Graft Survival Using the Pairing Technique: Implications for Placement and Clinical Applications

ABSTRACT

Introduction: The pairing technique in graft placement efficiently increases hair density by placing more coarse hairs per incision. However, there is limited to no information on the survival rate of the follicles.

Materials & Methods: We examined whether follicle survival was affected by implanting chubby grafts in pairs. Twenty 1-hair plus 1-hair paired grafts and 20 2-hair plus 1-hair paired grafts were transplanted into two 1cm² boxes in the mid-scalp region in one patient. Follicle survival rate was evaluated at 3, 4, 6, 8, 13, and 16 months. We then discussed the clinical application, including the appropriate contexts in which the pairing technique should be considered, and included three cases to demonstrate this.

Results: At 6, 8, 13, and 16 months, follicle survival rates were greater than 95%, excluding a number of extra hairs at one incision site. In practice, the pairing technique was performed safely by creating a proper incision site and effectively increasing the number of coarse hairs per incision.

Conclusion: With the pairing technique, we found that follicle survival remained unaffected even when two chubby grafts were transplanted in pairs at the same incision site. This approach can be particularly effective in areas where high hair density is required, such as partings or the frontal tuft of thinning hair, leading to more natural results. Additionally, we were able to transplant less optimal grafts, such as fine-hair grafts or completely transected grafts, together with coarse terminal hair grafts, especially during follicular unit transplantation (FUT). This enabled us to perform sophisticated surgeries without wasting donor tissue.