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There are 3 main instances in which a graft warrants removal: When they are misplaced, when increased hair loss exposes them further, or when grafts are pitted/ prominent. In this presentation, we explore the removal techniques as well as the most common risks associated with each. Particular attention will be given to the Micro-incisional technique, and advanced technique for graft removal that decreases the chance of re-growth of hairs in the original removal site while also limiting the incidence of scarring.
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Micro Excisional Graft Removal
Paul T. Rose , MD JDBernie Nusbaum, MD
Conflict of Interest
None
Need for Graft Removal
Misplaced grafts Increased hair loss exposing grafts Pitted grafts/prominent grafts
Techniques for removal of grafts
En bloc excision Punch removal
Hand held punch or mechanized device
Problems with Graft Removal
Transection- inability to account for hair angles
Burying of graft Inability to remove due to
tethering/scarring
Use of a Punch
Micro-incisional Technique
Use of custom made blades Blades can be cut to size attached to
various blade holders Depth can be set The incisions are directed AWAY from the
hairs Three to four incisions are made-these
may need to be joined, triangular or square/rectangular wound
Micro-incisional technique
Graft is lifted with forceps – at times two are needed
The blade can be inserted into the space created to cut any fibrous strands
Wound is allowed to heal via second intention healing
Micro Incisional Technique
Micro Incisional Technique
Advantage of Micro-incisional technique
Decreased rate of transection- more hairs for location to other sites
Less chance of re-growth of hairs in at original graft removal site
Small wounds-limited scarring, second intention helaing
