How are Different Sized Follicular Unit Grafts (FUGs) Used in Hair Transplant Surgery?

This question comes from a member of our hair loss social community and discussion forums: 

I recently underwent a hair transplant surgery consultation, and the doctor mentioned using different sized follicular unit grafts (FUG) in different areas of the scalp. However, I’m still confused and I don’t understand the concept of follicular unit graft sizes and how these would be used in hair transplant surgery?

Scalp hair naturally grows in “bundles” of hair follicles called “follicular units.” These units either consist of a single follicle, two follicles, three follicles, four follicles, and rarely five follicles. In modern hair transplant surgery, only follicular units are extracted and implanted into balding areas. This is why the term “FUT” stands for “Follicular Unit Hair Transplant Surgery.” Follicular Unit Hair Transplant Surgery can be performed one of two ways: either via Follicular Unit Strip Surgery (FUSS) or via Follicular Unit Extraction (FUE). 

When these follicular units are extracted during an FUSS or FUE procedure, they become “follicular unit grafts” (FUG). The FUGs are defined by the size of the follicular unit, i.e. single follicle, double follicle, triple follicle, or quadruple follicle. This is where the term “single graft,” “double graft,” et cetera, comes from. 

Each of these grafts must be placed in a specific region of the scalp to create a natural appearance. The first few millimeters of the frontal hairline – also known as the microhairline – must be filled with single unit grafts. If anything larger is used, the feathered transition zone is ruined and the frontal hairline will have a “pluggy appearance.” Next comes the macro hairline, which is created by naturally transitioning from single follicular unit grafts to double and triple unit grafts. From this point onward, a series of double, triple, and quadruple grafts may be used to recreate natural density in the posterior frontal scalp, midscalp, and vertex. In these areas, larger follicular units (triple and quadruple grafts) are often used to cover a larger area of scalp and offer the greatest amount of coverage with the fewest number of grafts – the biggest “bang for your buck,” if you will. 
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Blake Bloxham – formerly “Future_HT_Doc”

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