Scientific Articles

Hair transplantation is a scientific practice that requires an artistic perspective. Just as manual skill alone is not enough, it is impossible to talk about a hair transplantation process without scientific evidence and research. One of the most confusing issues in hair transplantation is the concepts of graft, hair follicle and follicular unit.

What is a Graft?

A graft is a structure that contains the hair follicle or follicles and the skin.

What is a Hair Root?

It is a single hair unit inside the graft.

What is a Follicular Unit?

Follicular unit, on the other hand, can be expressed as micro hair follicle bundles that can be found in the scalp in two or more numbers. In short, in hair transplantation, the graft is referred to as a follicular unit.
The difference between a graft and a hair follicle, which is a common misnomer, is that a graft is a single or multiple unit, while a hair follicle is a single unit. As a result, we should think of hair transplantation as a graft transplant, not a hair follicle transplant. There can be more than one hair follicle in a single graft and we collect grafts, not hair follicles, from the donor area. There can be 1, 2, 3, 4 or even 5 hair follicles in a single graft. However, we can only understand how many hair follicles will come out of a graft when the grafts are collected and the micro hair follicle bundles inside are exposed during hair transplantation.

In 2018, in our research published as a scientific article, we conducted a study that can help predict the area of the donor scalp with the probability of containing the number of follicular units to be transplanted.

We examined 1030 patients who underwent hair transplantation between January 2014 and January 2018 in our clinic. The mean age of the patients was 37.2 years. The grafts from the donor area contained at most 2 hair follicles. Follicular unit density ranged between 70 and 90 and hair density between 130 and 220 hairs/cm2. In addition, postoperative frontal edema was the most common complication.

In this study, in which we understood how important hair follicle density and the team are, 994 of the 1030 patients were male and 36 were female. The first hair transplantation sessions of all patients were taken as the first stage of the study. In all cases, the donor hair transplantation area was cut to 1 mm short. Depending on the hair thickness of the patients, 0.8 mm and 0.9 mm punctures were used to collect the follicles under sedation with the support of local anesthesia. The collected hair follicles were grouped according to the number of hair follicles in a special solution and made ready for transplantation. To increase the viability of the hair follicle, it was kept in the solution at 4 degrees. The recipient areas were then numbed with local anesthetic and prepared for transplantation. Hair follicles were transplanted at a distance of 1 - 1.4 mm from each other. The channels where the hair follicles were to be placed were opened using 1.2 and 1.5 m micro blades. After all hairs were implanted, antibiotics and painkillers were administered after the procedure. Patients were discharged for follow-up the next day after special dressing. The patients' hair was washed by the healthcare team for 10 days. The mean age of the patients was 37.2 years. Vakalarda ortalama olarak 3038 foliküler ünite, en az 615, en çok 5900 greft alındığı, en sık alınan greft tipinin ise 2 saç kökü içeren tip olduğu görüldü. Bu araştırmadan anlayacağımız sonuç şudur:
Her bir foliküler ünitede 1,2,3,4 hatta 5 saç kökü bulunabilir. Tek bir foliküler üniteden en fazla 2’li saç kökü çıkmıştır. Bu saç köklerinin hasar görmeden transfer edilmesi son derece önemlidir ve bu uygulamayı yapan ekibin başarısıdır. Herhangi bir insanın foliküler ünitesinde kaç adet saç kökünün bulunduğu tamamen kişiye özeldir ve bu durum tamamen genetik içeriklidir. Kişinin foliküler ünitesinde ne kadar çok saç kökü bulunursa, transfer edilen saç kökü sayısı da o derece artar. In summary, I am trying to express that hair transplantation gives more satisfactory results in cases where there are more hair follicles. However, it is not possible to predict how many hair follicles there are before the procedure and this situation only becomes clear during the procedure.

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