The most common problems with mini and micrograft hair transplant surgeries are wide donor scars, pluggy results due to inexperience or lack of ability, and incorrect angles and directions of growth. Micro and minigraft surgery also ushered in the problems associated with recipient site creation. During the age of the plug surgery recipient site creation involved making a 4mm hole to place the plug graft. With the more refined mini and micro graft procedures smaller incisions had to be made with needles and this is where depth control, density and angulation had to be understood, but rarely was. Problems associated with recipient site creation are:
1. Pitting – This is caused by incisions made to a depth that allows the graft to be placed too deep. The resulting wound will close up and the scar forms a divot like those seen on golf balls.
2. Cobblestoning. This is scarring produced by making incisions that cause too much damage to the skin. This can include too many incisions in one area, incisions that are too big, or both. The result are small bumps throughout the recipient zone.
3. Tenting – This is similar to cobblestoning but the bumps are smaller and are at the base of each follicle as it exits the scalp.
4. Ridging – This is scarring that occurs due to larger grafts being placed too close together for higher densities. The excessive skin tissue that is left at the base of each graft is absorbed into the recipient tissue but not completely. The result is a ridge of scar tissue along the hairline (where attempts at higher densities are made) that resembles a “ridge”.
All of these problems can be repaired with camouflage, extraction and reconstruction, laser resurfacing, corticosteroid injections, or a combination of these treatments. All will work to varying degrees but it also depends on characteristics specific to each case and each patient.
Aside from the problems listed above there is also the problem of donor scarring. During the earlier days of mini and micro graft surgeries the issue of donor scarring was not considered like it is today. This could be due to the hairstyles of the era but the attention that strip surgery received in the industry was due to the increased naturalness of results and the donor scarring was considered to be a logical trade off. Of course, in the earlier days of strip surgery, the level of expertise with regards to donor wound closure was also low so some of the earlier problems can be from lack of experience.