As men age they tend to lose their hair. There are many options for men who want to reverse hair loss. In this post we’ll take a look at “Microplugs.”
Microplugs permit improvement in coverage and the establishment of a more natural looking hairline. The surgeon produces these transplants by halving or quartering plugs of 3.0-4.5 mm. While a normal 4-mm graft holds 12-18 hairs, the microplug holds about 4 hairs. The surgeon may transplant as many as 200 microplugs in a session, inserting them in stab wounds made with a No. 15 scalpel. These are generally reserved for filling in the anterior hairline to avoid a tufty appearance, but the entire anterior border can be created with microplugs. Coverage may be slightly more expensive with micrografts than with 4-mm grafts.
Complications are uncommon with punch grafting. If transplanted plugs are taken from a site that eventually loses hair, the transplanted plugs also will lose their hair. The most common complaint of patients who have had punch grafting is tuftiness. The surgeon corrects this by placing more grafts or, if the problem is due to elevation of plugs, by shaving the elevated plugs flush with the skin. When the shaved plugs heal, the hair will regrow properly.
Patients who are not satisfied with punch grafting results are most often those who have not chosen to go back for more transplants to fill in between tufts. About 5% of patients may be disappointed in the coverage they achieve even with closely spaced transplants.
Punch grafting is effective for patients scarred by burns and those whose hairlines have been displaced by face-lift surgery. Punch grafts aren’t used to correct patches of baldness due to scarring disease processes such as discoid lupus erythematosus or lichen planopilaris because there is no way to predict whether an uninvolved donor site might be affected by the disease after the transplant. Transplants performed to cover burn scars are reimbursable by third-party payers under the category of reconstructive surgery.
Scalp reduction is used as an adjunct to punch grafting in patients who have extensive balding on the crown of the head and who have fairly flaccid scalps. With the patient sedated and anesthetized locally, or occasionally generally, the surgeon excises an ellipse, crescent, or Y of scalp and undermines the scalp surrounding the excision; some undermine all the way to the ears. Subcutaneous tissues are closed with absorbable sutures and the skin with metal staples, thus shrinking the bald area and reducing the number of punch grafts needed. Each scalp reduction can remove a strip of tissue about 2-5 cm (about 1-2 in) wide and u0-15 cm (4-6 in) long.
No matter how extensive the skin removal, there is a 20%-50% stretchback. This return of flexibility is helpful in patients with extensive baldness as it allows removal of more bald scalp in repeat procedures. Each reduction costs approximately $1,500.
Often, the anterior part of the scalp is first transplanted with punch grafts placed slightly lower than the desired hairline. Then the scalp reduction is done, raising the new hairline to its intended level, and the rest of the bald area is filled in with punch grafts. Alternatively, scalp reduction may precede punch grafting.