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Early in the history of hair transplantation large grafts were used. It was possible to create a natural-looking, undetectable transplant using large grafts but very few were done. It required careful planning beginning with the spacing of the first session and a minimum of four sessions followed up with one or two touch-up sessions after the hair had grown. Most patients ended up with what was called a “dolls head” look because the grafts in the first session were placed too far apart. Later the grafts became progressively smaller and were called minigrafts and micrografts. The final endpoint was follicular unit grafts, which are the natural groups of hair growing in the scalp and consist of 2 to 4 hairs. Grafts harvested by strip grafting are cut under the microscope. Technicians who are highly experienced rarely resect any hairs. Grafts removed by follicular unit extraction are blindly cut. The surgeon examines the angle which a group of hairs exit the scalp and guesses the angle under the skin.
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