The Problem of Popping

I would very much apreciate it if you could explain what “Popping” is all about. As I understand it, it limits the amount of hair that can be successfully transplanted.

Popping is a technical term referring to a problem with placing grafts into the recipient sites in the balding area in a hair transplant. The grafts are placed and then do not stay in place, ‘popping’ out of the site. In the early days when we didn’t trim the grafts as closely and the recipient sites were larger, the bulk of the graft was so large relative to the surrounding tissue, that the graft would not be held in place. When the surgeon placed another graft next to the one that was only a couple of millimeters away, the ‘mass’ from the graft into this next site, pushed the last graft that was placed out of the wound. You can imagine a cascade effect, you place one graft and then another and the first pops out. Then you finally get both the first and second secured and place a third when the first two then pop out. That was the way it used to be.

Today things have changed. When we introduced the microscope in 1994, it was evident that smaller and more accurate dissection meant better results than dissection with other less powerful magnification tools. The grafts are smaller and can be more carefully dissected, so that the bulk of today’s follicular units is less than the old minigraft. The recipient sites are much smaller today, we use needles in the 0.8 – 1.0 mm range to make the sites. The results of the smaller site is that the ‘hole’ that is made tends to ‘hug’ the graft and the ‘bulk’ of the graft is of less consequence in the hands of an expert graft placer. Today the best surgeons have staff whose skills have built over years, allowing the grafts to be placed without disturbing the last graft placed. So, popping which was a major problem when we were getting the number of grafts from 500 up to 2000 in 1993, became less of a problem as we moved into the 3000-4000 grafts per session size.

To conclude, your question of popping is more of a historical question than a problem today. What is still relevant today, however, is that surgeons who use larger sites (greater than 1.2mm in size) to manage their grafts, are still practicing older techniques and popping (which is not a problem for us) still remains one for those less skilled in the art of today’s techniques.