How are the grafts inserted?

It has been stated that the standard of care for hair transplant surgery is that the assistants place the grafts. Dr. Keene goes above and beyond the standard of care by actively participating in graft placement. She places most of the grafts, along with her most experienced nurses. She does not leave this step in the hands of unsupervised technicians.

This stage of the procedure is just as important to the final outcome of surgery as the creation of the recipient sites. Here’s why:

First, graft survival is affected by a number of factors, including the manner in which the grafts are handled during the placing phases of the surgery. For example, a graft must be handled gently to avoid damage to the follicles.

Additionally, graft hydration is one of the most crucial factors in graft survival. No matter how carefully one dissects a graft, or creates a recipient site, if the graft is allowed to become dehydrated, it will often not survive. Close supervision insures that a graft is not left on a finger or hand until it has dried out.

Dr. Keene has invented a patent pending graft holder that maintains optimum graft hydration throughout the process of dissection and placement, and prevents the risk of graft dehydration during all phases of the surgery. During dissection, the grafts are stored directly in this apparatus, that is then mounted on the finger during graft placement, so grafts are never out of their hydrating solution.

In addition to maintaining optimal survival during placement, placing the graft according to its natural angle is important.

As demonstrated in the photo to the right, follicular unit graft hair has a natural angle. While the slant of the incision creates the angle of growth to some extent, the natural angle of the graft contributes. If it is not placed in the recipient site at the proper angle, it will appear less natural, and may be at odds with native or surrounding hair. This is not always discernable in a photograph, but can be seen when up close and in personal contact.

Another advantage to the doctor inserting grafts is that Dr. Keene varies her recipient site sizes to accommodate different graft sizes, and by placing with her assistants, she is able to direct her staff to insure that the appropriate graft sizes are placed in the appropriate recipient sites.

Finally, Dr. Keene places grafts while dissection is occurring, so she can tell if the patient’s donor area is producing too many one or two hair follicular units, and suggest that the staff perform follicular pairings to create more three or four haired grafts, where appropriate.

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