The Art and Science of Hair Transplantation

Authors

  • Damkerng Pathomvanich Institution Stough Clinic 408/138 Phaholyotin Place 32nd D, Phaholyotin Road, Phayathai, Bangkok 10400, Thailand.

Abstract

Background: Big round grafts (plugs) were extensively used in hair transplantation since 1960 till late 1988. Realizing the doll look, the size of the grafts were getting smaller to split and quarter grafts and finally mini and micro-grafts in the late 1980. In the past few years, the use of follicular unit graft in large quantity have replaced mini-micro grafts to create mother nature looking result. Hair line designed which was straight and bell shape in the past have been changed to irregular and slightly asymmetric to achieve natural and undetectable result.

Materials and Methods: Hair line is drawn in irregular fashion with or without temple hair line restoration. Single strip harvesting under local anesthetic is carefully dissected into follicular unit grafts that contain 1 to 4 hairs. Single hair follicular unit grafts are transplanted in the front row. Follicular unit containing 2 to 4 hairs are mixed and transplanted behind the single hair. Dense packing is required to achieve good density. Natural and undetectable hair growth in good candidate can be observed 10 to 12 months after surgery. Two to three sessions may be needed for added density.

Discussion: Hair transplantation is the art and science challenging the hair transplant surgeons. Understanding the pathogenesis of hair loss, anatomy and hair flow (direction, angle) in conjunction with training in hair restoration are essential for successful and natural results. All follicular unit grafts look best and unnoticeable. Mini-micrografts can also result in natural look if the frontal zone, part side and the crown contain the area at least two centimeters of follicular unit grafts

References

1. Limmer B. Thought on the extensive micro grafting technique in hair transplantation. Hair Transplant Forum International 1996; 6: 16-8.

2. Shapiro R. Total micrograft megasessions-a follow-up. Hair Transplant Forum International 1997; 7: 23-4.

3. Okuda S. Klinische und experimentelle Untersuchungenuber die Transplantation von lebenden Haaren, Jpn J Dermatol (in Japanese) 1939; 40: 537.

4. Okuda S. Clinical and experimental studies of transplantation of living hair. Jpn J Dermatol (in Japanese) 1939;46:135-8.

5. Orentreich N. Autografts in alopecias and other selected dermatological conditions. Ann NY Acad Sci 1959; 83:4463.

6. Unger W. Punch hair transplantation. In: Epstein E, editor. Dermatology clinics, skin surgery. Philadelphia: WB Sarunders;1984. p. 303-17.

7. Nussbaum B, Lewis L. Hair transplantation, a three-stage approach for creating the hairline. J Dermatol Surg Oncol 1992;18: 327-8.

8. Orentreich DS, Orentreich N. Hair transplantation. J Dermatol Surg Oncol 1985: 11: 319-24.

9. Alt T. Hair transplantation and scalp reduction. In: Coleman WP, III, Hanke CW, Alt T, Asken S, editors. Cosmetic of the skin. Philadelphia: BC Decker; 1991. p. 103-46.

10. Norwood O'T. Hair transplant surgery. Springfield IL: Charles C Thomas; 1973.

11. Gibbon RD, et al. Quantification of scalp hair- a computer- aided methodology. J Invest Dermatol 1986; 86: 78-82.

12. Gibbons RD, Fiedler-Weiss VC. Computer-aided quantification of scalp hair. Dermatol Clin 1986; 4:627-39.

13. Norwood O'T. Hair transplant surgery. 2nd ed. Springfield IL: Charles C Thomas; 1984.

14. Pecoraro V, Astore IPL. Measurements of hair growth under physiological conditions. In: Orfanos CE, Happle R, editors. Hair and hair diseases. New York: Springer-Verlag; 1989.

15. Rassman WR, Pomerantz MA. The art and science of mini-grafting. Int J Aesthetic Rest Surg 1993; 1: 27-36.

16. Unger WP, Nordstrom REA. Hair transplantation. 2nd ed. New York: Marcel Dekker; 1988. p. 151-3.

17. Van Neste D, Dumortier M, DeCoster W. Phototrichogram analysis; technical: aspects and problems in relation to automated quantitative evaluation of hair growth by computer-assisted image analysis. In: Van Neste D, Lachapella JM, Antoine JL, editors. Trends in human hair growth and alopecia research. Boston: Kluwer; 1989.

18. Van Neste D. Dynamic exploration of hair growth: critical review of methods available and their usefulness in the clinical trial protocol. In: Van Neste D, Lachapelle JM, Antoine JP, editors. Trends in human hair growth and alopecia research. Boston: Kluwer; 1989.

19. Limmer BL. Survival of micrografts as a function of time from donor site removal to recipient site implantation. Presented at the First Meeting of International Society of Hair Restoration Surgeons. Dallas, TX: April 30-May 2, 1993.

20. Limmer BL. Elliptical donor harvesting, hair replacement, surgical and medical. Dow B. Stough, editor. Mosby-Yearbook; 1996. p. 142-7.

21. Lucas M. The treatment of male baldness exclusively with mini-grafts. Z Hautkr 1987: 62:1735-45.

22. Lucas M. The use of minigrafts in hair transplanting surgery. J Dermatol Surg Oncol 1988; 14: 1389-92.

23. Norwood OT. Patient selection. Hair transplant design, and hairstyle. J Dermatol Surg Oncol 1992; 18: 386-94.

24. Unger W. Punch hair transplantation. In: Epstein E, editor. Dermatology clinics, skin surgery. Philadelphia: WB Saunders;1984. p. 303-17.

25. Cohen I. Donor island harvesting for micro- and minigrafting. J Dermatol Surg Oncol 1989; 15: 384-5.

26. Unger WP. Total excision techniques in donor area harvesting for hair transplanting. Am J Cosmet Surg 1994; 11:15-22.

27. Straub P. The donor site revisited. Hair Transplant Forum 1991;1:4.

28. Straub P. Evaluating the knife tecnique. Hair Transplant Forum 1992; 2:2-4.

29. Scarborough D. The triple-bladed knife in perspective. Hair Transplant Forum 1991; 2:5

30. stough D, Proper use of the knife. Hair Transplant Forum 1992;2: 10.

31. Stegman S, Tromovitch T, Glogan R. In: Anesthesia, basic of Dermatologic Surgery. Chicago: Year Book Medical Publisher; 1983. p. 23-31.

32. Fox B. Anesthesia. In: Norwood O, Shiell R, editors. Hair transplant surgery. Springfield IL: Charles C Thomas; 1984. p.245-64.

33. Alt T. Hair transplantation and scalp reduction. In: Coleman W, II, Hanke CW, Alt T, Asken S, editors. Cosmetic surgery of the skin. Philadelphia: BC Decker; 1991, p. 103-46.

34. Grekin RC, Aulatta MJ. Local anesthesia and dermatologic surgery. J Am Acad Dermatol 1988; 19:599-614.

35. McKay W, Morris R, Mushlin P. Sodium bicarbonate apenuate pain on skin infiltration with lidocaine with or without epinephrine. Anesth Analg 1987: 66: 572-4.

36. Pathomvanich D. Donor harvesting a new approach to minimizing follicular transection. Dermatol Surg 2000; 26:335-48.

37. Wagner R, Flores C, Argo L.A double-blind placebo controled study of a 5% lidocaine/prilocaine cream (EMLA) for topical anesthesia during thermolipis. J Dermatol Surg Oncol 1994;20:148-50.

38. Lycka BAS. EMLA, a new and effective topical anesthetic. J Dermatol Surg Oncol 1992; 19; 859-62.

39. coleman W, II, Klein JA. Use of the tumescent technique for scalp surgery. Dermabrasion Soft Tissue Reconstr 1992; 18:130-5.

40. Norwood OT. Tumescent anesthesia (Editorial Response). Hair Transplant Forum 1991; 1: 6.

41. Marritt E. Single hair transplantation of hairline refinement: a practical solution. J Dermatol Surg Oncol 1984; 10:962.

42. Nordstrom REA. "Micrografts" for improvement of the frontal hairline after hair transplant. Aesthetic Plast Surg 1981; 5:97.

43.Jimenez FJ, Avram SR, Stough DB. The surgical pearl: the Yeh needle-a solid needle for single-hair recipient sites. J Am Acad Dermatol 1995; 32:1041-2.

44. Stough DB, IV. Hair transplantation by the feathering zone technique: new tools for the nineties. Am J Cosmet Surg 1992;9:243.

45. Nordstrom REA. "Micrografts" for improvement of the frontal hairline after hair transplant. Aesthetic Plast Surg 1981;5:97.

46. Stough DB, II, Nelson BR, Stough DB, IV. Incisional slit grafting. J Dermatol Surg Oncol 1991; 17: 53-60.

47. Swinehart J, Griffin El. Slit grafting: the use of serrated island grafts in male and female-pattern alopecia. J Dermatol Surg Oncol 1001; 17: 243-53.

48. Shiell RC, Norwood OT. Micrografts and minigrafts. In: Norwood OT, Shiell RC, editors. Hair transplant surgery. 2nd ed. Springfield II: Charles C Thomas; 1984. p. 107-10.

49. Brandy DA. Conventional grafting combined with mini grafing: a new approach. J Dermatol Surg Oncol 1987;13:60-3.

50. Brandy DA. A new instrument for the expedient production of minigrafts. J Dermatol Surg Oncol 1992; 18: 487.

51. Norwood OT, Shield RC. In: Norwood OT, Shiell RC, editors. Hair transplant surgery. 2nd ed. Springfield III: Charles C Thomas; 1984.

52. Frechet P. Micro and mini hair grafting using the standard hair implantation procedure. J Dermatol Surg Oncol 1989;15:533-6.

Downloads

Published

2003-09-30

How to Cite

1.
Pathomvanich D. The Art and Science of Hair Transplantation. Thai J Surg [Internet]. 2003 Sep. 30 [cited 2024 Jul. 18];24(3):73-80. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/242920

Issue

Vol. 24 No. 3 (2003): July - September

Section

Original Articles

License

Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.