I went in today to a random barber in town to get my hair evened up and faded in the back, as I plan to let my hair grow out now. Anyway, I told him right away that I have a challenge for him: I want to get the hair on the sides and back as short as possible while still leaving my still-pink scar concealed. He seemed unimpressed that I am 17 days post-op from a HT surgery.

His first comment was "I have never seen a HT scar like this" to which I replied "What do you usually see? How many have you seen?" He said he has 5 regular customers who have had HT's, none with a strip scar. They have all had "little round punch holes" as he described it. I commented that they must have been HT's from many years ago and he said 2 of the guys had them less than a year ago. A 28 year old and a 26 year old. The other patients were older and had the regular "doll head" look as he put it. He said that he could never cut any of their hair as short as mine was even before I went in today b/c those holes would show easily through. I was shocked about 2 things: a) this barber had never seen a strip scar, and b) there are doctors still performing mini's and micro's (I suspect). The patients had gone to local clinics, he said.

I have to ask: is this still an accepted method of HT? I guess I have gotten spoiled by all of the info I've seen on these forums over the past year. I feel very fortunate that I learned about follicular unit transplant before I dove in. I feel bad for the folks who are driven by the depression and embarrasment of going bald into a clinic that does not provide the best product available. I guess to that end, the article in the very popular GQ mag will hopefully prove to educate those who otherwise have no direction in HT. The barber felt genuinely bad for these young guys with their bad HT work. Now I do too.

This post really makes me mad (Not you, Hugh, I'm glad you wrote it). As a guy with those punch scars, I've got to tell you it really sucks. And the fact that there are better ways of doing transplants, that obviously aren't being used, sucks even worse.

Hair transplants have been done on a commercial level since the late 50s, with the punch graft method as the harvest technique. This creates the "shotgun blast" scarring in the donor area, as big plugs were punched out, and the holes were left open. The patient is sent home with open wounds in the donor area, that form big scars.

The strip excision didn't really start to get popular until the late 80s- early 90s, with the majority (over 50% = majority) of clinics adopting the strip harvest method around 1991 or 1992. However lots of clinics were slow to adapt the strip technique, and I've heard rumors of clinics who still use punch grafting, but usually these are in foriegn countries. So it bugs me to hear that clinics are still using this technique (You are in Michigan, correct?) It is totally unnacceptable in 2004.

As far as the Minigraft question, the term refers only to the graft size, not the harvest method. Punch graft ("open donor") harvesting can be used to create "standard plugs", or those plugs could be cut into smaller pieces
like Minigrafts.

If I remember correctly, it goes something like this:
Standard grafts ("full size plugs") = 4mm to 5mm (This is the size of a pencil eraser... huge!)

Minigrafts = 1.5 to 2 mm (I may be remembering this wrong, maybe someone can look it up)

Micrografts = less than 1.5 mm. Technically, a "FU" graft is a specially prepared type of Micrograft.

To answer your question, the majority of clinics use a "mixed graft" approach where they place Micrografts in the front hairline, and Minigrafts everywhere behind the hairline. However, that is not considered the best approach. Most clinics do use a donor strip, but do not use microscopes to create the all-FU transplant that most of us consider to be the Gold Standard. Even though mixed grafts are not considered the best, this approach is faster and easier for the clinic than doing an all FU transplant, so it is more profitable. It can be hard to transition from a mixed graft procedure to an all-FU procedure, as far as training the staff and ensuring quality results. Many clinics consider the mixed graft approach "good enough" and don't want to slow down their cash flow while they transition their approach to something new, slower and harder.

Some clinics use a coupled fu. It does not look natural on me. Remember, one fu per recipient site.