Just Splitting Hairs? or is Transection Important?

Transection can occur at various stages of the hair transplant procedure and relates to impairment or damage that can be caused to the lower section of the hair follicle, the bulb; this can impair the regrowth and graft survival. The donor resources are finite so every follicular unit counts, transection needs to be kept to a minimum to ensure not just for correct donor hair management but also for the result in the recipient area.

Harvesting of the hair follicles is the first stage that transection can occur; be it with the FUT or FUE technique as the FU´s need to be extracted from the scalp and the two techniques differ in the extraction process.

Transected Follicular Units

Transected Follicular Units

FUE is a blind technique in respect of extraction as it is impossible to determine the direction of the FU under the skin; great care is required when making the punch in terms of direction and depth of the FU. The first number of punches made help to determine the direction of the follicular unit and depth, although this can vary in some cases and will certainly vary dependent on the area of the scalp.

FUT the donor can be “ballooned” to enlarge the area of the strip so under magnification it is easier to extract around the peripheral FU´s. The strip is removed and given to the technicians to be divided. The strip is divided into small sections and then the individual units can be cut and divided into their natural groupings all under magnification, cleaned and kept in a holding solution.

All aspects should be monitored by the doctors to ensure quality control, high standards and minimum transection percentages

If transected or split follicular units are left in the donor area this can compromise the quality of the donor area, reduce the hair density or increase the miniaturisation of the hair remaining in the donor; this will impact on future procedures in both the donor and recipient areas.

There are legitimate reasons why a follicular unit may be transected but this is not to kill the graft but to divide the FU into smaller units; a three hair unit divided into a 2 and 1 hair unit; for legitimate reasons if smaller units are required, hair line work for example. If the follicular units are divided then more “grafts” are created, as many clinics charge per graft placed this can unrealistically inflate the total number of grafts but the same amount of hairs.

If transected grafts or split grafts are placed in the recipient it can affect the overall result, transected will not grow and if too many are divided it will affect the distribution of hair in key areas to recreate the density required. The quality of the medical team is vital, being well trained and working with small instruments under magnification to ensure the highest graft survival rate as possible.

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