles can be so acute that the base of one follicle lies under the shaft of the next; this close proximity placement must also be undertaken with magnification to ensure correct direct, depth and graft care, not to place the graft too deep or crush the bulb with the forceps whilst handling. The trimmed grafts have very little volume other than the functional follicle so they are perfect for dense packing but are delicate and easily traumatised.

Dr. Christian Bisanga is a member of the International Hair Restoration Society, ISHRS.