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BHR Clinic Patient Advisor
We are often asked whether it is necessary to split grafts with FUE or what the transection rate would be with FUE.
When people speak of hair transplantation and ask "how many did you have?" they always refer to "grafts", a graft can simply be a piece of tissue with hair, it does not always represent reality of what your donor can give.
In essence and in true form a graft should represent a "FU" or Follicular Unit, a group of hairs that grow together and can range from 1-4 hairs, possibly 5 but rarer. Different areas of the scalp or donor area will have different concentrations of hair numbers, for example more 1 and 2 hairs around the sides and more 3 and 4 hair units around the back at the occipital area.
When designing a hair transplant it is important for a varied mix of each hair grouping, for example single hair units for the hair line and larger groupings to add the thickness, so it is important when harvesting the follicular units they are removed intact.
Splitting of hair groups can occur with either Strip or FUE, but we will discuss FUE as in the pure form it does mean "Follicular Unit Extraction". When the FUE punch encompasses the hair unit the diameter of the punch must be large enough to house the entire unit and a little fatty tissue around but also small enough to not overlap surrounding hair units.
There can be a number of negative effects if a hair unit is compromised, or "transected", this is when the hair unit is split, for example a 3 hair unit is split into 2 and 1 hair, this would then make up 2 "grafts" instead of 1, same amount of hair though is present, this means if the patient is paying per graft he/she will be paying more than required for the same amount of hair.
Transection can also kill the hair, damage the follicular unit. By splitting follicular units vital aspects of the unit could be damaged or lost, protective fatty tissue around the unit, muscle receptors and other glands maybe missing or damaged. Leaving a partial follicular unit in the donor has no real benefit to the operation or the patient, if an educated extraction pattern is thought out the donor will not be over harvested or obviously lower density, and as the trauma of the splitting can damage the hair unit anyway there is achance the hair will miniaturise anyway or worse actually die.
There is usually no reason to split the graft with FUE as by the nature of the technique the hair units can be cherry picked from around the scalp and enough single hair units for example can be found for hair line work, splitting and leaving hair in the donor can be detrimental and of no benefit and also reduces the hair count per graft so the patient loses out on their natural number groupings.
Removing and using an intact follicular unit requires skilled extraction with an FUE punch, the diameter of the punch has to be correct and a very good understanding of the skin anatomy is required to understand angle and directional changes under the skin surface to ensure there is no accidental or purpose splitting of the hair units.
The exception to the rule whereby splitting could legitimately happen in specific cases is rare and not the norm, but should be voiced and qualified. For example if we/the patient wanted a partial shave to hide the extraction, thus limit the harvest zone it may be required to split a few down for temple or hair line reconstruction, but this is a limited example and not common at all. Likewise where the donor has been compromised through previous surgeries, there may not be the required singles needed for the surgery and therefore a legitimate reason to split multiples into singles. In such cases the patient would be informed of this practice and the reasons why.
When people speak of hair transplantation and ask "how many did you have?" they always refer to "grafts", a graft can simply be a piece of tissue with hair, it does not always represent reality of what your donor can give.
In essence and in true form a graft should represent a "FU" or Follicular Unit, a group of hairs that grow together and can range from 1-4 hairs, possibly 5 but rarer. Different areas of the scalp or donor area will have different concentrations of hair numbers, for example more 1 and 2 hairs around the sides and more 3 and 4 hair units around the back at the occipital area.
When designing a hair transplant it is important for a varied mix of each hair grouping, for example single hair units for the hair line and larger groupings to add the thickness, so it is important when harvesting the follicular units they are removed intact.
Splitting of hair groups can occur with either Strip or FUE, but we will discuss FUE as in the pure form it does mean "Follicular Unit Extraction". When the FUE punch encompasses the hair unit the diameter of the punch must be large enough to house the entire unit and a little fatty tissue around but also small enough to not overlap surrounding hair units.
There can be a number of negative effects if a hair unit is compromised, or "transected", this is when the hair unit is split, for example a 3 hair unit is split into 2 and 1 hair, this would then make up 2 "grafts" instead of 1, same amount of hair though is present, this means if the patient is paying per graft he/she will be paying more than required for the same amount of hair.
Transection can also kill the hair, damage the follicular unit. By splitting follicular units vital aspects of the unit could be damaged or lost, protective fatty tissue around the unit, muscle receptors and other glands maybe missing or damaged. Leaving a partial follicular unit in the donor has no real benefit to the operation or the patient, if an educated extraction pattern is thought out the donor will not be over harvested or obviously lower density, and as the trauma of the splitting can damage the hair unit anyway there is achance the hair will miniaturise anyway or worse actually die.
There is usually no reason to split the graft with FUE as by the nature of the technique the hair units can be cherry picked from around the scalp and enough single hair units for example can be found for hair line work, splitting and leaving hair in the donor can be detrimental and of no benefit and also reduces the hair count per graft so the patient loses out on their natural number groupings.
Removing and using an intact follicular unit requires skilled extraction with an FUE punch, the diameter of the punch has to be correct and a very good understanding of the skin anatomy is required to understand angle and directional changes under the skin surface to ensure there is no accidental or purpose splitting of the hair units.
The exception to the rule whereby splitting could legitimately happen in specific cases is rare and not the norm, but should be voiced and qualified. For example if we/the patient wanted a partial shave to hide the extraction, thus limit the harvest zone it may be required to split a few down for temple or hair line reconstruction, but this is a limited example and not common at all. Likewise where the donor has been compromised through previous surgeries, there may not be the required singles needed for the surgery and therefore a legitimate reason to split multiples into singles. In such cases the patient would be informed of this practice and the reasons why.
