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Hair Loss Treatment at NHI

Mini-micrografting

This technique is not performed by NHI.

Mini-micrografting is a popular technique in which the donor tissue is removed with a multi-bladed knife and is then cut into smaller pieces depending upon the desired size. Those that contain 1-2 hairs are referred to as micrografts and those that have 3-6 hairs are called minigrafts. Often the minigrafts produced by this technique contain considerably more than 6 hairs. A more accurate term for the procedure is "mini-micrografts cut to size," since the grafts are cut to a predetermined size rather than dissected the way they naturally grow.

This photo shows a multi-bladed knife used in Mini-micrografting. In this case the knife is loaded with 8 parallel blades.
This shows a donor strip that has been harvested from the donor area using the multi-bladed knife pictured above. Note that the strip has been divided into thin slivers as it was removed from the scalp. The problem with this "blind" harvesting technique is that although the blades are perfectly parallel, the follicular units are random in the scalp and the follicles themselves are not aligned parallel. As a result the follicular units are broken apart and the follicles themselves are often transected.
To add insult to injury, the strip is then further cut into horizontal sections, again disregarding the follicular anatomy. This causes additional transection and a further break-up of the naturally occurring follicular units in the scalp.
This slide shows a histologic view of how the multi-bladed knife and vertical sections break up the scalp's natural anatomy.
This slide is an example of a section cut with a multi-bladed knife that was originally used as an example of the "clean" incision made by this instrument. When viewed under a stereo-microscope, however, a significant amount of transection is readily apparent. In this small piece alone, 9 hair shafts have their bulbs completely cut off, with a similar amount of damage on the other side.

As we can see, in mini-micrografting the grafts do not necessarily correspond to the naturally occurring follicular units, so that individual follicular units may be split up or combined. In addition, the harvesting and dissecting techniques do not insure that the individual follicles are kept intact. Another problem with this technique, is that in order not to prevent excessive wasteage, all the tissue from the donor site is transplanted. If any of this tissue were trimmed, the multiple hair fragments produced by the multi-bladed knife would be lost. As a result, the intervening bald skin in the donor area is transplanted along with the hair. This results in grafts that are larger than necessary and larger recipient sites to hold them. Of course, larger recipient sites can compromise the blood supply in the area where the grafts are being placed and limit the survival of the transplant.

In sum, with Mini-micrografting, neither preserving follicular units nor even keeping hair follicles intact are felt to be that important. Rather, the speed and economics of the procedure are the important factors. Mini-micrografters use a multi-bladed knife to quickly generate thin strips of tissue and then use direct visualization (rather than microscopic control) to cut the tissue. The resulting grafts are generally larger than follicular units and have considerably more follicular transection (injury).

The following table summarizes the major differences between the technique of Mini-micrografting just described and that of New Hair Institute's Follicular Unit Transplantation. For a more detailed discussion of this technique please refer to the section on Follicular Unit Transplantation on our site.

  Follicular Unit Transplantation Mini-Micrografting
THE GRAFTS
Follicular Units used exclusively Yes No
Graft size Uniformly small Larger
Number of hairs per graft 1-4 1-6 (or more)
Hair/skin ratio in graft High Average
Extra skin transplanted No Yes
Wound size Uniformly small Variable
THE TECHNIQUE
Harvesting type Single-Strip Multi-bladed knife
Microscopic dissection required Yes No
Preservation of Follicular Units Yes No
Follicular transection No Yes
Maximizes donor supply Yes No
THE RESULTS
Healing time Fast Slower
Skin surface change No Yes
Maximum fullness Yes No
Totally undetectable Yes No
COST & CONVENIENCE
Staff requirements Moderate Small
Duration of individual procedure Long Short
Time for complete restoration Short Long
Cost per procedure More Less
Total cost for restoration Similar Similar

It should be apparent from the above comparison that Follicular Unit Transplantation is superior in producing a natural, undetectable result, in maximizing healing, and preserving the patient's donor supply. Mini-micrografting is popular with doctors because it requires a smaller staff and each procedure is cheaper and shorter. However, in the final result it often takes more procedures and may cost the patient just as much. Not such a bargain for an inferior technique.

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