Hair Transplant Terms & Definitions M-R
Male Pattern Hair Loss (MPH) – The pattern of loss formed when men lose hair due to genetic predisposition. The pattern forms in one of several predictable outlines as classified by the Norwood/Hamilton hair loss charts. These charts are considered to be fairly inaccurate as they do not cover the full extent of common patterns found in nature but they are used as a basis for reference in the medical community.
Manual Punch - Manual punches are used in FUE procedures for follicular extraction. A manual punch is a cylindrical tool with one end having a hollow, sharp edge designed to perforate skin tissue. The cutting surface can be smooth or serrated. There are also punches that have a less sharp or "blunt" tip that is just sharp enough to cut skin but not so sharp that they easily cut hairs. This is to reduce "transection" of hairs thereby increasing survival rates. A manual punch is held in the practitioner's hand and is rotated back and forth between the thumb and forefinger with pressure applied. The sharp end of the punch is slipped over the hairs of the target follicular unit and the skin tissue is cut or "scored" to a depth of 3.5mm to 4mm. This is roughly the depth of the average human hair. Once the desired depth is reached the graft is gently extracted using forceps.
Micrograft – A piece of hair bearing tissue prepared for insertion into the recipient scalp of a hair restoration patient. Micrografts usually contain one or two hairs and are usually used in the hairline. The term is antiquated and usually refers to the state of the art surgery dominant during middle and late 19990’s.
Minigraft - A piece of hair bearing tissue prepared for insertion into the recipient scalp of a hair restoration patient. Minigrafts usually contain three to ten or more hairs and are usually used behind micrografts that are used for the hairline. The purpose is to add bulk and coverage. The term is antiquated and usually refers to the state of the art surgery dominant during middle and late 19990’s.
Miniaturization – When DHT is affecting a hair the process reduces the diameter of the hair and causes the hair to appear finer. The hair also has a shorter anagen phase thus it cannot grow as long as neighboring hair that is not miniaturizing as well. It is a key identifier when visually inspecting for signs of future hair loss.
Minoxidil - An antihypertensive (high blood pressure) medication in prescription form, usually in 10mg dosages. It is classified as a vasodilator in that it physically opens blood vessels for increased flow. In topical form it is used to prevent hair loss and can be found in 2%, 5%, 10% and 15% concentrations. In 2% and 5% concentrations it is found in North America as Rogaine and in Europe as Regaine. Since the medication has gone off patent it is the most widely used over the counter generic medication to fight and prevent hair loss and is found in hundreds of hair loss products as one of the listed ingredients.
Mini-Micro Grafting - The early days of strip excision surgery or "FUSS" did not use microscopes for dissecting follicular units away from each other. Technicians would wear magnifying loupes when dissecting donor hairs and the resulting grafts would sometimes contain one or two hairs (micro grafts) or three, four or even up to ten or more hairs (mini-grafts). The tissue around the hair grouping would be considerable so the incision for the graft would be rather large. Mini-micro grafting is not a bad procedure in and of itself as natural results can be obtained however high density is not possible. Multiple sessions are necessary to get the same density possible with follicular unit grafting.
Motorized punch - The principal is the same as the manual punch but in order to avoid fatigue a hand held motorized device is used. There are many variations of motorized punches, too many to list here, with most inexpensive models coming out of China. The two most commonly found motorized FUE punches, at the time of this writing, are listed below.
- Powered SafeScribe - Arguably, the most popular motorized punch appears to be the Powered SafeScribe system invented by Dr. Jim Harris of Hair Sciences Center in Denver, Colorado USA. This is the motorized version of the original SafeScribe system also developed by Dr. Harris. The SafeScribe and Powered SafeScribe use a dull or blunt punch.
- PCID - This is the Powered Cole Isolation Device, developed by Dr. John Cole of Alpharetta, Georgia USA. At first glance this is a more advanced version of powered FUE extraction as it includes a touchscreen that gives the operator a more comprehensive degree of control. The punches used for this system are sharp rather than blunt and Dr. Cole claims they are the sharpest punches for FUE in the world.
Multi-blade scalpel - This was used by most hair transplant surgeons during the beginning of the use of strip excision surgery. A multi-blade scalpel consisted of a single handle with multiple blades, sometimes consisting of two scalpel blades and sometimes up to four scalpel blades. Some clinics still use this type of scalpel for strip removal but it is widely considered to be too primitive and wasteful as transection rates are considered to be very high.
Necrosis - This is basically every hair transplant surgeons' worst nightmare. Necrosis is dead tissue or skin that has died. This can happen for a number of reasons but specifically to the subject of surgical hair restoration it will usually happen due to one of two reasons.
- Many times a doctor will make density claims that cannot be realistically met and when he/she tries to meet these expectations the recipient scalp cannot handle the trauma. The disruption of blood flow when dense packing in some cases can literally starve an isolated region of recipient scalp of blood thus the tissue literally dies. Necrosis will start as a bruise that appears to be darker than the rest of the already reddish/pinkish recipient scalp. This is blood pooling in the skin and clotting. When this happens the clot prevents additional blood flow from reaching the area and the skin tissue gets darker and darker until it appears black. Eventually infection sets in and the area much be cleansed and debridement (dead or infected tissue removal) must begin. The healing process can take several weeks and months and the eventual result is usually a large scar with intermittent areas of hair growth.
- If infection occurs during a hair transplant and anti-biotics are not introduced soon enough then the infection can reach deeper into the recipient scalp and over a larger area and eventually some of the tissue in the recipient scalp gets so infected that it must be removed via debridement. Scar tissue forms after several months of recovery and healing.
NeoGraft - This device is the first of the automated FUE extraction systems on the market. With a massive marketing campaign in print and online Neograft has had so much exposure that some people refer to the "Neograft technique” not realizing that it is not a technique but simply a tool. NeoGraft is an extraction and implantation tool all in one. Using a motorized punch the practitioner isolates a follicular unit then once the graft is scored a suction device pulls the graft out of the donor tissue and deposits the graft into a reservoir. Once the extraction process is complete the handle can be reversed and modified so that the vacuum can then deliver the graft from the reservoir back into the recipient site make by the doctor or technician. Some physicians that use the Neograft machine have modified it so that it does not use suction to remove grafts due to their concern regarding desiccation. These doctors have effectively disabled the vacuum feature and simply use the device for scoring and placement with extraction being performed manually with standard forceps.
Norwood - Often referred to as "NW", this refers to hair loss measurement system first presented by Dr. O'tar Norwood in 1975 for describing the various patterns found in male hair loss. While highly inaccurate and incomplete it is considered to be the standard in which all hair restoration clinics classify their patients. There are 7 Norwood levels and various sub-levels with "NW7" being the most aggressive level. The Norwood chart does not apply to female hair loss.
Pitting - Sometimes referred to as “pit scarring”. Pitting is a visible type of scarring that forms in the recipient scalp after surgical hair restoration. Pitting is usually caused by inaccurate depth control during the incision making process. If the incision is made deeper than necessary for a particular graft the top of the graft will ultimately wind up below the plane of the recipient scalp thus forming a “divot”. Once the wound heals around the graft the skin at the base of the graft is concave. When multiple grafts have similar results the appearance can resemble the surface of a golf ball.
Plug Hair Transplant or "plugs" - First used in 1952 by Dr. Norman Orentreich who is considered to be the "Father" of surgical hair restoration. This is a term used to describe a method of transplanting hair that utilizes a surgical punch approximately 2mm to 4mm in diameter. The punch is used to score and remove a piece of tissue from the traditional safe donor zone and it is then transplanted into the thin or bald recipient scalp into an equal sized incision. Each plug will consist of twenty or more hairs depending on the density in the donor zone from which the plug was removed for transplantation. The open wounds where the plugs were harvested are left to heal with no closure from sutures or staples. Large round scars develop which are difficult to hide. The growth from plug surgery can allow for a near native density to be achieved but the orientation of the plugs and the unnatural arrangement that usually accompanies such procedures make the practice of transplanting plugs outdated. This is the procedure that helped coin the term "doll head hair". Plug surgery was the dominant form of surgical hair restoration for approximately forty years until the wide spread use of strip surgery in the early 1990's.
Proscar - The brand name for finasteride as originally marketed by Merck Pharmaceuticals. It was approved for the treatment of benign prostate hyperplasia (BPH) by the FDA in 1992. It is manufactured in 5mg dosages. Many doctors prescribe Proscar with directions to quarter the pill with one quarter of the pill to be taken daily as a more affordable method of use for patients looking to use the medication for the prevention of hair loss.
1.) Transplantation of pubic hair to thin or balding areas of the scalp. This is considered to be a fringe procedure and is rarely performed. Has been used in cases where other sources of donor hair have been exhausted and the patient is in need of repair.
2.) Transplanting hair from the scalp or other areas of the body to the pubic zone. This was one of the earliest types of hair transplant procedures performed by Dr. Tamura, a Japanese dermatologist, before WWII. (source- American Hair Loss Association)
Recipient Site – This is the incision where grafts are placed during surgical hair restoration. Incisions are made into the recipient scalp with a blade or needle or needle type device such as an implanter pen.
Ridging – Ridging is a form of scarring from recipient site creation. It usually forms in the hairline area after attempts are made to “dense pack” with needles that are too large and/or with grafts that have an unnecessary amount of fatty tissue attached at the time of implantation. Scar tissue forms and the cumulative effect creates an elevation of the entire anterior recipient zone,
Rogaine – The commercial name for minoxidil in North America. It is available in 2% and 5% concentrations.
Terms & Definitions D-L