This article was submitted to us for publishing and was partially written by Dr. Carlos Wesley, who is recommended on the Hair Transplant Network. For a complete list of contributors to this article, scroll down to the bottom of this article.

Hair Transplantation Procedures

Overview

Background

Hair transplantation procedures are used to treat various forms and degrees of permanent alopecia in both men and women. Intact hair follicles may be harvested from within the safe donor area of a patient’s scalp by either strip method or follicular unit extraction (FUE); each harvesting method has unique advantages and disadvantages. The refinement of follicular unit transplanting over the last decade has led to markedly improved hair survival and natural-appearing results.

This article provides a broad overview of the techniques used by various hair transplant surgeons throughout the world. Founded on the principal of donor dominance (ie, hair follicles continue to grow in the new recipient area to which they are introduced as long as they would have in the donor area from which they are extracted), the field of hair restoration surgery (HRS) has evolved considerably since its inception in the 1950s. Natural-appearing results are consistently achievable and reflect a surgeon’s technical skill and artistic creativity.

Indications

Hair transplantation is a surgical procedure used for the correction of androgenic alopecia (AGA), cicatricial (scarring) alopecia, or any form of permanent hair loss in both men and women.^[1,2]

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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In this video, Dr. Herbert Feinberg compares the old hair plugs of the past to today’s state of the art follicular unit hair restoration surgery. Dr. Feinberg removes the donor tissue using a single blade to minimize any transection of the follicles. His experienced staff then use microscopes to carefully trim the donor tissue into naturally occurring 1 2, 3, and 4 hair follicular unit grafts.

Dr. Feinberg is recommended by the Hair Transplant Network. For more information on Dr. Feinberg and his technique, visit his profile here.

To see all of our hair transplant videos, visit our Hair Transplant Video Channel on YouTube

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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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Technorati Tags: Dr. Herbert Feinberg, follicular unit, hair restoration, Hair Transplant Network, hair transplant videos, Hair Transplant, YouTube

Dr. Robert Bernstein of New York, New York, discusses the history and evolution of hair transplantation to today’s state of the art hair restoration procedures.

Dr. Bernstein is a member of the esteemed Coalition of Independent Hair Restoration Physicians and is recommended by the Hair Transplant Network. To learn about our criteria for recommending physicians, click here.

To see all of our hair transplant videos, visit our Hair Transplant Video Channel on YouTube.

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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Technorati Tags: Dr. Robert Bernstein, hair transplantation, hair restoration, Coalition of Independent Hair Restoration Physicians, Hair Transplant Network, hair transplant videos, Hair Transplant, YouTube

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:

After doing some research on hair restoration surgery, it seems like almost all hair transplant surgeons recommend that only single hair follicular unit grafts are used in the newly constructed hairline. However, I’m curious, is it ever appropriate to utilize multiple hair follicular unit grafts (2-3 hairs) in the hairline during a hair transplant procedure?

I would say that one of the main points of “Hair Tranplants 101″ is to always use single hairs/follicular units to create the hairline.

Although multiple hair grafts in patients with white, light grey, or blonde hair might not be as noticeable compared to patients with darker hair, it’s still not recommended for any hair restoration patient.

In fact, I have successfully removed multi-haired grafts in the hairline many times over the years.

Dr. Glenn Charles

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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

Follow our community on Twitter

Watch hair transplant videos on YouTube

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Technorati Tags: Hair Loss, hair transplant surgeon, hair restoration surgery, hair transplant, single hair follicular unit grafts, multiple hair follicular unit grafts, hair transplant procedure, multiple hair grafts, hair restoration patient

This hair loss question was posted directly to Dr. Raymond Konior of Chicago, IL,  who is a member of the Coalition of Independent Hair Restoration Physicians.   See his professional answer below.

At what age and degree of hair loss is it appropriate to transplant a patient’s crown?

The crown has been described as the “black hole” of the scalp. Based on that, I believe a very large percentage of patients seeking hair restoration should avoid grafting into the crown region, especially young men in whom it is often impossible to determine how far the pattern will progress. This recommendation is based on the finite nature of donor supply and on the progressive nature of male pattern balding, i.e. there is an imbalance between supply and demand. The fact of the matter, however, is that despite prolonged and detailed consultative discussion relating to the risks and limitations of grafting the crown, many men are still adamant about obtaining some crown coverage. Although it is difficult to predict with absolute certainty everyone who is a rock solid candidate, it is possible to weed out the majority of poor candidates and to institute a safe grafting strategy which will avoid future problems for most patients

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”.

Balding men and women who underwent surgical hair restoration in the early years, prior to the advancement of follicular unit transplantation (FUT) and follicular unit extraction (FUE), were often left with unnatural and unsightly “hair plugs“. These larger grafts created an effect much like that of doll’s hair. Today, many of these patients are seeking to revise or even remove these older grafts completely.   Below, recommended hair transplant surgeon  Dr. Michael Beehner discusses the process of removing plugs:

One thing to bear in mind is that, regardless of what size punch you use in cutting these old hair transplant grafts out, with a single pass procedure there will always be some hairs that don’t get removed and still grow. Therefore, it always requires a second smaller pass, usually with a smaller punch, to get complete eradication of the hairs.

The patient below has very fair Irish/English scalp skin and the redness you see will most certainly be better at the one year point. However, I think, cosmetically, it will look best with some dermabrasion or laser resurfacing to give it an “even”, homogeneous look, which is what he is after.

Mike Beehner, M.D.

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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

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

I have mini-grafts at my hairline from a hair transplant 10 years ago. You would probably not be able to tell unless you were staring at them from a few inches away. If there was one place they were visible, it’d be right at the root which is unnaturally thick. Natural hair at the hairline is typically very soft and light. So, I’m wondering if anyone has tried lightening the root of those hair shafts right at the hairline to lessen the appearance of transplants?

Since dying or lightening your hair isn’t permanent and doesn’t typically result in significant damage to the follicle, it is worth a try and may make the hairline a little less noticeable.

You may also want to consider hair restoration surgery to remove and redistribute part of the mini grafts. Another option is placing some additional follicular unit grafts around and in between the mini grafts to help camouflage them. These techniques have been used quite successfully to enhance the appearance of older, mini-graft procedures.

Dr. Glenn Charles

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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

Get Proven Hair Loss Treatments at the Best Prices by visiting our new Online Hair Loss Product Store

This concern comes from a member of our Hair Restoration Social Community and Discussion Forums:

I underwent follicular unit transplantation (FUT) several years ago and was not pleased with the results. After the procedure, I found out that the hair transplant surgeon and staff split, or cut, the follicular units down to a smaller size before implanting into the balding scalp. What does this mean? Should hair restoration surgeons practice “graft splitting ?” Could this have caused the sub-par results?

From what I can tell, many hair restoration clinics do participate in this practice. However, I don’t believe splitting grafts is inherently unethical, nor do I believe it creates a sub-par result if performed properly.

It seems as if practices split follicular unit grafts when they need smaller, 1-2 (or singular) hair units for refined areas of the scalp, like the hairline. The controversy surrounding graft splitting arises when clinics allegedly split grafts simply to charge patients more money (based upon a pay-per-graft type scale). However, most of the information regarding this practice seems to come from anecdotal evidence via the internet, and it does not appear overtly common. If ethical hair transplant teams (surgeons and technicians) are splitting a small number of grafts carefully (under microscopic visualization) to create a greater number of singular unit grafts for the hairline, there does not seem to be any issues involved with splitting follicular units.

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Blake Bloxham – aka Future_HT_Doc