The Use of Micrografts and Minigrafts in the Aesthetic Reconstruction of the Face and Scalp

Abstract

Hair transplantation by use of micrografts (one- to two-hair follicular unit grafts) and minigrafts (three- to four-hair follicular unit grafts) used in large numbers (>1000 grafts) in a single session was initially described for the treatment of male pattern baldness. More recently, the author has found many other applications, particularly in facial and scalp reconstruction. The most common causes for aesthetic hair restoration of those areas in the author's experience include hair loss resulting from aesthetic facial rejuvenation surgery, revision of unsatisfactory results from previous hair transplantation, burn alopecia, congenital reasons, and hair loss after oncologic resections. The basic technique is described in detail, with variations given for each of the challenging anatomic areas, including the sideburns and temporal hairline, eyebrows, eyelashes, mustache, beard, and remaining scalp. Special attention is given to the direction of hair growth, hair texture, aesthetic planning, and absence of detectable scars, in order to mimic nature and to result in a minimal number of procedures. The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp has been found to be safe and predictable, and has provided a high level of patient satisfaction.

Hair Transplant

“…10 Bard-Parker blade. The graft is then cut into 2-mm sections using 3.5 × loupe magnifi cation ( Barrera, 2003 ). Micrografts or minigrafts can then be dissected from these sections again using magnifi cation, which is typically performed by the surgeon's assistant.…”

“…In the 1950s, Orentreich (1959) popularized hair plugs, using punch grafts. This was popular for many years; however, plug grafts lead to an unnatural doll-like look ( Barrera, 2003 ;Vogel, 2000 ). The grafts are placed in rows and do not fl ow with the direction of the original hairline.…”

“…The most common area used is around the occipital protuberance at least 4 cm above the posterior neck hairline ( Reed, 2007 ). This is considered the "safe donor area" ( Barrera, 2003 ).…”

An Algorithmic Approach for Reconstruction of Burn Alopecia

“…The detailed techniques for each method followed previously published reports. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] All operations were performed at our institution by 1 plastic surgeon.…”

“…1 Based on these principles, numerous reconstructive methods, including hair grafting, serial excision, local scalp flaps, and scalp extension and scalp expansion procedures have been described in case reports and small case series. [2][3][4][5][6][7][8][9][10][11][12] Although various methods have been introduced, a standard method does not exist because each method has both advantages and disadvantages, and each patient has different conditions of burn alopecia. Therefore, as always in plastic surgery, surgeons should consider relevant conditions of burn alopecia and choose a treatment option tailored to the individual patient.…”