wookster
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http://hairlosstalk.com/surgicalops/ht9b.htm
http://hairlosstalk.com/surgicalops/ht9b.htm
There are multiple problems with patients who have received larger grafts.
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As a result of the contraction of plugs once they have been transplanted, the density of hair in the plugs may actually exceed the donor density. This produces a pattern of excessive density within the larger grafts and empty spaces between them. In most patients who will have a significant amount of balding, there is not enough donor hair to both fill in the spaces between the plugs and cover all the area that needs to have hair. As a result, the surgeon is left with the dilemma of choosing between a pluggy look scattered over a large area or very high density in some areas with insufficient coverage in others. Often the patient is left with both problems!
It is important to note that one often observes less density in the grafts than one would anticipate from the size of the harvested plug. This can be due to a number of different mechanisms. Two of the most common are hair loss from poor harvesting techniques, and hair loss caused by a phenomenon called "doughnutting." In doughnutting, the centers of grafts get insufficient oxygen following transplantation and therefore, the follicles in the central portion of the grafts fail to survive. This results in hair growing only in the periphery of the grafts. This was a common phenomenon in 4- and 5-mm plugs, but can also be noted in grafts 3-mm in size. A "crescent moon" deformity occurs when these two problems exist simultaneously and the transection, in effect, cuts off half of the doughnut leaving a crescent moon shape. An additional problem is that, in these cases, even though the appearance might not be very pluggy, the total available donor hair is markedly decreased. These problems do not occur with micrografts or follicular unit grafts.