Hair transplantation has evolved significantly over the past three decades. We are now able to improve the lives of so many people, not only patients with male pattern baldness and female androgenic alopecia. Many other conditions can be immensely helped with state-of-the-art hair transplantation, including scarring alopecia after facial rejuvenation surgery (loss of the temporal hairline and sideburn) and alopecia caused by trauma, burns, radiation therapy, and congenital defects. Still, we are unable to predictably clone hair follicles, so a prerequisite is to have a sufficient supply of donor hair, generally in the occipital and temporal areas. The most common types of alopecias that I treat in my practice include: (1) male pattern baldness and (2) scarring alopecia resulting from face-lift procedures.
This article focuses on my personal technique.
The key principles for a natural result in hair transplantation surgery include:
Small grafts. These include one to two follicular unit grafts at the front hairline, and two to three or four hair follicular unit grafts posterior to this.
Level of the hairline. There is no magic measurement. Craniofacial proportions vary from person to person. We must aim for the most aesthetically pleasant level (6 to 9 cm from the eyebrows) and plan for the long term.
Design. Slight irregularity is very important to mimic nature.
Density. We need sufficient density to blend naturally with the neighboring areas, generally a minimum of 70 to 100 hairs per square centimeter.
Direction of hair growth. This should be consistent with residual native hair, particularly at the boundaries of the affected areas. At the front hairline, the direction is usually anterior at about a 30-degree angle and with a slight left or right orientation (sometimes straight upward). On the sideburns and temporal areas, the optimal direction often is downward, sometimes with a diagonal posterior direction and occasionally almost a straight posterior direction.
Absence of detectable scarring. There should be no stigmata to indicate that a surgical procedure was performed. We can do this today without detectable scarring on the grafted area and with minimal scarring on the donor area. This is accomplished by using ultrafine blades such as 15- or 22.5-degree SharPoint blades as we transplant hair follicular units, performing a slight trichophytic closure of the donor site, and closing without tension.
Plastic Surgery Pulse News, Volume 4