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This question, asked by a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

In my research, I have noticed that the hair restoration physicians who perform sagittal incisions do sessions averaging about 2500 grafts and then want you to come in later for further surgeries. Those who do lateral slit incisions average about 4,500 grafts in only one hair transplant surgery. What is everybody’s preference? Has anyone done both?

Both the sagittal and coronal slit have their place in hair transplantation. I often use combinations and have done very large cases using both methods. It should really depend on the individual factors of the case including, but not limited to, the type of hair the patient has, existing hair that the doctor needs to avoid damaging and the number of grafts per sq cm being placed.

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David (TakingThePlunge) Forum Co-Moderator and Editorial Assistant for the Hair Restoration Forum and Social Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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Coalition hair restoration surgeon Dr. William Lindsey recently discussed the importance of utilizing single hair follicular unit grafts (grafts comprised of one, singular hair) in hairlines during hair transplant surgery. According to Dr. Lindsey:

We try to pack the hairline with single grafts, back about 1/4 to 3/8 of an inch and then we move to double follicular unit grafts (comprised of two haired units). Only much further into the midscalp do we use three hair grafts.

Remember, hair transplantation does not cure patients of baldness, it provides hair loss sufferers coverage of bald scalp. The key in hairline restoration, specifically, is creating a look that is dense and yet natural. The best way to create this natural, appropriate appearance is to utilize single grafts exclusively.

When seeking “bulk” in the midscalp and vertex, using two and three hair units spread slightly further apart is appropriate and creates a natural appearance.

Dr. William Lindsey
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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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Technorati Tags: hair restoration, hair transplant surgery, hairline, single grafts, hair transplantation, hair loss, hairline restoration

In the hands of a skilled and experienced hair restoration physician, today’s ultra-refined follicular unit hair transplants can produce thick, natural looking results. However, many factors can affect the appearance of fullness. Among these factors include scalp and hair characteristics. In fact, the relationship between the hair and scalp are a key element in hair transplant surgery.

While a hair transplant surgeon’s artful placement of follicular unit grafts can enhance the look of transplanted hair leading to a thicker and fuller appearance, the following characteristics play an important role in creating a desirable result:

• The Number of Grafts: This number depends on the hair transplant patient’s available donor hair density and scalp elasticity.   The larger the numbers, the fuller and thicker the result will appear.

• Hair Shaft Diameter: Thicker hairs can lead to an aided appearance of fullness.

• Hair/Scalp Color Ratio: Patients with a lower hair to scalp contrast ratio typically experience a thicker looking appearing result than those with a high hair to scalp contrast ratio, even if all other variables are the same.   However, this additional appearance of fullness is just an illusion.

• Degree of Hair Loss:  The more hair loss a patient has, a greater number of grafts will be necessary to achieve the same results as someone with lesser degrees of balding.

To read more about this topic and contribute your thoughts and experience, join the discussion thread, What is the Best Type of Hair for Hair Transplant Surgery started by Hair Restoration Forum member “Newhairplease”.

The following article, written by Coalition hair transplant surgeon Dr. Victor Hasson, was posted on our Hair Restoration Social Community and Discussion Forums.

Frequently, patients ask us about styling options after the hair grows in from their hair transplant. Will they be able to style their hair in any fashion or will they be forced to style it in a particular way to maintain coverage and naturalness?

In general, if the transplanted hair is directed correctly, the styling options will increase with higher transplant densities. At low density it is important to comb the hair in a particular direction to maintain the hair shingling effect to bridge over balding scalp until the hairs reach the next follicular unit (FU) at which point the hairs from that next FU will take over the coverage function. In addition, lower densities will require longer length hair for coverage. However, there is a point where the hair can be too long, thus making the hair appear to give less coverage. Each patient is different so it is up to the individual to find the best length to maximize coverage given their degree of hair loss and coverage..

If an individual intends to part their hair through a transplanted area that was previously bald the transplanted hair density required rises dramatically. The shingling effect is largely negated here and what becomes impacted is the distance between transplanted FU’s. Generally, for a part to look natural, transplanted densities of 50 FU per cm2 and up are necessary. Obviously the hair characteristics such as shaft diameter, color and curl will come into play as well.

It’s no secret that hair transplant surgery is a complex procedure requiring the skills of an experienced physician and the clockwork precision of a highly trained staff. Within the realm of surgical hair restoration, there lie many lingering debates regarding technique; FUE vs. FUT, sutures vs. staples, shaving the head vs. not shaving, just to name a few. But, perhaps one of the most misunderstood of these techniques is the method used to make the incisions for placing the follicular unit grafts.

The two most common slit-making techniques are parallel (sagital) and perpendicular (lateral/coronal).   By definition, sagital incisions run parallel (vertical) alongside and in-between existing hairs while the lateral incisions bisect existing hairs perpendicular (horizontal) like a T.   Learn more about parallel versus perpendicular incisions by visiting “Hair Transplant Photos – Parallel (Sagital) versus Perpendicular (Lateral/Coronal) Incisions“.

But, what does that mean to the prospective hair transplant patient? Is one technique always better than the other? Are both techniques ever used in the same procedure?

For the answers to these questions, visit the discussion topic, Does the Lateral Slit Technique Provide Better Yield than Sagital Technique?, started by Hair Loss Forum member “j1j9j85″. You are encouraged to provide your input to this important topic.

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David – aka TakingThePlunge
Assistant Publisher and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

The following thorough response to this thread from the Hair Restoration Social Community and Discussion Forums, was written by forum member “weweregods.”

Several factors figure in to how dense a physician might pack an area receiving hair transplantation:

1) Hair characteristics – If the hair diameter is large, course, and of a wavy texture, the hair transplant physician won’t need to pack the area as densely because these characteristics help with the illusion of density.

2) Density of the donor – If the donor area is dense, then there will be more follicular unit grafts to use for transplanting, which may factor into the decision to pack denser. Not everyone has 90 grafts/sq cm. Some may have much more and some much less.

3) Density of natural, non-miniaturizing hair – If the doctor transplants denser than the surrounding hair then the transplant will look strange. Ideally, the physician wants to create an illusion that will blend the natural and the transplanted hair in a smooth way.

4) Scalp laxity – The laxity of the scalp also factors into how dense the transplanted area will be as it may limit how many grafts may be taken from the donor area.

5) Positioning of the hair – Some doctors can transplant the hairs so that they grow parallel to the scalp and may, for instance, design a hairline that appears denser because it grows very near the scalp.

This question, which was answered by Coalition Surgeon Dr. Cam Simmons, was asked by a member of our Hair Restoration Social Community and Discussion Forums:

Is the reason why most people don’t have their temple points addressed by hair restoration surgery because it’s the hardest area to make “natural looking?” I have yet to see good, not great, but good temple point work done. Today’s hair transplant doctors have mastered the best techniques on the top of the head. Hopefully they will start spending more time on the sides.

You are right. Temporal points are one of the more challenging areas to transplant. The angle and direction of the hair are critical. The very flat angles required means we can’t put the grafts as close together as we could on the top. The transplanted hair is directed away from the incision so the bases of the follicular unit grafts near the incisions are visible whereas, in the front, you see the tips of the hairs first. Even if you brush the frontal hair back, you see the bend in the hair and not the base.

Larger grafts can stand out like a sore thumb in the temples so we will not get as much density when we are using 1s and 2s. I think most hair transplant doctors would rather achieve the look of thinning, natural-looking temporal points than having denser, less natural-looking temporal points. Subtle temporal points can make a difference even if they aren’t dense.

In a recent hair restoration discussion thread, the question of using lateral versus sagittal (vertical) slit technique in hair transplant surgery was discussed. Slits simply refer to the incisions made in the balding scalp by the hair transplant surgeon. These sites are the future recipients of the transplanted follicular unit grafts, and can be made in two opposing directions: lateral (running horizontally, or from “ear-to-ear”) or sagittal (running vertically). Although both methods are technically acceptable, hair restoration physicians utilize different incision styles and many actually use a combination of both types in different parts of the scalp.

Recommended hair transplant surgeon Dr. Parsa Mohebi, for example, states he uses saggital incisions in the hairline and only implants singular follicular unit grafts into these recipient sites. Dr. Mohebi explains that these types of incisions minimize trauma to small dermal blood vessels in the front of the scalp; he utilizes lateral incisions in the remainder of the scalp to increase the appearance of density. Many other hair restoration physicians utilize a similar model and agree that saggital incisions are useful in the hairline, but lateral incisions should be used throughout the rest of the transplanted scalp. Other surgeons utilize lateral incisions over the entirety of the balding scalp and believe it creates greater density.

Since differing, acceptable methods exist, incision sites is a topic that breeds healthy debate in the hair restoration community, and the hair restoration discussion topic does lateral slit technique provide better yield than saggital slit techinque? is proof of its relevancy. Do you have opinions on whether lateral or saggital slit technique results in less trauma, greater density, or improved yields? If so, please visit the discussion topic and share your thoughts!

This insightful article was written by  Dr. Michael Meshkin  of Newport Beach, CA who is one of our recommended hair restoration physicians.

Some consider hair to be the most aesthetic part of the face. As such, baldness can dominate one’s appearance, drawing attention from a beautiful face. The hairline is where your scalp hair borders your forehead and frames your face, thereby bringing out the beauty and richness of one’s features. When the hairline starts to recede, one’s facial features also recede into the background. A primary reason for seeking hair restoration is to restore your appearance to the condition before hair loss. One of the more critical decisions in hair restoration is determining where your new hairline should be, which should carefully be discussed with your physician. The physician should follow several cosmetic rules to design the hairline.   The doctor should place the hairline in correct position. The doctor should use all of the cosmetic guidelines, rules and tools available for creating the hairline such as the following:

• Rule of thirds- dividing the face in three equal proportions(described by Leonardo De Vinci)
• Measuring more than 8 cm from the mid-glabellar point
• Hairline not lower than the original hairline before hair loss  began
• Customize the correct shape of hairline individually such as:   widows peak, and correct flaring
• Creating different shapes of forelock for people with limited donor area
• Irregular soft and subtle hairline

Reconstructing a natural looking hairline is one of the most important facets of surgical hair restoration. What good would a thick head of hair do with an unsightly and abnormal looking hairline?

World class hair transplant surgeons take special care to establish suitable hairline placement and position to assure a proper and natural framing of the face. Single haired follicular units (groups of hairs as they occur naturally in the scalp) are carefully placed and angled correctly into tiny incisions to most accurately mimic nature.

Determining a suitable hairline placement depends on a physician’s artistry and patient’s characteristics. Whereas most hair loss sufferers would love to re-obtain their youthful looking hairline, it’s not always in the patient’s best interest.

Recently, forum member “Pharma” shares his desire for a youthful looking hairline with our community. To learn when recreating a youthful looking hairline is and isn’t appropriate and to contribute your input, visit the discussion thread “Youthful Hairline“.

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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Technorati Tags: natural looking hairline, hair restoration, follicular units, hair loss, Bill Seemiller