Does anyone have any opinion as to which offers better success – hair from the beard or from the chest? From an aesthetic perspective, it appears chest hair may be a better option as it’s less visible to others than the beard. How about the quality of transplanted hair (texture specifically)? Would chest hair be equally good (or comparable from the scalp)?
Body hair is a boon for patients with a meager supply of scalp donor hair or in patients who are coming in for a revision of a poor hair transplant result. Besides rapid follicular unit extraction (FUE) harvest, body hair transplantation (BHT) is presently my favorite field!
Though follicular unit strip surgery (FUSS) is undoubtedly the Gold Standard of surgical hair restoration and shall always remain so, FUE rose in popularity due mostly to the fact that it has opened the horizons to a limitless supply of grafts by expanding the traditional donor availability. The other advantages may be debatable but this has no opposition even from die-hard strip surgeons. Thanks to FUE, the patient base has markedly increased in size. Repair cases and cases with extensive balding which were shunned earlier, can again think of getting back a “head full of hair.”
I have a very different approach to a client with hair loss which I feel shall be progressive in the long term. I goad all patients with a long term plan for their progressive balding to allow me to harvest beard grafts (besides scalp grafts of course) for a better hairline definition and mid-scalp fill and keep their remaining scalp grafts as a rain check for future requirements, especially in the crown.
For example, in a 25 year old with a Norwood Scale type 3 vertex pattern, I would plant scalp hair within the first 1.5 cm along the hairline, mix scalp grafts with beard grafts in a laid down optimal ratio till the highest point of the head. For the crown area I would encourage him to accept a low density preferably with chest grafts or chest grafts with a sprinkling of scalp grafts. I never use beard hair for the crown area. It is only to be used for the mid-scalp and just behind the hairline.
For me and my patients “only ABC is GOOD!” (A- Axilla or armpit, B- Beard, C-Chest): I am not fond of using any hair other than beard, chest and axilla (in this order of preference) since leg, arm, belly hair, in my experience, take a long time to grow if at all.
In darker racial groups I do not venture outside the ‘shadow area’ of the beard which lies on and behind the jawline and above the Adam’s apple due to the possible risk of visible scarring).
Average amount of harvestable grafts (1st session) in diverse racial groups in my practice:
|Donor||Caucasian||South Asian||East Asian||Arab||African|
|Beard||2554 (full beard)||585||263||515||102|
Given the fact that in a second session, you can harvest usually half the number of grafts again after a gap of 6 months, realization shall dawn upon you that an average patient (except East Asian) has a large donor area just waiting to be harvested. This realization is fast becoming the game changer today in the field of surgical hair restoration.
Body hair, mostly alone, has been routinely used at my clinic for the following indications-
1. Hair transplant cripples
2. Extensive baldness with a poor donor area of the scalp and,
3. Camouflaging wide strip scars.
You can see some of my cases on this forum where almost exclusive BHT was done for want of healthy scalp grafts.
Two thousand chest grafts is not possible from the chest in one session in the vast majority. I have difficulty in harvesting more than 600-800 in one session from those well-endowed with hair over the chest and I have been doing chest for over 5 years now.
Dr. Tejinder Bhatti
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