Graft

A graft is the transplantable piece of tissue containing one follicular unit — the working currency of hair restoration. Counts are quoted in grafts, surgical plans are built in grafts, prices are set per graft, and donor capacity is budgeted in grafts. One graft typically carries one to four hairs, which is precisely why the currency needs auditing: two identical graft counts can differ by a thousand hairs.

Physically, a graft is more than hair: it is the follicle in a sleeve of supporting tissue — perifollicular fat and connective tissue that protect it against drying and handling trauma. Teams describe grafts stripped too close as skeletonised; they dry faster and tolerate placement worse. Graft quality is therefore set at extraction and dissection, before implantation has any say, and it is judged under magnification, not by eye.

Between extraction and placement, a graft is a small piece of living tissue with no blood supply, and everything about good practice follows from that sentence: chilled holding solution, short out-of-body time, hydration at every step, minimal grasping, and placement that pushes on tissue rather than on the follicle. Each individual lapse is survivable; stacked lapses surface twelve months later as a thin result nobody can explain.

Operationally, grafts are counted and classified as they come off the field — singles, doubles, triples, with damaged or transected units logged honestly. That count is the session’s accounting: it reconciles the plan against what was actually harvested and placed, it feeds any survival audit later, and it is the number the patient paid for. A clinic that cannot show how it counts has told you something about every other number it quotes.

The per-graft economy also carries incentives worth naming. Pricing by graft rewards volume, and volume pressure is how donor areas get spent and units get split. The countermeasure is not a different pricing model so much as documentation — plans, counts and photographs that keep the currency honest.