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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.

Fortunately, current medical therapy and low-level laser light devices can potentially halt and partially reverse hair loss. If combined with modern techniques in hair transplantation, it is possible to consistently restore a natural frame of hair around the face (Figures 79–1 and 79–2). The era of large, pluggy, unnatural transplanted hair, which existed from the 1960s until the 1990s, no longer exists. Currently, the cosmetic standard for transplantation is to transplant individual follicular units 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.

Figure 79–1

Before hair transplantation.

Figure 79–2

After 900 1-3 hair grafts.


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 in order to rule out medical or dermatological causes of hair loss. If there is any question, additional lab work and potentially a biopsy should be done prior to proceeding. Key questions to ask during the consult 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?

On physical exam, available donor density and caliber of hairs are the 2 most important physical characteristics to determine. Patients with high donor density are able to undergo larger procedures and thus cover more of their exposed scalp. Patients with thick caliber and coarse, wavy hair will be able to create the perception of thick transplanted hair, whereas patients receiving an equal number of fine, straight hairs will appear to have received much less hair even if the same number of grafts is transplanted.

The physician should review the ongoing nature of male-pattern 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, and thus a hair transplant will have the most significant impact if a patient is able to stop further hair loss. With today’s medical treatments, this is possible for a majority of patients and should be a topic of discussion during the consult. In all patients with hair loss, minoxidil should be discussed. It has been proven ...

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