My patient came over yesterday so I could take out his stitches (from the hair graft site in the back of the head). I’m familiar with Dr. Kurgis’ work, but something VERY interesting struck me. First, a little background … and then the “interesting part."
In the “old days” surgeons assumed they needed large hair grafts so the follicles would “take.” Today they know that even a single follicle will re-grow. They also discovered that the larger grafts become “doll-like” because as the wound contracts (normal wound-healing) the follicles squeeze together and form a clump of hairs … a very unnatural “doll head” look. So, the mini-grafts are what all top surgeons do today (one hair, or one follicle unit). But there’s more …
When we did grafts (in the old days) we attempted to align the epidermis (of the graft) to the epidermis on the scalp (the receptor site). Problem is, this seldom was possible. If the (graft) epidermis is placed too deep, the epidermis at the hair forms a tiny depression; if placed a bit too high, you get the common “hair-transplant bump.” All of these errors look dreadful, and you all have seen these. (These are the ones we have to remove.)
Dr. Kurgis’ (brilliant) remedy is to not put the hair graft in all the way. Instead, he allows the graft epidermis to completely stick up above the graft site. In this way, the entire graft epidermis, and some of the dermis, desiccates. He WANTS the graft epidermis to die off! The epidermis at the graft site fills in (of course), and now the hairs is perfectly aligned and there is no possibility of a bump or a depression. (This was Kurgis’ thoughtful addition to this procedure.) But now, something even more interesting … and the reason for this post.
I noticed on this patient that the hair grafts in the front of his head didn’t look “put in” deep enough! Only about half of the follicle was placed in the graft site! Indeed, the entire (assumed) location of the bulge was ABOVE the scalp and therefore desiccated and non-viable (looked like a lumpy crust). So, here’s the explanation (from the surgeon).
In the front of the head, it’s preferable to have smaller hairs (and follicles). Having big hairs in the front looks unnatural. (Remember, they only use BIG hair grafts from the back of the head). So, to “create” smaller hairs/follicles he only puts the follicle in “half-way.” In so doing, he creates a smaller follicle and consequently a finer/smaller hair (for the front of the hairline).
Surprisingly, this “half” hair graft is able to completely survive and regrow WITHOUT a papilla and WITHOUT a “bulge.” So, what do you make of this? I have formed a conclusion, but I’m interested in your thoughts. (Funny how information from other procedures can impact what we do? I think this “revelation” might impact our treatment protocol.) Ideas?