To meet the demand for natural-looking hairlines, doctors began decreasing the size of grafts in the 1980s. Smaller grafts had the advantage of being less visible during the transition period after transplantation and before the hair had grown in. Large grafts placed in a frontal hairline look pluggy and unnatural when the hair was combed back or to the side. The patient in this situation was forced to comb his hair forward and down to hide his hairline. When large grafts are placed behind the hairline or in the crown, they tend to look like intermittent clumps of hair and are very difficult to disguise.

The amount of time and work needed to place a large number of tiny grafts is much greater than the time and work needed to place a smaller number of larger grafts. Smaller grafts also produce a thinner (but more natural) appearance. If the restoration process is stopped before completion, the patient will still look natural. Larger grafts tend to obligate the patient to complete multiple sessions in the quest for natural-looking results and the patient's appearance can be strikingly unnatural before the work is completed. Even with additional work, the large graft transplants often fail to appear natural because they are intrinsically clumpy. On close inspection, it is literally impossible for large graft transplants to look and feel natural, even after the best work.

Patients should discuss the size of the grafts and the planned distribution of the grafts in detail with their surgeons. Some surgeons use larger grafts for the bulk of the work and then use smaller grafts in an attempt to hide the larger grafts. Others only transplant small grafts. Some hair transplant surgeons invent unusual terms for grafts in an attempt to make it appear that they have some special, unique knowledge or technique. These terms are intended to imply special variations in graft sizes or an invisible appearance of the grafts. Do not be confused by arcane terminology. The potential patient should be wary when a doctor claims to have a unique technology or technique that no other doctor knows about or uses, unless it is documented and published in a peer-reviewed medical journal.