What is Mini Grafting and Micro Grafting?
Mini grafting and micro grafting is an older form of strip surgery, which is where a "strip" of hair-bearing flesh is removed, dissected, then re-grafted onto the recipient scalp. In the early days of hair restoration, technicians would have to wear jeweler’s loupes when dissecting the hair bearing tissue, which only allowed a limited range of magnification. This meant less refinement, higher transection rates as well as "chubbier" grafts. This describes grafts that have a substantial amount of tissue surrounding the follicle and hairs. The resulting micro-grafts would contain one to two hairs (micro-grafts) but the amount of tissue left behind would be more than that found on properly dissected follicular units with the same hair counts. Mini-grafts, which are larger than micro-grafts, would contain as little as three or more hairs but many of these mini-grafts containing six to ten hairs.
Is Mini Grafting and Micro Grafting Outdated?
Although mini grafting and micro grafting certainly originates from an older technique, they are not necessarily “bad” per se. It is still possible to use these styles of grafts and obtain natural-looking results. However, achieving a high level of density with this technique is not possible, which means that it may be good for recreating a low density area of the scalp, such as areas behind the hair line, but not for recreating a high density area like frontal hairline. As a result, a few rare physicians tend to use these grafts in a supportive role in combination with more modern procedures such as follicular unit extraction (FUE) and follicular unit strip surgery (FUSS), or simply elect not to use them at all.
Mini grafting and micro grafting became less popular once stereoscopic dissecting microscopes revolutionized the way physicians harvest hair as the higher magnification levels allowed for specific follicular bundles to be safely separated from each other. FUE and FUSS are two strategies that allow physicians to harvest follicular units in their true, natural form, as they exist in the scalp. These harvesting styles have a much lower transection rate, allowing for much higher densities to be achieved in a single session, and are easier to control with regards to angle and direction for a more natural result.
Is There a Case for Mini Grafting and Micro Grafting Today?
Yes, there is still a case to be presented in support of mini grafting but not so much for micro-grafting. Because mini grafts can have multiple follicular units for a total of six to ten hairs (sometimes more), the volume of hair that this creates is better than what can be found with a similar number of follicular units that have, at most, four or five hairs (rarely) but usually one, two or three hairs. This negates the need for density in one procedure as the number of hairs in each graft are naturally of a higher density inside each mini graft than what any surgeon could achieve by dense packing follicular units side by side. The density of mini grafts when placed next to each other however have rather large spaces, which is what makes them less natural at shorter hair lengths that would qualify as "buzz cuts". If the patient knows that they will never have such short hair styles then an argument could be made in favor of mini grafts for areas behind the hairline as they can help to achieve strong hair volume.
What are the Side Effects of Micro Grafting and Mini Grafting?
The side effects of mini grafting and micro grafting can include:
- Necrosis – if enough blood pools under the skin due to too many mini-grafts placed too close to each other then the size of the incisions to accommodate the larger nature of the grafts can be too traumatic for the skin causing subsequent tissue death.
- Infection – Again, if the skin is traumatized excessively from attempts of dense packing then infection can easily take hold.
- Ridging – This occurs when excessive tissue is inserted into a concentrated area and it cannot be absorbed by the body. This potential side effect is one of the main reasons why multiple passes are required to achieve cosmetic density when compared to follicular units from FUE or FUSS.