At LJHR we perform our procedures utilizing the most up to date surgical techniques available. Ultra refined follicular unit transplantation refers to the most recent evolution involving the hair restoration process. As is common knowledge by now, the technique of hair restoration has evolved from the utilization of large round "plugs" of the 1960's and early 1970's, to the use of "mini micrografts" of the 1980's and early 1990's, to today's techniques wherein smaller and more densely placed incisions allow for placement of surgically refined individual follicular units.
Dr. Carman has further refined his graft site creation process by incorporating the use of custom made surgical blades which he makes specifically to custom match the exact required size for each individual patient at the time of surgery. This method produces the most natural appearing result, and when used in combination with other technical options, such as combination grafting, one can achieve excellent new hair growth that is so natural as to be undetectable even under close scrutiny.
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Hair grows naturally on the scalp in what are called follicular units. Each single hair may exist as a single follicular unit, alone by itself, so to speak, but more commonly they exist in groups that average two or more hairs per follicular unit. Some hair can grow in densely packed follicular units of up to three or four hairs. Therefore, great skill and care must be taken at the microdissection stage of creating the grafts, both to insure that naturally occurring one hair grafts are preserved, as well as to appropriately select and preserve those follicular units which will be most aesthetically pleasing for use as two and three hair transplants. Single hair transplantation is utilized along the frontal portion of the hair-bearing scalp, to recreate a fine, soft, natural appearing hairline. We also utilize single hair grafts as appropriate in central crown and temporal point recreations, as well as for eyebrow and eyelash reconstruction.
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In general, it has been our experience that some of the larger occurring follicular units can grow more robustly when left in their naturally occurring two, three, or four hair configurations. A "multi-unit" graft refers to a graft that contains two follicular units, each unit averaging two hair follicles. They are commonly referred to as a "double-follicular unit" (DFU). The process of moving a greater amount of hair mass can be achieved by the judicious use of these "DFU's", wherein we take advantage of the close association that two "sister" follicular units share. These "multi-unit" grafts are used predominantly when we employ the technique of combination grafting, wherein the goal is to recreate an area of increased hair mass.
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Combination grafting refers to the technique of placing intermixed single follicular units with "multi-follicular" or "double-follicular" units (DFU's) when indicated in the appropriate recipient areas.
In our experience, we have found that the use of this technique can give the appearance of a greater amount of hair mass per given area than could otherwise be achieved utilizing solely single follicular unit micrografting techniques.
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Follicular Unit Extraction refers to a second method of harvesting donor hair, as an option to the donor strip harvesting method that is more commonly employed. With this method, donor hair is removed utilizing a 1 mm punch that makes a circumferential incision in the skin around the follicular unit. As the FUE method does not leave a linear scar, it can be used in patients who wish to wear their hair very short. Other indications for this method of graft extraction include a tight scalp that would not tolerate excision of a long linear strip, and, patients who may have healed poorly from a previous strip harvest procedure.
It should be pointed out that this method has it's own limitations and complications, as follows. Because of the need to intersperse the excisions evenly within the areas of hair that are not harvested (for cosmetic reasons), there is a limitation in the amount of hair that can be harvested at any one time utilizing this technique, and it typically yields one-half the amount one would obtain otherwise. Thus, it is a less efficient technique than the strip harvesting procedure. Other significant complications of this technique are its higher transection rate and the possibility of buried grafts that may form cysts at a later time.
Still, when given the appropriate indications for its use, donor harvesting by the FUE method can be a useful tool in the hands of a skilled hair restoration surgeon.
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The type of hair loss encountered by women is generally different than that pattern of hair loss experienced by men. Women experience hair loss as a generalized thinning process that occurs throughout the entire hair-bearing surface of the scalp. Therefore, the recreation of a natural looking head of hair in these patients requires a particularly focused approach that relies heavily on the artistic skills of the transplant surgeon along with strong two-way communication between the surgeon and patient.
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