Old Style grafts are cir­cu­lar pieces of scalp con­tain­ing any­where from 7–15 hair fol­li­cles. This old-fashioned tech­nique, is not typ­i­cally used today, how­ever some­times they are com­bined with smaller min­i­grafts and micro­grafts to cre­ate a more nat­ural appear­ance. Since the 1970’s through the 1980’s hair trans­plan­ta­tion with Old Style grafts, or “plugs” as they are com­monly referred to, was the stan­dard method of sur­gi­cal hair restora­tion. Presently most hair trans­plants are accom­plished with min­i­grafts and micro­grafts alone. This tech­nique is also used to revise unsightly hair­lines caused by old tech­niques such as “plugs”.

Revi­sion of the hair line can be restored by a sur­gi­cal hair restora­tion sur­geon, with immense prac­tice of today’s inno­v­a­tive tech­niques. Meth­ods such as, stereo­scopic micro­scope dis­sect­ing gives sur­geons a greatly enlarged and, there­fore com­pletely clear view of the struc­ture of your hair and the way it is placed in its nat­ural state. This enables sur­geons to work with great pre­ci­sion between each fol­lic­u­lar unit and pre­serve not only the hair but also its vital struc­tures such as the seba­ceous glands and the hair roots. With­out the stereo­scopic micro­scope, there is a dan­ger that the sur­geon could cut through some of the hairs vital struc­tures and dam­age them in the process. Grafts trans­planted with the stereo­scopic micro­scope will be health­ier and there­fore will grow more vig­or­ously.

Hair Fol­li­cles

Hair has two dis­tinct struc­tures — first, the fol­li­cle itself, which resides in the skin, and sec­ond, the shaft, which is what is vis­i­ble above the scalp.

Two sheaths, an inner and outer sheath, sur­round the fol­li­cle. These struc­tures pro­tect and form the grow­ing hair shaft. The inner sheath fol­lows the hair shaft and ends below the open­ing of a seba­ceous (oil) gland, and some­times an apoc­rine (scent) gland. The outer sheath con­tin­ues all the way up to the gland. A mus­cle called an erec­tor pili mus­cle attaches below the gland to a fibrous layer around the outer sheath. When this mus­cle con­tracts, it causes the hair to stand up which also causes the seba­ceous gland to secrete oil.

Hair Shafts

The hair shaft is made of a hard pro­tein called ker­atin and is made in three lay­ers. This pro­tein is actu­ally dead, so the hair that you see is not a liv­ing struc­ture. The inner layer is the medulla. The sec­ond layer is the cor­tex and the outer layer is the cuti­cle. The cor­tex makes up the major­ity of the hair shaft. The cuti­cle is a tightly formed struc­ture made of shingle-like over­lap­ping scales. It is both the cor­tex and the medulla that holds the hair’s pig­ment, giv­ing it its color.

Hair Growth Cycle

Hair on the scalp grows about .3 to .4 mm/day or about 6 inches per year. Unlike other mam­mals, human hair growth and shed­ding is ran­dom and not sea­sonal or cycli­cal. At any given time, a ran­dom num­ber of hairs will be in one of three stages of growth and shed­ding: ana­gen, cata­gen, and telogen.

Many early hair trans­plant tech­niques used large grafts; this old tech­nique caused “plugs” which are not aes­thet­i­cally accept­able by today’s stan­dard. It is no longer nec­es­sary to be stuck with the dis­sat­is­fac­tion and embar­rass­ment of plugs.  By trans­plant­ing ultra micro grafts we are enable to alter the unnat­ural look of old tech­nique.  Also, in some cases we are able to remove those old plugs and trim them to mini and micro grafts and re-transplant them. In most cases, our patients receive dra­matic improve­ment with his revi­sion tech­niques. There­fore patients can expect the finest avail­able work so that future revi­sion work is greatly minimized.