However, I get a kick out of telling people
when they come in, "Did we get the hair from you are somebody in the
family because I can't find the scar" because the techniques for
closing the back are so sophisticated now. Basically, once we take the
tissue out we underline and loosen the scalp up, we close it without
tension, we put in some buried sutures into a membrane under the scalp
called the galea.
DAVID R. MARKS, MD: I think we actually have
MICHAEL L. REED, MD: We bring that together. Then
we close, without tension on the surface. There's no tension and
the sutures come out at 10-14 days and most people heal with a pencil line
scar. I think in this photograph you can see the immediately
postoperatively the shaved area with the running suture across it. The
service ones will be removed, the buried ones will dissolve themselves.
When it's all done most of the patients get a pencil line scar.
DAVID R. MARKS, MD: The hair grows over it.
REED, MD: The hair at both ends comes together so that even though there
's less hair there than there was before because it is a finite
number of hairs, these hairs don't replicate. There are a fixed
number of hairs brining the two edges together leaving a little tiny
pencil line scar results in a very nice look that's undetectable.
ROBERT V. CATTANI, MD: I think what Dr. Reed has just expounded
on is of major import here because in patient education, what they have to
know is in days of old we actually got a drill and drilled into the back
of the scalp and took out these plugs. There's not a person out
there in the audience who doesn't know what a plug is and
that's not a good thing. We took out these plugs. Not only did it
limit the amount we could harvest, but it left these deficits in the
scalp. One of the major contributions that has been made in hair
restoration in the modern age is, we went from that to this very long
strip that we suture together and this is a major concern. Every patient
asks me, "Doc, are they going to be able to tell?" I tell them, "No, it is
quite undetectable from that donor area," and we're able to
harvest more in there.
DAVID R. MARKS, MD: Of course, one of the
reasons for the undetectable nature of transplants now is that
you're dividing the harvest site into follicular units. We have
some pictures of that, but just tell me how that's done.
MICHAEL L. REED, MD: There's different ways of doing it. You can
see here close up. What's happening here is this is actually a
segment of the living scalp that has been removed, the whole piece. This
is now being cut under a dissecting microscope into small slivers. Each of
those slivers, and you see a whole bunch of the them there in a petri
dish, those slivers are then subsequently, using magnifying lenses and
backlighting on the dissecting microscope, are dissected into the final
tiny grafts which contain anywhere from one to maybe three follicular unit
DAVID R. MARKS, MD: How do you know how thin to cut
MICHAEL L. REED, MD: We allow the scalp to determine what
it needs because some people have larger follicular units, denser
follicular units. So we will cut according to what the scalp requires.
Also some people have more elasticity in the top of the head, some people
have less. So we go back and forth and we do a sizing, I call it, where we
do different kinds of openings and then we get several different sizes of
grafts and shapes of grafts and we fit them and see what fits best. Then
we take those standards back to the techniques who then follow the
instructions and we make a certain number of each depending on how much
air you're going to cover.