A hair transplant is basically a redistribution of hair follicles from a place with dense hair to areas of hair loss. Patients must be skillfully assessed to determine if they are good candidates.

Decades ago, “plugs” were used as grafts. These were 4- to 5-millimeter round “punch” grafts taken from the back of the scalp, each graft containing 10 to 12 hair follicles.

When grafted, these looked unnatural – like a toy doll’s hair or a “sprigged” lawn. This method required a second and third session months later to fill in between the first session of grafts.

Next, various flaps of hair-bearing scalp were rotated from the side and “swung” into the new position to create a hair line. It looked like a carpet and was not attractive at all.

Finally, the FUE (follicular unit extraction) came about, leading to a monumental advancement in hair restoration. This is essentially taking 1-millimeter grafts of scalp containing from one to four hair follicles.

The one-hair grafts are used in the front hairline, which appears natural. For more density, the multiple follicle grafts are used behind the hairline. So, when performed with skill, 1-millimeter grafts containing one to four follicles look completely natural.

How to harvest the grafts? The strip technique is done by taking a strip of hair-bearing scalp from the back of the head. Then, under magnification, the strip is cut into the small grafts that are needed. The donor site is sutured up, leaving a linear scar.

If the patient has long hair, the scar is not noticeable. With short hair, however, it can sometimes be quite noticeable.

Unlike the strip method, FUE grafts are taken with 1-millimeter punches containing one to four follicles. This leaves only a small dot where each graft is taken from and is hardly ever noticeable.

When NeoGraft, an automated FUE, came into the picture, up to 2,500 grafts could be performed in one session.

The downside of any FUE procedure is the need to cut the hair very short in the donor site. It takes 10 to 12 days for the hair to grow out enough to cover the donor site.

With long hair (most women), it can take months for the hair to achieve a desired hair length. Some think this is not a problem because they can cover the area with the surrounding hair. Others choose the strip method with no donor site hair loss.

So, the strip method will leave a linear scar that might be noticeable with short hair. NeoGraft will result in a shaved donor site hair, which, while temporary, will be noticeable for 10 to 12 days.

The grafted area for both procedures is the same. Both are performed under local anesthesia with minimal discomfort. When performed with skill, both are stellar procedures, and both men and women are elated with the results.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerand associates.com