A Close-Up Look at Microscopes

We’ve recently read some interesting articles and advertisements on the use of microscopes in surgical hair transplant surgeries. We’ve found that there are surgeons who vehemently believe that microscopes are an advancement to the procedure, although there are no clinical studies to support this. Other surgeons have no use for them, finding them to cause more harm than good. And still others simply use them as a marketing tool – placing them in their lobby rather than in the back-office where they would be utilized.

We decided to take a closer look.

First, it’s important to understand the need for microscopic vision enhancement in a surgical hair transplant procedure. When the “donor strip” is removed from the back of the head, the tissue is placed in cold saline solution. The tissue is then cut into sections. Each section is then dissected even further, “harvesting” the individual follicular units in the skin. It is during this stage of the process that microscopic vision is beneficial, but since follicular units aren’t microscopic themselves – you can see them with the naked eye. An increase of 2x to 3x normal is more than sufficient.

The increased vision allows those dissecting the tissue to see the hair follicles closely. Using a surgical blade, the excess tissue surrounding each follicular unit is cut away, leaving only the individual follicular units and a small amount of surrounding tissue.

Most hair transplant practices throughout the world continue to utilize magnifying eyewear (“loops”) rather than microscopes. The reasoning is that the loops are significantly easier, faster and more efficient than using microscopes. Many surgeons believe that the use of microscopes actually jeopardizes the viability of follicles – due to the extended period of time the follicles are required to be out of the saline solution and ultimately the scalp, drying them out, as well as due to the increase in heat, generated by the microscope itself.

What about claims that microscopes can “reduce waste by up to 20%?”
Well, it’s important to understand exactly what is being claimed here before we gage its value. A 20% reduction in waste is not the same as a 20% increase in viable follicles. The 20%, in this case, refers only to the number of follicles either damaged during the harvesting stage (where the surgical blade actually cuts into the follicle itself) or found to be damaged due to natural causes when harvesting takes place. There are factors that play a part in this (quality of the hair and follicles, color and texture of the hair, hair density, expertise and training of the medical staff, etc.), but as with most things, certain averages do become evident when considering a variety of example cases, and “human error” (not visual aids) are the primary cause of damage.

Here’s what we’ve discovered...

Patients with finer, faint-colored hair tend to have a slightly higher percentage of loss and tissue waste. This is largely due to the fact that some follicles are almost invisible in the tissue – regardless of magnification. 10% to 15% of the follicles are also in a resting phase – the “telogen phase.” They are smaller, less viable, surrounded by fatty tissue, and the follicles themselves can be clear. They are more easily discovered through touch rather than sight. This is where an experienced, well-trained and caring medical professional is crucial.

We discovered that the follicles feel firm (like a small seed) and are more dense than the fatty tissue in between the follicular units. When a surgical blade comes near this denser matter, it moves slightly, avoiding the blade. It is a self-protecting response on the follicles’ part, and the result is that Mother Nature herself helps shield these less visible follicles from being cut by the blade.

What were the results… how much waste occurred during “harvesting” using a microscope and “harvesting” without using a microscope? The results were virtually the same in every case. Out of 100 viable grafts (follicular units) harvested an average of 5 follicles were deemed “non-viable” due to both damage resulting from the harvesting and natural causes. This gives us an average of 5% waste. (And for the record, 20% of 5 follicular units is 1 follicular unit.)

We also found that utilizing microscopes added, approximately, 25% to 30% more time to a procedure length, so the follicles have a greater chance of dehydration and death.

Conclusion? There is no difference. There is no measurable benefit or detriment to the choice of vision-enhancement. Microscopes or loops - it is purely a preference determined by the medical staff themselves.

As we’ve said all along, the only real decision one needs to make when considering surgical hair restoration is choosing the right doctor. Blades, microscopic techniques, anesthesia… they are all tools. It is the doctor behind the tools that matters… as well as the medical staff behind the doctor.

Dr. Randall Sword has helped more Southern California men and women recover from hair loss than any other practicing physician. Don’t compromise when it comes to your hair restoration. Insist on the best.

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