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Hair grafts for male pattern baldnessScalp from areas where the hair is thick can be transplanted to bald areas. These grafts retain the character of the donor site. Grafts are of two types: strip grafts or individual plugs.
Strips grafts, as the name suggests, are long strips of hair bearing skin. They are mainly used to provide thick even coverage in the front of the scalp, especially in younger men. It is common to combine them with individual plugs.
Individual plugs are mainly used to fill in areas which already have a hairline produced by flaps or strips. They are divided into two types based on their size. Large grafts are about 3 to 5 mm across and contain many hair follicles. Small grafts are 1-2 mm across and contain only a few hair follicles.
The large hair plugs are the traditional punch grafts. Because of their size they allow for rapid filling of bald areas. Three to four sessions of about 50 plugs are usually needed.
A variant of the punch graft is the square graft which because of its straight edge permits a more smooth line to be made.
Small grafts are called mini and micro grafts. Because of their small size they have a less artificial appearance. However, they do require many sessions with several hundred grafts inserted at each session.
In general it is better to place the hairline higher rather than lower. This is because it is relatively easy to correct high hairline but almost impossible to correct a low one.
Some surgeons recommend treatment with minoxidil around the time of grafting to reduce the amount of hair loss.
Patients with curly hair tend to get better results than patients with straight hair. Blondes and those with salt and paper hair usually achieve better cosmetic results.
Hair grafts are less likely to be successful in black patients because the spiral shape of the follicles makes them vulnerable to damage and the hair pattern is less dense. Keloid formation is also a risk.