Dr. Wolf’s Opinion on Microscope Dissection:
There is a relative paucity of objective studies in hair transplantation, but I do recall the studies done by Bob B. and Bill R. that showed increased graft numbers when using microscopes. Over the years as I increased the number of microscopes and power of magnification I noticed the number of grafts from a strip increased. A follicular unit cut without any magnification can look as good, identical, or even better than one cut with magnification. But that’s not the criteria which should be used, an increase in the number of preserved follicles is. What is being lost isn’t being seen because it can’t be seen without higher powers of magnification and it’s in the garbage. If one believes these studies and the experience of those who have seen the light, by not using higher powers of magnification one is committing follicular homicide. This is not in the best interest of the patient regardless of cost to the physician and patient in money and/or time. If the past one could argue that not using magnification didn’t really make a difference because we didn’t know. That is no longer true so there is no excuse in my opinion. There are ways to magnify without microscopes but I found increased grafts numbers going from loupes to 6X magnification and even more from 6X to 10X magnification. I refer to cutting slivers and the grafts from the slivers with magnification, either/or doesn’t count. No assistant has 6X eyes regardless of gender or ethnicity.
Concerning follicular unit terminology, there are those that are benefiting from the semantics of FU transplants without really doing them. A local competitor, ISHRS member, advertises that he does “follicular unit minigrafts” that average 5 to 7 hairs per graft. Of course all hair is made up of FUs as all things are made of atoms. To say you drive an “atomic car” would be theoretically correct because it is made of atoms. Semantically and with regard to accepted ideas one would assume that the car was powered using atomic energy. So calling your car “atomic” would be deceptive. In my view it is deceptive to say you use FUs if they are not separated from the FUs around them. A real FU to be used in hair transplant surgery takes an investment in time, skill, energy, and patience to create and it doesn’t exist semantically or for practical purposes unless it is separated from those FUs around it with levels of magnification needed to entirely see all the FUs that exist in a donor strip and sliver. Naming minigrafts by the numbers of FUs in them and implying that one is performing FU hair transplants is deceptive and wrong in my opinion unless every FU is seen and all the dissection is being done with higher powers of magnification. Simply counting how many FUs are in a graft doesn’t automatically make it FU surgery any more than me “saying” I drive an “atomic car” because the car is made of atoms.