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Hair transplantation is an historic procedure that is done very much today as it was decades ago. While the number of grafts transplanted in a single session has increased over the years, from a few hundred to thousands in a single session, the fundamental concept of moving individual hairs from the back or sides of the head to the top has not changed. (and probably never will) One of the major advancements has been the change from large circular plugs that contain many hairs to single or double hair units that create a more natural appearance and hairlines.

But no matter how many hair units are transferred and the location to which they are implanted, they must be harvested. Until the day comes when one’s individual hair follicles can be grown in cell culture and then used as transplants, the patient must be their own ‘recycling’ center. The standard method of donor site hair harvest has been the strip method. But cutting out a strip of hair along the back of the head, hairs can be cut out from the skin strip and prepared for transplantation. While effective, this creates a donor scar that may or may not create a favorable scar. For many men, trade-off of a scalp scar for having more hair on the top of the head may be a risky decision.

One major improvement in hair restoration has been the Neograft system. This is lower power suction system that allows the donor harvest to be done without a long scar across the back of the head. The device extracts a 1mm section of skin with the hair follicles in them. In essence it cuts out 1mm plugs if you will all along the desired donor area. It does this automatically and then sucks the grafts into a container which captures them. By spacing out this small 1mm sections throughout the donor area, a long linear scar is avoided. These 1mm holes do not require closure and heal by contraction within a few days. While every incision on the scalp will leave a scar, these many ‘dot’ scars heal imperceptibly by the scalp’s native ability to contract. This is in essence a scar dispersement strategy.This not only avoids the scalp scar’s potential to widen and become noticeable but enables the donor area to be reharvested later. (provided that the spacing of the Neograft harvest is 20% or less of the total surface area)

One other advantage of the Neograft system is that the harvested grafts are already prepared for implantation. Unlike strip grafts where a technician must prepare all of the grafts from the donor strip, the Neograft extraction process does that at the time of suction harvest. Whether that leads to better graft survival (less of a shock effect) has been debated and has not yet been scientifically proven, users of the system feel that is another one of the method’s benefits.

Neograft also has a power method of graft implantation. In a reverse method to extraction, the device sucks up the individual grafts and then injects them into the prepared slits in the recipient site. This is a very clever and, quite frankly, cool method of insertion but there does not appear to be a biologic or time-saving value over the traditional method of individual forceps insertion.

Neograft has been touted as a ‘game changer’ in hair transplantation surgery. And it is but not because it makes hair transplantation faster, more effective, or cheaper. It does so because it eliminates the donor scar. That may seem to be a trivial issue but it is a major consideration for many potential hair transplantation patient.s As I always tell my cosmetic surgery patients for any procedure, it is all about trading off one problem for another. Every cosmetic procedure has trade-offs (some major and some minor) so you had better like and be accepting of whatever the trade-offs are. When a long scar exists across the back of your head that will be a major aesthetic issue if one ever decides that they need or want to wear short hair or have a buzz cut. (and some hair transplant patients do end up making that decision based on their genetic predisposition to balding and the quality of their hair transplant result) Neograft ‘s minimally invasive approach to harvest now makes that a safer decision and one never ends up in a worse place with the appearance of their scalp no matter how their hair transplant result turns out.

Dr. Barry Eppley

Indianapolis, Indiana

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