How should I call it? Hair transplant or follicular unit extraction

When we talk about hair restoration surgery, both hair transplant and hair micrograft refer to the exact same technique. Therefore, either name would be correct. Both are used to refer to the specific surgical technique used to "place hair" where it no longer grows naturally. As you will see, both names were adopted because they describe the surgical techniques and the advancements that have occurred.

Why hair transplant?

Many people wonder why hair can be moved from one place to another, and it is precisely this action that has led to it being called a transplant. Hair is a dynamic structure created by the hair follicle, a compact structure where all the stem cells are located, but independently for each hair. Throughout life, these stem cells act as a reservoir that will continue to create hair and make it grow. These cells can be transported to a new location, where, after a recovery period, they will begin to create new hairs. That is why it is important to understand that we are not extracting isolated hair, as would happen with tweezers, but rather extracting the entire "organ" responsible for generating the hair. I believe it is better understood with an example: it is as if we were transplanting a kidney, but instead of from one person to another, from one part of the body to another where it is needed. That explains very well why it is called a "hair transplant."

And why hair micrograft as a synonym?

The use of the term hair micrograft is due to the combination of two concepts: one is the surgical technique used, and the other is the history of the technique. In surgery, any surgery, a graft is body tissue that is completely removed and separated from the body to then be used in another area. Skin grafts are used to cover wounds that are too large, or bone grafts are used to reconstruct bone fractures, for example. Grafts are very useful, but they also require meticulous surgical technique because they are fragile. When separated from the original or donor area, they do not receive nutrition from the blood vessels to which they were attached. That is why extreme caution is required to keep them in ideal conditions until we relocate them to their "final destination," where they will gradually "reconnect" with the new blood vessels. When this happens, it is said that the graft has "taken," meaning it has attached to the new connections, adapted to life in the new location, and its cells will begin to grow again. In the case of a hair micrograft, its cells will generate hair again.

The second concept explains why we speak of micrografts and not simply grafts, and this is understood when we review the history of hair transplantation (briefly, don't worry!)

In its early days, and because of what I told you about grafts being fragile structures, large "pieces" of skin with hair were taken from one area of the scalp to be placed in another, usually the frontal area, which is the most lost and the most important from an aesthetic point of view. These large grafts (or macrografts due to their size) had to be placed separately so that the new blood vessels could attach to them and begin to grow. This made the results of these transplants scarcely natural, and it is known as "doll's hair transplant." With the evolution of transplantation and its technical improvement, these macrografts were gradually reduced in size until they became microscopic. Current grafts are visible to the naked eye, but to work with them (and not go blind in the attempt), it is necessary to use special microscopic magnifying glasses. The great benefit of using micrografts is that the result can be 100% natural, as it is equivalent to transplanting hair by hair.

As you have seen, in hair restoration, the goal is to achieve the most natural results possible so that the person regains the appearance they lost due to alopecia. The technique used can be called hair transplant (because we are moving hair from one location to another) or hair micrograft (by using microscopic skin grafts with hair). Whatever it is called, as it is a meticulous surgery, it should always be performed by expert hands to achieve optimal results.

References:

Rose PT. Advances in Hair Restoration. Dermatol Clin. 2018;36(1):57–62. doi:10.1016/j.det.2017.09.008

Rogers NE. Hair transplantation update. Semin Cutan Med Surg. 2015;34(2):89–94. doi:10.12788/j.sder.2015.0131

Bicknell LM, Kash N, Kavouspour C, Rashid RM. Follicular unit extraction hair transplant harvest: a review of current recommendations and future considerations. Dermatol Online J. 2014;20(3):doj_21754. Published 2014 Mar 17.