are coupled fu's a mini/micro

[EastCoast]

Is it unheard for a Doctor to couple fu in a couple of select spots. Is that a mini-micro graft ? If not, what is the difference of a mini-micro compared to a FU. I the fat is trimmed etc, sites are smaler, etc. What is the difference between place 2 one hair fu together, and a micrograft of 2 hair ?

[Dr. Michael Beehner]

Dear East Coast,

There is a lot of misunderstanding as to what some of these terms mean, which describe various types of grafts.

First of all, there is no such thing as a "microminigraft". For many years "micro-minigrafting" referred to a type of transplanting in which small one and two-hair thin grafts were always called "micrografts" and anything larger than that was called a "minigraft." Micrografts were traditionally used at the front hairline and minigrafts were used behind them. Because the minigrafts in the early days were quite large, with 7-10 hairs in them sometimes, and because they often weren't used very artistically - often being placed at 90 degree angle, growing straight out of the head like a tree - they understandably got a bad reputation. During this era, which went from the late 1980's till around 1996 or so, the great majority of all grafts were cut using "loupes" of around 2-2.5 power magnification. It was somewhat of a "slicin' and dicin'" type of dissection, though with relatively decent magnification and, by high-quality practices, done with as much care as they could bring to the task.

Since that time, however, the majority of practices now use microscopes of various powers to cut their grafts (the Mantis is 6x magnification, and the other stereomicroscopes, including the Mejgi ones that we employ, are 10x). Using this kind of magnification, it becomes obvious when you look under the scope that you are dealing with these little separated islands of hairs called "follicular units". In the majority of patients at least half of these are composed of 2 hairs each, a quarter of 1 hair, and another quarter of 3-4 hairs. Some of these FU's are in closer proximity to a given neighboring FU than others are. In these instances, oftentimes, if greater density is needed in the "frontal core" zone at the top of the head, the physician or his assistant cut and dissect in such a way as to encircle the two of these together, thus yielding a 4 or 5-hair "double follicular unit." The term "minigraft" and the term "micro-minigrafting" both have come to carry a negative "Wild West-shoot em'up" type of connotation, whereas the artistic use of "double FU's" and "triple FU's" ,using this type of dissection, is anything but wild. In fact, it takes a good deal of time, care, and artistic ability.

When you hear that two FU's were placed together into a recipient site, this can mean one of two totally different things: If you take two slim 2-3-hair FU's and put them together in the jewelers forceps and place them side-by-side into a narrow needle hole, you then have perhaps 4-5 hairs in a very tiny space, which creates a very dark,compressed "dental floss" type of look that you would never want anywhere near a hairline or outer area. On the other hand, if you precisely cut out two FU's as one piece of tissue, along with the small amount of intervening bald skin that separates them naturally, and you place that graft into a recipient site - whether it is a small slit, a small slot, or even a small round hole - which is the same size as the graft, then those two FU's exist on the transplanted head with the natural distance between them that existed in the donor area, and they are capable of imparting natural density to the scalp in the area where they are used and needed for that task.

One important place that the old term "micrograft" can truly be used is in the patient who has an overwhelming number of 2,3, and 4-hair FU's and hardly any naturally occurring 1-hair FU's. In this instance, we cut 2-hair FU's into two separate 1-hair grafts, which we then call "micrografts," according to the rules of the old terminology. These 1-hair grafts are necessary to impart a "natural" look to the front hairline, and are also necessary in the rear transplanted border. Research studies have shown that these grafts grow just as well as the intact 2-hair FU.

I hope this makes this terminology clearer and takes some of the emotional overlay out of discussions involving these terms.

Mike Beehner, M.D.

[EastCoast]

Thank you so much. That is the best explanation I have found.