Wasted Donor Hair
There is a "hidden problem" with the punch graft technique. The problem is that rarely does all the hair in the plugs actually grow. Although, the results of poor growth may looks less pluggy, this represents another step in which large amounts of the patient's precious donor hair is wasted.
The follow schematic illustrates the problem:
The figure, above left, shows a schematic of the classic 4-mm punch graft. The first problem is that the punch can't adjust for the fact that the hairs grow on an angle, so the hair shaft is cut (transected) when the graft is removed (punched out of the donor area). The second problem is that the punch is so large that the center of the graft doesn't get enough blood supply after it has been transplanted. As a result, the hair in the center of the graft doesn't get enough oxygen and dies, leaving bald spot in the middle of the graft (shown in the middle figure above). When you combine the lack of growth in the center of the graft, with follicles on one side of the graft cut off when the punch does not follow the angle of the hairs, you get a "Crescent Moon" deformity (shown above right). These problems are illustrated in the following patient.
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The patient above had large grafts in his temple area that should have contained 20-25 hairs each. Because of wastage from the punch-graft technique only very few actually grew. Even though the results don't look pluggy, a huge amount of hair has been wasted. In addition, you can see the scarring in the skin around the grafts. His restoration, and others, can be seen by viewing the Repair Work section in the Patient Photo Galleries or in The Patient's Guide to Hair Restoration.
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