The indications for follicular unit grafting are many, and in the author's opinion, it is the procedure of choice for over 90% of cases. However, there are exceptions when follicular unit grafting may not be better than, and maybe less effective than micro/minigrafting. Individuals with gray, white, blonde, or salt and pepper colored hair are usually best treated with larger minigrafts containing 2-5 hairs. In these cases, the final result is every bit as natural in appearance, and there is less risk of accidental transection of the hairs (which are very difficult to visualize) during the graft dissection process. Women are often best treated with follicular unit grafting, but sometimes larger grafts containing 3-6 hairs are transplanted well behind the hairline to maximally increase density. Finally, in revision cases where large (4-10 hairs) and even very large (10-20 hairs) grafts were previously placed, individual follicular unit grafts are usually needed only along the anterior-most hairline, with minigrafts more effective for filling in the areas between the large and very large grafts. In all of the above examples, the microscope is still used for graft dissection, helping to minimize hair transaction and assuring the highest yield of hair growth.

Practicing in Miami, large minorities of the patients for hair transplantation are of Hispanic or Mediterranean origin. Like Asians, these ethnic groups tend to have darker hairs, and the diameter of these hairs tends to be higher, making it more challenging to obtain a natural appearing result. These individuals with darker, thicker hairs probably benefit the most from follicular unit grafting.

As with any plastic surgery procedure, the minimizing of complications and/or less than excellent results is essential. With growing experience, the author now avoids performing cases of greater than 2400 to 2500 grafts, because of the small but real risk of poor hair growth and/or compromised healing. Working as a team with a combined experience of over 40 years of hair transplantation, consistently excellent results are now attainable.

CONCLUSIONS

The author's initial 2 ½ year experience with follicular unit grafting has proven the technique to be worth the additional labor, effort, and expense needed to perform it properly. For the great majority of individuals looking for the most natural appearing results, follicular unit grafting is the procedure of choice.

REFERENCES
1. Okudas S. The study of clinical experiments of hair transplantation. Jpn J Dermatol Urol 46:135-138, 1939.
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15. Epstein JE. Hair transplantation for men with advanced degrees of hair loss. Plast. Recon. Surg. In press.

FIGURES

Figure 1. Illustration of the follicular unit grafting procedure. A single donor strip is subdivided into "slivers" 1 and 2 follicular units wide, which are then dissected into individual follicular unit grafts containing 1, 2, and 3 (and the occasional 4) hairs. All dissection is performed under binocular microscopes.

Figure 2. Patient No. 1. Before (a, b) and 8 months after (c, d) 2200 grafts.

Figure 3. Patient No. 2. Before (a, b, c) and 6 months after (d, e, f) 2300 grafts.