Transection

Transection is damage to a follicle during extraction, where the punch cuts through it rather than freeing it intact. Transected grafts are still counted and frequently do not grow.

Where you'll meet it

Almost nowhere, which is the point. It happens during extraction, it is measured by checking extracted grafts for damage, and almost no clinic volunteers the number. You are most likely to see it on forums, in the context of a result that grew thinner than expected.

How does a follicle get transected?

In FUE, a punch under a millimetre across cuts a circle around each follicular unit and frees it from the surrounding tissue. The follicles run at an angle beneath the skin, often curving, and the operator cannot see them below the surface. They follow the angle by the direction of the hair above the skin, by feel and by experience. Get the angle or depth wrong and the punch slices through part or all of a follicle rather than around it.

Partial transection, where one hair of a three-hair unit is cut, is more common than complete transection. A partly damaged unit may still grow some hair. A badly damaged one often grows nothing.

Why does it matter?

Because a transected graft is still extracted, still counted, still sorted, still planted and still charged for, and it may simply not grow. You find out at twelve months, as a result thinner than the count suggested, and you cannot prove why. It also wastes donor supply: the follicle is gone from the back of your head and has not arrived anywhere useful.

What affects the rate?

Operator experience above everything. Also punch size and type, the depth setting on a motorised punch, how curly the hair is beneath the skin, how thick and firm the skin is, and how fast the team is working. Very curly hair, common in people of African descent, is especially hard to extract intact and needs a surgeon who does it regularly. A clinic running many cases a day has an incentive to work quickly, and speed costs grafts.

Is transection lower with FUT?

Usually. In FUT the strip is dissected under microscopes with the follicles visible, so units can be separated without cutting through them. Some transection still happens at the edges of the strip, but rates are typically lower. Good FUE clinics narrow the gap considerably, which is why the operator matters more than the method.

What should you ask?

What their transection rate is and how they measure it. Many surgeons check the first grafts of a session under magnification and adjust the punch until damage is low, then spot-check as they go. A surgeon who has a number and can describe how they arrived at it has been counting, which is itself the answer you want. A surgeon who says it does not happen in their clinic has not been counting.

Ask too what happens if growth falls short at twelve to eighteen months, and get it in writing. Graft and follicular unit explain what you are actually paying for.

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