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Hair is one of the few physical characteristics over which we have voluntary control. The length, the color, and how we style our hair are a reflection of our personality and how we project ourselves to the world. When our hair involuntarily begins to disappear, it is a source of ongoing emotional and psychological stress for many men and women.

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Fortunately, modern techniques in hair transplantation can consistently restore a natural frame of hair around the face (Figures 76–1 and 76–2). The era of large, pluggy, unnatural transplanted hair, which existed from the 1960s until 1990s no longer exists. Currently, the cosmetic standard for transplantation is to create consistently natural appearing transplanted hair for men and women. This chapter will be an overview of state-of-the-art techniques in hair transplantation.

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As with all surgical procedures, a consultation is vital to the success of the procedure. In addition to a physical examination, a thorough hair loss and medical history should be obtained. Key questions include: How long the hair loss has been going on? What medications have been used to date, and with what success? What is the goal of the patient from the procedure?

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On physical exam, the caliber of hair follicles and available donor density are the two most important physical characteristics to determine. Patients with thick caliber, coarse hair and high donor density will be able to create the perception of thick transplanted hair while patients receiving an equal number of fine caliber follicles, with poor to average donor density will appear to have received much less hair.

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The physician should review the ongoing nature of male and female pattern hair loss. Patients should be aware that the net perceived density of the procedure equals the number of follicles transplanted minus their ongoing hair loss. For all patients, the role of minoxidil and finasteride for men, and minoxidil for women should be reviewed. Both medications are FDA-approved and are highly effective to help maintain existing hair.

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If a patient uses a medication and undergoes hair transplantation, there can be a substantial increase in perceived density, both short and long term. Despite the success of medications, it should also be emphasized that the medications are elective and can be stopped at any time. It is the obligation of the surgeon to plan a transplant anticipating future hair loss. If a patient ever does discontinue the medication and more of their original hair is lost, the transplant should appear natural both short and long term.

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An overview of the procedure, preoperative and postoperative instructions should be reviewed.

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