Factors Affecting the Growth and Survival of Follicular Grafts
Hair transplantation has come a long way, but one constant remains: the survival of follicular grafts is critical to a successful outcome. Transplanted hair follicles must survive the journey from donor site to recipient site, and multiple biological, technical, and procedural factors influence whether those grafts thrive—or fail.
A landmark review published in the Journal of Cutaneous and Aesthetic Surgeryry explores the key factors impacting graft growth and survival. In this post, we break down the science—and explain how the Advanced FUE® protocol at Advanced Hair ensures every graft has the best chance to grow strong, natural hair for life.
What Are Follicular Grafts?
A follicular graft is a unit of hair follicles extracted from the donor area—typically the back or sides of the scalp—and transplanted into thinning or balding areas. These grafts contain the genetic blueprint for healthy, DHT-resistant hair growth, but their survival depends on how they are handled, stored, and implanted.
Key Factors Affecting Graft Survival
1. Time Outside the Body ("Ischemia Time")
Once a graft is removed, it begins to lose viability. The longer it stays outside the body before implantation, the greater the chance of cellular damage. The study emphasizes that minimizing "out-of-body" time is essential for survival and growth.
2. Desiccation (Drying Out)
Hair follicles are delicate. Exposure to air—even briefly—can cause dehydration and damage. This is why constant hydration during extraction, storage, and placement is non-negotiable.
3. Storage Solutions and Temperature
Grafts stored in a cold, buffered saline or specialized solution (like HypoThermosol®) have significantly higher survival rates. The right temperature (4°C) helps preserve cellular metabolism and protects against stress.
4. Mechanical Trauma
Rough handling during extraction or placement can crush, transect, or damage follicles. Precision tools and a skilled hand are vital to preserving the graft’s integrity.
5. Oxygen Deprivation
Long exposure to low-oxygen environments contributes to graft stress. Some clinics now explore oxygen-rich or antioxidant-enriched storage mediums to improve outcomes.
6. Recipient Site Handling
Even after grafts are placed, their survival depends on how well the recipient area is prepared. Adequate spacing, minimal bleeding, and stable vascular supply help secure the graft and promote integration.
How Advanced Hair Maximizes Graft Survival
At Advanced Hair Restoration, our Advanced FUE® protocol was built around the science of graft viability. We don’t leave it to chance—we follow strict, research-backed protocols that ensure each follicular unit is protected at every step.
Here's how we do it:
Tightly Controlled Graft Hydration: Grafts are kept continuously moist using proprietary hydration methods from extraction to placement.
Minimal Ischemia Time: Our system is optimized to reduce time outside the body, moving seamlessly from harvest to implantation.
Temperature-Controlled Holding Solutions: Grafts are stored in chilled solutions that preserve cellular integrity and reduce oxidative stress.
A Highly Skilled Surgical Team: Our surgeons and technicians handle thousands of grafts daily with expert precision. Every movement is measured, every graft protected.
Artistic Recipient Site Creation: Our physicians create recipient sites with careful angling, spacing, and density—ensuring both survival and natural appearance.
Experience Makes the Difference
While tools and protocols are important, nothing replaces experience. At Advanced Hair, our physicians rank among the top 1% of hair restoration surgeons globally. That matters, because no matter how advanced the technique, the outcome is only as good as the hands that perform it.
Hair transplantation is as much art as it is science. Our team’s consistency, repetition, and attention to detail ensures your grafts don’t just survive—they thrive.
Summary
Follicular graft survival is the foundation of any successful hair transplant. The research is clear: factors like hydration, temperature, handling, and timing all matter. But equally important is the experience of the team and the discipline of the process.
At Advanced Hair, we’ve designed every aspect of our Advanced FUE® protocol to give your grafts the best chance to succeed—for natural, permanent results you can count on.