The art of mixing follicular units and follicular groupings in hair restoration surgery

BACKGROUND. Follicular grafting yields good results, but takes an excessively long time to perform the procedure. Iatrogenic damage can also occur to the follicular units during the dissection phase when two follicular units are very close together. OBJECTIVE. The objective was to minimize the length of time to perform the procedure and to limit iatrogenic damage to the follicular units during the dissection phase. METHODS. A donor strip is divided under a stereoscopic microscope into one-, two-, three-, and four-haired follicular units and three- and four-haired follicular groupings. Three- and four-haired follicular groupings are formed when 2 two-haired follicular units or a three-haired follicular unit and one-haired follicular unit are very close together. These hair grafts are then inserted into incisions that are 1.0 to 2.5 mm in length and are arranged in accordance to the particular hairstyle desired by the patient. RESULTS. The technique used in this article accomplishes consistently excellent results while creating an environment that prevents damage to follicular units that are extremely close together. This technique requires less time and damages fewer follicular units. CONCLUSIONS. When performing hair restoration surgery, it is many times counterproductive to use follicular units exclusively.