Hair Restoration Techniques

MOSAIC® HAIR RESTORATION : A Paradigm Shift in Hair Transplant Surgery

Hair restoration surgeons generally design the recipient area in predetermined zones each composed entirely of one, two or three hair follicular units. Assuming the ultimate goal of a transplant procedure is to achieve the most natural appearing results; it is contradictory that the procedure is carried out in this manner since, in nature, follicular units of different hair numbers are not confined to zones in the human scalp. In fact, we have observed that follicular units naturally occur in an arrangement consisting of unique percentages of one, two, and three hair follicular units in different mixed configurations with unique inter-follicular distances –in other words: a unique pattern for each individual. Our novel procedure consists of designing the recipient area in this individualized manner, different for each patient, mimicking their unique follicular unit arrangement pattern and have termed this the “Mosaic® Hair Restoration.”

In practice, our surgeons obtain several magnified images of the patient’s scalp in areas unaffected by the balding process. We analyze the images to tabulate the percentages of one, two or three hair follicular units and determine their topographical arrangement unique for that patient. This data is then used for creating a personalized, most natural, design for implantation of the recipient zone.

In addition to the Mosaic® Hair Restoration procedure, we offer two additional types of hair transplant replacement procedures, one termed Follicular Isolation Technique (FIT) (aka FUE) and the other Follicular Unit Grafting (FUG or FUT).

What are Follicular Units?

The hair in every person’s scalp grows in tiny groups called Follicular Units. Although scientists have recognized this for some time, physicians performing hair restoration surgery largely ignored their existence. The Follicular Unit of the adult human scalp consists of 1-4 terminal (full thickness) hair follicles.

The Follicular Unit is very small and can only be identified under magnification. The instrument commonly used to measure these naturally occurring groups is called a Densitometer. It is a simple tool that is placed on a small area of scalp whose hair has been clipped closed to the skin surface. Its use should be an integral part of your hair loss evaluation. Follicular Units are best viewed under a microscope, where they are seen as well-formed structures in the skin.

Follicular Isolation Technique

Follicular Isolation Technique, referred to as FIT, is a technique co-developed by Dr. Rose. The procedure involves removing the naturally occurring groupings of hair (follicular units) one by one. With a FIT procedure, the donor hairs are isolated and removed with a one millimeter punch device which is often utilized with a specially constructed head positioning device co-developed by Dr. Rose.

The advantages of this technique include maintaining the donor area without any linear scar visible to the naked eye. In fact the donor area appears to heal faster than with traditional methods and the patient can wear his or her hair as short as desired, but not completely shaven without being concerned about a linear scar.

The technique is especially useful for young men who want to have a procedure, do not require large numbers of grafts,and wish to wear their hair very short.

In addition, the patients who have a limited donor area can also benefit from this procedure. Many patients who have been extensively harvested are not good candidates for further  strip harvesting. For these patients, grafts that would otherwise be unavailable may be obtained in significant numbers. In most cases, sessions of 600-800 grafts can be accomplished quite readily in a single day.

How is Follicular Unit Grafting performed?

FUG or FUT : The key to Follicular Unit Grafting is to transfer intact Follicular Units from the permanent donor zone in the back of the scalp to the recipient (balding) areas. In order to remove Follicular Units from the back of the scalp with minimal damage , the donor tissue must be removed in one piece. This technique is called “Single Strip Harvesting.” It is an essential component of Follicular Unit Grafting as it not only preserves the follicular units, but also it prevents damage (transection) to the individual hair follicles and insures maximum growth.

LEDGE Closure Technique

The LEDGE closure technique is another evolutionary achievement in modern day hair replacement technology developed by Dr. Rose. The LEDGE closure is a virtually non-scarring technique for minimizing the visibility of donor strip sites used in Follicular Unit Grafting (FUG or FUT). Dr. Rose has presented this technique to hair restoration surgeons worldwide.

The closure is performed with minimal, or no tension with a single layer closure (instead of a two layer). Dr. Rose has stated “I think that more and more physicians are going to a single layer closure and a two layer closure is not “the norm”. A single layer closure causes less trauma to the tissue and I feel that there is less pain and less scar tissue produced.”

The end result for the patient is that the technique allows hair to grow through the donor-area scar, providing added camouflage, and patients who have undergone the procedure are able to cut the hair over the donor area quite close. You can look at the results for yourself:

We have been using the LEDGE technique for several years, when appropriate for the patient, and have had very encouraging results.

Microscopic Dissection

The second essential component of Follicular Unit Grafting is “Microscopic Dissection.” In this step, the donor tissue (obtained with single-strip harvesting) is carefully subdivided into individual, naturally occurring Follicular Units under the careful control of a Dissecting Stereo-microscope. In the process, the non-hair bearing (bald) skin surrounding each Follicular Unit is carefully removed producing a tiny, compact graft, while avoiding damage to the hair follicles.

Complete stereo-microscopic dissection has been shown to produce an increased yield of both the absolute number of follicular units, as well as the total amount of hair, in upward of 25% when compared to other non-microscope techniques.

A major advantage of Follicular Unit Grafting (besides preserving follicular units and maximizing growth) is the ability to use small recipient sites. Grafts comprised of individual follicular units are small because Follicular Units are themselves small, but also because the surrounding non-hair bearing tissue is removed under the microscope and doesn’t need to be transplanted. Follicular Unit grafts can be inserted into tiny sites in the recipient area, which heal in just a few days, without leaving any marks.

The very small sites permit many follicular unit grafts to be safely transplanted in a single procedure allowing the entire hair restoration process to be completed as quickly as possible. When performed by a skilled surgical team, Follicular Unit Transplantation can provide a totally natural looking result in one or two sessions.

The Downside of Minigrafing

Critics of this technique (Minigrafing – where a donor “Strip” is not used) point out that achieving maximum density at the expense of naturalness is not a desirable goal and feel that the same density can be better achieved by newer techniques. The major concerns with mini-micro grafting are that damage to the hair follicles caused by the multi-bladed knife will impair full hair growth. The lack of preservation of the natural hair groupings in the scalp (called follicular units) will produce less than natural results, and the larger wounds needed for mini-grafts take longer to heal and may result in permanent changes in the surface of the scalp.

In mini-micro grafting, neither preserving follicular units nor even keeping hair follicles intact are felt to be particularly important. Rather, the speed and economics of the procedure are the driving factors.

The Natural Hairline

Our doctors are specialist in creating natural hairlines and have written ground-breaking papers for peer reviewed journals on the subject for both men and women.


MIAMI OFFICE: Offices of Merrick Park • 4425 Ponce de Leon Boulevard, Suite 230 • Coral Gables, FL 33146
Toll-Free 877.443.9070 • Phone 305.448.9100 • Email drnusbaum@miamihair.comwww.MiamiHair.com