Graft Excision

Suturing After Graft Excision

It is important that the areas from which the large grafts are removed are sutured closed. This will result in significantly faster healing and less scarring than if the holes are left open. Holes that are not sutured will heal with round, white scars that will mimic the look of the plugs. In addition, new hair may not grow as well, or look as natural, when transplanted into these scars. Suturing is critical for grafts that are removed in cosmetically important areas, however, even if the grafts that are to be removed lie behind the hairline and it is anticipated that the area will eventually be covered with transplanted hair, they still should be sutured closed.

Planning Combined Repair

 

It is important to wait a minimum of eight weeks after a graft excision before performing another graft excision, so that the sutured skin will have healed enough to permit another procedure in the same area without opening any of the original wounds, and so that any follicles that were missed in the prior procedure will have time to grow new hair. These follicles can then be identified and, if necessary, removed in the next session.

For the same reason, it is necessary to wait at least 8 weeks after a graft excision to perform a camouflage procedure. Waiting at least 8 weeks will insure that all of the problem grafts will have been adequately removed and will allow the skin to heal enough that it can support a camouflage session where additional follicular units (obtained from the donor area) are transplanted into the front or top of the scalp.

FUT vs. FUE in Combined Repair

In the camouflage step of the hair transplant repair, there are several advantages to removing additional hair using a strip excision (rather than FUE). With a strip, we are often able to remove all or some of the prior donor scar(s), improving the appearance of the donor area. Second, in areas of scarring, FUT (under microscopic control) is generally best for harvesting hair with minimal damage, as scar tissue can make FUE more difficult. When a strip excision is not possible, FUE is useful to either obtain more hair for the top of the scalp or to add hair directly into a problem donor scar to make it less visible.

Placement of Hair from Excised Grafts

When hair is removed during a graft excision, this hair should be placed behind, rather than at, the frontal hairline. The reason is that the hair that is obtained from a graft is often associated with scar tissue and has a tendency to become wiry after it is re-transplanted. This hair is good for “filler” in the mid-scalp, but is not ideal for the hairline. New hair, obtained from the donor area, will usually have a more natural appearance.