The Patient's Guide to Hair Restoration - New Hair Institute

damage is done to surrounding tissue, the recipient tissue directly under the
beam is totally destroyed.
The laser has the additional disadvantages of increased set-up time,
greater cost, and potential eye hazards. The laser operator lacks the precise
tactile and visual guidance to adjust for depth and angle when making sites on a
curved scalp. Most important, the laser destroys tissue and unnecessarily
increases the recipient wound size.
Ridging
Another significant cosmetic problem produced by larger grafts is the extra
volume of tissue introduced into the recipient site. This extra tissue produces a
fullness and elevation of the transplanted area and a clinically apparent ridge,
separating it from the surrounding bald scalp. In some patients, this problem is
compounded by a negative reaction of the surrounding tissue in response to the
transplanted grafts. This phenomenon, termed “hyperfibrotic change” by Dr. Dow
Stough, accentuates the abnormal contour of the transplanted area. In addition,
there is some evidence that the hair subsequently placed into this area may
exhibit sub-optimal growth.
Hyperfibrotic changes are rarely seen with very small grafts and have not
been reported with Follicular Unit Transplantation.
Wasting Hair
Wastage of donor hair, not often noted initially, is a major limitation to
preserving adequate density for sufficient coverage. It is the hidden enemy of all
successful repairs. Hair wastage comes in many forms: poor graft harvesting
and dissection, improper graft storage and handling, keeping the grafts out of the
body too long, packing the transplanted grafts too closely in the scalp, poor preoperative
preparation, or inadequate post-op care. Literally every step of a
poorly executed transplant may serve to deplete one’s donor supply.
An interesting paradox occurs with the old punch-graft technique. When
the procedure is executed flawlessly, most of the donor hair is captured in each
punch and the growth of the grafts appears pluggy, inciting immediate complaints
on the part of the patient. When the procedure is performed poorly, there is
increased transection of the harvested follicles and inadequate growth in the
centers of the larger grafts, both contributing to a softer, more natural look.
Although in the latter situation, the patients are initially more satisfied, the poor
growth is evidence that there will be problems with hair supply down the line and,
ultimately, a worse cosmetic result.
Donor Scarring
Although the major effect of scarring in the donor area is to decrease the
amount of available hair, when scarring is severe, the scar itself may become a
cosmetic problem. The situations where this is most likely to occur are when the
scar is: placed too high (in the non-permanent zone), placed too low (near the
nape of the neck or over the ear), excessively wide in any location, or raised (a
hypertrophic scar or a keloid).
Limiting Factor in Repair Procedures