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Hair Transplantation: The Technique and the Art

When it comes to hair transplantation in Beverly Hills, a common theme among patients centers around the obsession and questions about extraction methods.  This is in part because companies who make follicular extraction devices and the physicians who own them like to boast how their product is superior to their competitor’s technology.  

While discussing extraction methods remains an important discussion with patients, it often inappropriately dominates the dialogue.  Yes, it is essential to review with the patient the different ways hair follicles can be removed from the scalp.  And it is equally imperative that potential donor site scars be addressed.  But should it really be the primary focus of the consult?

It is true of course that patients seeking a hair transplant will search for options that yield natural looking results.  And the less scars—the less evidence that one’s hairline and density may have been enhanced by human hands.  But once the decision between FUT (follicular unit transplantation), or the “strip method”, and FUE (follicular unit extraction) has been made, the discussion should move toward to the the technique that is ultimately responsible for the visible result—implantation—affording equal or more time.

If the conversation isn’t controlled, the patient will almost always dwell on the latest and greatest “hair transplantation device”, as if the newer and more expensive the machine the better the hair transplantation.  With NeoGraft®, Smart Graft®, and Artas®, each possessing big marketing dollars behind their cause, it is easy to see why men or women who want more hair may get bogged down in the details of extraction.  

What patients need to understand is that extraction is one element of the process.   And in skilled hands, it is an often irrelevant one once the decision to proceed with FUE has been made.  This is largely in part because NeoGraft®, Smart Graft®, and Artas® all perform the same function in very similar manners.  In experienced extractors, the follicle will be harvested with little trauma and survive the transplantation process.  In inexperienced extractors, the follicle survival rate succumbs to the laws of probability with the survival rate inversely proportional to the level of experience. 

The second, and arguably far more important element in the hair transplantation is the placement of grafts. Once it is established that by any FUE machine that the large majority of follicles will be harvested properly, the type or machine becomes truly irrelevant to the patient.  Thus, an honest conversation with the patient will focus on the plan, the preservation of follicles during the transplantation, site creation for follicles, and the orientation and distribution of follicles placed in the scalp.  

The Plan

The plan for a hair transplantation must include not only the proposed areas for grafting and the amount of follicles necessary to achieve the desired result, but also must take into consideration the patient age and rapidly of the hair loss.  

The Preservation of Follicles

Once the follicles are removed from the scalp, they must enter an environment suitable for life.  They should be cooled and remain moist with either saline, saline mixed with blood, or a pH balancing solution like Hypothermosol®.

Site Creation

Sites must be made at the appropriate depth, angle, and in the proper density to achieve natural looking results.

The Orientation of Follicles

Above: site placement to ensure proper hair growth density and orientation. 

The direction of hair growth is critical in creating natural looking results. This orientation is determined by the angle and trajectory of site placement.

Distribution of follicles

Above: implanted follicles. Notice the single unit follicles placed in the leading hairline. 

Perhaps most improper to natural looking hairline results is the proper distribution of the follicles. Follicles can possess anywhere between one to four hairs.  In the mid and back of the scalp, many of these multi-unit follicles are present. However, in the front of the scalp and near the hairline, the large majority of hairs are single unit follicles. When multi unit follicles are misplaced into the hairline, the results can mimic plugs. 

In summary, extraction is an important component in the hair transplantation process. FUT or strip method extraction can generate unsightly scars in the back of the head.  These large scars can be avoided with FUE, or follicular unit extraction. However, when it comes to FUE, the success of the extraction process is more dependent on experience of the extractor than that of the technology provided to perform the extraction. And more important than all of this when it comes to creating beautiful, natural looking hair restorations is the planning, the preservation of follicles, site creation, orientation of follicles, and distribution of follicles.  And these are all done with the human hand with technique independent of extraction method. 

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