Results and Expectations of the Modern Hair Transplant
The art and science of hair transplant surgery has come a long way since the 1960's when it was first developed.
Early hair transplants used very large grafts which were harvested from the back of the head using large round punch biopsy instruments.
These grafts had 20 or more hairs in them, which when placed in the recipient area in the front of the scalp caused an unnatural appearance.
Some likened the appearance to "doll's hair", in which the hairs emerge from the head in separate thick tufts which are separated by blank spaces.
Obviously, this is not how hair comes out of our heads in nature, so that hair transplants done decades ago have caused a bit of a poor reputation to our specialty.
A modern hair transplant should follow the natural order of hair growth and architecture as closely as possible.
Hairs naturally grow out of our scalps in groupings of 1, 2, or 3 hairs and emerge randomly.
Therefore a hair transplant operation should only use 1, 2, or 3 hair grafts and place them randomly in the recipient area.
In addition, the grafts should be placed in the same angle and direction of any existing hair in the area.
Regarding the hairline, the grafts placed here should be primarily 1 hair grafts and should follow a bit of a saw-tooth pattern.
Have you ever seen a row of trees in an almond orchard all lined up in perfect rows? If you have you would notice that the overall pattern looks man-made due to the lack of irregularity.
The frontal hairline should not appear man-made, and therefore should incorporate random bumps and irregularities in order to appear natural.
Utilizing these small grafts placed as closely together as possible and in a random pattern, a modern day hair transplant should result in an undetectable appearance with an illusion of much more hair density.
I use the word illusion for the following reason.
A young person who has not lost any hair yet has about 90 grafts for each square centimeter of skin.
When the hair transplant surgeon makes the tiny little slits in the skin to place the new grafts, only about 30-35 slits can be made in a square centimeter without injuring the tissue and jeopardizing graft growth.
Therefore when we complete a hair transplant, we do not restore the scalp to 90 grafts per centimeter, rather we restore to 1/3 normal density in the case of absolute baldness up to 2/3 normal density in the case of a patient with some existing hair.
This does not result in a full head of hair, but it gives the patient an appearance of fullness and density that should meet or exceed their expectations.
Most men do not notice that their hair is thin until about half of it is gone, therefore by approaching or exceeding 50% normal density with the new grafts, the hair transplant surgeon can make the patients hair look full.
In my experience, patients are universally thrilled about their new hair and they say that it gives them more confidence and a sense of youthfulness.
Patients need to be aware of the limitations of a hair transplant procedure and have appropriate expectations prior to surgery.
If those criteria are met, both the patient and surgeon can expect a very mutually satisfying outcome.
Early hair transplants used very large grafts which were harvested from the back of the head using large round punch biopsy instruments.
These grafts had 20 or more hairs in them, which when placed in the recipient area in the front of the scalp caused an unnatural appearance.
Some likened the appearance to "doll's hair", in which the hairs emerge from the head in separate thick tufts which are separated by blank spaces.
Obviously, this is not how hair comes out of our heads in nature, so that hair transplants done decades ago have caused a bit of a poor reputation to our specialty.
A modern hair transplant should follow the natural order of hair growth and architecture as closely as possible.
Hairs naturally grow out of our scalps in groupings of 1, 2, or 3 hairs and emerge randomly.
Therefore a hair transplant operation should only use 1, 2, or 3 hair grafts and place them randomly in the recipient area.
In addition, the grafts should be placed in the same angle and direction of any existing hair in the area.
Regarding the hairline, the grafts placed here should be primarily 1 hair grafts and should follow a bit of a saw-tooth pattern.
Have you ever seen a row of trees in an almond orchard all lined up in perfect rows? If you have you would notice that the overall pattern looks man-made due to the lack of irregularity.
The frontal hairline should not appear man-made, and therefore should incorporate random bumps and irregularities in order to appear natural.
Utilizing these small grafts placed as closely together as possible and in a random pattern, a modern day hair transplant should result in an undetectable appearance with an illusion of much more hair density.
I use the word illusion for the following reason.
A young person who has not lost any hair yet has about 90 grafts for each square centimeter of skin.
When the hair transplant surgeon makes the tiny little slits in the skin to place the new grafts, only about 30-35 slits can be made in a square centimeter without injuring the tissue and jeopardizing graft growth.
Therefore when we complete a hair transplant, we do not restore the scalp to 90 grafts per centimeter, rather we restore to 1/3 normal density in the case of absolute baldness up to 2/3 normal density in the case of a patient with some existing hair.
This does not result in a full head of hair, but it gives the patient an appearance of fullness and density that should meet or exceed their expectations.
Most men do not notice that their hair is thin until about half of it is gone, therefore by approaching or exceeding 50% normal density with the new grafts, the hair transplant surgeon can make the patients hair look full.
In my experience, patients are universally thrilled about their new hair and they say that it gives them more confidence and a sense of youthfulness.
Patients need to be aware of the limitations of a hair transplant procedure and have appropriate expectations prior to surgery.
If those criteria are met, both the patient and surgeon can expect a very mutually satisfying outcome.
