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Hair Transplantation

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Evidence-Based Procedural Dermatology
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Abstract

Hair transplantation surgery has evolved radically since its introduction in the German literature by Dieffenbach in the early nineteenth century. Since that time, from the first report of successful punch graft transplantation for alopecia by Okuda in the 1930s, to Norman Orentreich’s use of larger 6–8 mm punch grafts and his description of the concept of donor site dominance in the 1950s, to the definition of the follicular unit by Headington and the development of follicular unit transplantation by Limmer and its subsequent championing by Bernstein and Rassman in the 1990s, the field has trended towards developing techniques that achieve more natural-appearing and esthetic end-results [1–5]. Alternate techniques such as scalp reduction and scalp flaps have been described but they have become largely obsolete because outcomes that were too frequently esthetically unpleasing. Developing an evidence-based approach to hair restoration surgery is difficult, however, because most hair restoration techniques have been described in case series, anecdotal reports, position papers, and colloquium guidelines, and have not been compared in large, prospective, randomized controlled trials [6].

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References

  1. Epstein JS. Evolution of techniques in hair transplantation: a 12-year perspective. Facial Plast Surg. 2007; 23:51–9.

    Article  PubMed  CAS  Google Scholar 

  2. Orentreich N. Autografts in alopecias and other selected dermatological conditions. Ann N Y Acad Sci. 1959;83:463–79.

    Article  PubMed  CAS  Google Scholar 

  3. Rassman WR, Bernstein RM, McClellan R, Jones R, Worton E, Uyttendaele H. Follicular unit extraction: minimally invasive surgery for hair transplantation. Dermatol Surg. 2002;28:720–8.

    Article  PubMed  Google Scholar 

  4. Rawnsley JD. Hair restoration. Facial Plast Surg Clin North Am. 2008;16:289–97.

    Article  PubMed  Google Scholar 

  5. Unger WP. The history of hair transplantation. Dermatol Surg. 2000;26:181–9.

    Article  PubMed  CAS  Google Scholar 

  6. Patwardhan N, Mysore V. IADVL Dermatosurgery Task Force. Hair transplantation: standard guidelines of care. Indian J Dermatol Venereol Leprol. 2008;74(Suppl):S46–53.

    PubMed  Google Scholar 

  7. Ebell MH, Siwek J, Weiss BD, Woolf SH, Susman JL, Ewigman B, et al. Simplifying the language of evidence to improve patient care: strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in medical literature. J Fam Pract. 2004;53:111–20.

    PubMed  Google Scholar 

  8. Bernstein RM, Rassman WR. Follicular unit transplantation. Dermatol Clin. 2005;23:393–414.

    Article  PubMed  CAS  Google Scholar 

  9. Bernstein RM, Rassman WR. Follicular transplantation. Patient evaluation and surgical planning. Dermatol Surg. 1997;23:771–84.

    Article  PubMed  CAS  Google Scholar 

  10. Olsen EA, Messenger AG, Shapiro J, Bergfeld WF, Hordinsky MK, Roberts JL, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. 2005;52:301–11.

    Article  PubMed  Google Scholar 

  11. Rebora A. Pathogenesis of androgenetic alopecia. J Am Acad Dermatol. 2004;50:777–9.

    Article  PubMed  Google Scholar 

  12. Whiting DA. Possible mechanisms of miniaturization during androgenetic alopecia or pattern hair loss. J Am Acad Dermatol. 2001;45:S81–6.

    Article  PubMed  CAS  Google Scholar 

  13. Chartier MB, Hoss DM, Grant-Kels JM. Approach to the adult female patient with diffuse nonscarring alopecia. J Am Acad Dermatol. 2002;47:809–18.

    Article  PubMed  Google Scholar 

  14. Unger WP, Unger RH. The art of hair transplantation in women. Dermatology. 2004;4:26–8.

    Google Scholar 

  15. Avram MR, Cole JP, Gandelman M, Haber R, Knudsen R, Leavitt MT, et al. Roundtable consensus meeting of the 9th annual meeting of The International Society of Hair Restoration Surgery. The potential role of minoxidil in the hair transplantation setting. Dermatol Surg. 2002;28:894–900.

    Article  PubMed  Google Scholar 

  16. Thompson IM, Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003;349:215–24.

    Article  PubMed  CAS  Google Scholar 

  17. Bouhanna P. Androgenetic alopecia: combining medical and surgical treatments. Dermatol Surg. 2003;29:1130–4.

    Article  PubMed  Google Scholar 

  18. Lam SM, Karamanovski E. Surgical hair restoration. Oper Tech Otolaryngol. 2007;18:195–202.

    Article  Google Scholar 

  19. Arnold J. Mini-blades and a mini-blade handle for hair transplantation. Am J Cosm Surg. 1997;14:195–200.

    Google Scholar 

  20. Headington JT. Transverse microscopic anatomy of the human scalp. A basis for a morphometric approach to disorders of the hair follicle. Arch Dermatol. 1984;120:449–56.

    Article  PubMed  CAS  Google Scholar 

  21. Choi YC, Kim JC. Single hair transplantation using the Choi hair transplanter. J Dermatol Surg Oncol. 1992;18:945–8.

    PubMed  CAS  Google Scholar 

  22. Bernstein RM, Rassman WR, Rashid N. A new suture for hair transplantation: poliglecaprone 25. Dermatol Surg. 2001;27:5–11.

    Article  PubMed  CAS  Google Scholar 

  23. Bernstein RM. Measurements in hair restoration. Hair Transplant Forum Int. 1998;8:27.

    Google Scholar 

  24. Bernstein RM, Rassman WR, Seager D, Shapiro R, Cooley JE, Norwood OT, et al. Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques. Dermatol Surg. 1998;24:957–63.

    Article  PubMed  CAS  Google Scholar 

  25. Bernstein RM, Rassman WR. The aesthetics of follicular transplantation. Dermatol Surg. 1997;23:785–99.

    Article  PubMed  CAS  Google Scholar 

  26. Bernstein RM, Rassman WR. The logic of follicular unit transplantation. Dermatol Clin. 1999;17:277–95.

    Article  PubMed  CAS  Google Scholar 

  27. Bernstein RM, Rassman WR. What is delayed growth? Hair Transplant Forum Int. 1997;7:22.

    Google Scholar 

  28. Stough D, Whitworth JM. Methodology of follicular unit hair transplantation. Dermatol Clin. 1999;17: 297–306.

    PubMed  CAS  Google Scholar 

  29. Tan Baser N, Cigsar B, Balci Akbuga U, Terzioglu A, Aslan G. Follicular unit transplantation for male-­pattern hair loss: evaluation of 120 patients. J Plast Reconstr Aesthet Surg. 2006;59:1162–9.

    Article  PubMed  Google Scholar 

  30. Leavitt M, Perez-Meza D, Barusco M. Research symposium 1999–2000: clinical update on research studies reported at the world hair restoration society/international society of hair restoration surgery live surgery workshop. Int J Cosm Surg Aesthet Derm. 2001;3:135–8.

    Article  Google Scholar 

  31. Mayer and Keene. Study comparing follicular unit growth with different planting densities. In: Presented at the 2003 annual meeting of the International Society of Hair Restoration Surgery.

    Google Scholar 

  32. Mayer and Keene. Hair transplant study. In: Presented at the 2005 annual meeting of the International Society of Hair Restoration Surgery.

    Google Scholar 

  33. Alhaddab M, Kohn T, Mark S. Effect of graft size, angle, and intergraft distance on dense packing in hair transplants. Dermatol Surg. 2004;31:650–4.

    Article  Google Scholar 

  34. Marritt E. The death of the density debate. Dermatol Surg. 1999;25:654–60.

    Article  PubMed  CAS  Google Scholar 

  35. Unger WP. Density issue in hair transplantation. Dermatol Surg. 1998;24:297.

    PubMed  CAS  Google Scholar 

  36. Unger RH, Unger WP. What’s new in hair transplants? Skin Therapy Lett. 2003;8:5–7.

    PubMed  CAS  Google Scholar 

  37. Seery GE. Hair transplantation: management of donor area. Dermatol Surg. 2002;28:136–42.

    Article  PubMed  Google Scholar 

  38. Brandy DA. Intricacies of the single-scar technique for donor harvesting in hair transplantation surgery. Dermatol Surg. 2004;30:837–44.

    Article  PubMed  Google Scholar 

  39. Seager DJ, Simmons C. Local anesthesia in hair transplantation. Dermatol Surg. 2002;28:320–8.

    Article  PubMed  Google Scholar 

  40. Brandy DA. New instrumentation for hair transplantation surgery. Dermatol Surg. 1998;24:629–31.

    Article  PubMed  CAS  Google Scholar 

  41. Chang SC. Estimation of number of grafts and donor area. Hair Transplant Forum Int. 2001;11:101–3.

    Google Scholar 

  42. Jimenez F, Ruifernández JM. Distribution of human hair in follicular units. A mathematical model for estimating the donor size in follicular unit transplantation. Dermatol Surg. 1999;25(4):294–8.

    Article  PubMed  CAS  Google Scholar 

  43. Unger WP. Suturing of donor sites. In: Unger WP, editor. Hair transplantation. New York: Marcel Dekker; 1979. p. 64.

    Google Scholar 

  44. Bernstein RM, Rassman WR. Dissecting microscope versus magnifying loupes with transillumination in the preparation of follicular unit grafts. A bilateral controlled study. Dermatol Surg. 1998;24:875–80.

    Article  PubMed  CAS  Google Scholar 

  45. Seager D. Binocular stereoscopic dissecting microscopes: should we use them? Hair Transplant Forum Int. 1996;6:2–5.

    Google Scholar 

  46. Brandy DA. A technique for hair-grafting in between existing follicles in patients with early pattern baldness. Dermatol Surg. 2000;26:801–5.

    Article  PubMed  CAS  Google Scholar 

  47. Beehner ML. A comparison of hair growth between follicular-unit grafts trimmed “skinny” vs. “chubby”. Dermatol Surg. 1999;25:339–40.

    Article  PubMed  CAS  Google Scholar 

  48. Kurata S, Ezaki T, Itami S, Terashi H, Takayusu S. Viability of isolated single hair follicles preserved at 4 degrees C. Dermatol Surg. 1999;25:26–9.

    Article  PubMed  CAS  Google Scholar 

  49. Raposio E, Cella A, Panarese P, Mantero S, Nordstrom REA, et al. Effects of cooling micrografts in hair transplantation surgery. Dermatol Surg. 2001;25: 705–9.

    Article  Google Scholar 

  50. Harris JA. Follicular unit extraction. Facial Plast Surg. 2008;24:404–13.

    Article  PubMed  CAS  Google Scholar 

  51. Onda M, Igawa HH, Inoue K, Tanino R. Novel technique of follicular unit extraction hair transplantation with a powered punching device. Dermatol Surg. 2008;34:683–8.

    Article  Google Scholar 

  52. Brandy DA, Meshkin M. Utilization of No-Kor needles for slit-micrografting. J Dermatol Surg Oncol. 1994;20:336–9.

    PubMed  CAS  Google Scholar 

  53. Avram MR. Polarized light-emitting diode magnification for optimal recipient site creation during hair transplant. Dermatol Surg. 2005;31:1124–7.

    Article  PubMed  CAS  Google Scholar 

  54. Beehner M. Hairline design in hair replacement surgery. Facial Plast Surg. 2008;24:389–403.

    Article  PubMed  CAS  Google Scholar 

  55. Lam SM, Hempstead BR, Williams EF. A philosophy and strategy for surgical hair restoration: a 10-year experience. Dermatol Surg. 2002;28:1035–42.

    Article  PubMed  Google Scholar 

  56. Brandy DA. The art of mixing follicular units and follicular groupings in hair restoration surgery. Dermatol Surg. 2004;30:846–56.

    Article  PubMed  Google Scholar 

  57. Unger W. Different grafts for different purposes. Am J Cosm Surg. 1997;14:177–83.

    Google Scholar 

  58. Unger WP. Hair transplantation: current concepts and techniques. J Investig Dermatol Symp Proc. 2005;10: 225–9.

    Article  PubMed  Google Scholar 

  59. Agrawal M. Modern artificial hair implantation: a pilot study of 10 patients. J Cosmet Dermatol. 2008;7: 315–23.

    Article  PubMed  Google Scholar 

  60. Marritt E. Transplantation of single hairs from the scalp as eyelashes. Review of the literature and a case report. J Dermatol Surg Oncol. 1980;6:271–3.

    PubMed  CAS  Google Scholar 

  61. Al-Bdour MD. Eyebrow to eyelid cilia transplant: a case report. Case Rep Clin Pract Rev. 2005;6:351–3.

    Google Scholar 

  62. Straub PM. Replacing facial hair. Facial Plast Surg. 2008;24:446–52.

    Article  PubMed  CAS  Google Scholar 

  63. Unger WP. Hair transplantation. In: Arndt KA, Dover JS, Kaminer MS, editors. Atlas of cosmetic surgery. Philadelphia: WB Saunders; 2002. p. 231–63.

    Google Scholar 

  64. Unger M. Scalp reduction. In: Unger W, editor. Hair transplantation. 3rd ed. New York: Marcel Dekker; 1995. p. 549–69.

    Google Scholar 

  65. Epstein JS, Kabaker SS, Puig C, Maas C. Scalp extension in the treatment of male pattern baldness. Am J Cosm Surg. 1996;13:135–9.

    Google Scholar 

  66. Frechet P. Scalp extension. In: Unger W, editor. Hair transplantation. 3rd ed. New York: Marcel Dekker; 1995. p. 642–62.

    Google Scholar 

  67. Mangubat EA. Scalp reconstruction and repair. Facial Plast Surg. 2008;24:428–45.

    Article  PubMed  CAS  Google Scholar 

  68. Perez-Meza D, Niedbalski R. Complications in hair restoration surgery. Oral Maxillofac Surg Clin North Am. 2009;21:119–48.

    Article  PubMed  Google Scholar 

  69. Vogel JE. Hair restoration complications: an approach to the unnatural-appearing hair transplant. Facial Plast Surg. 2008;24:453–61.

    Article  PubMed  CAS  Google Scholar 

  70. Cooley J, Vogel J. Loss of the dermal papilla during graft dissection and placement: another cause of x-factor? Hair Transplant Forum Int. 1997;7:20–1.

    Google Scholar 

  71. Avram MR, Leonard Jr RT, Epstein ES, Williams JL, Bauman AJ. The current role of laser/light sources in the treatment of male and female pattern hair loss. J Cosmet Laser Ther. 2007;9:27–8.

    Article  PubMed  Google Scholar 

  72. New Hair Institute. Follicular unit transplants. www.newhair.com/treatment/follicular-unittransplants.asp. Accessed 14 March 2009.

  73. Limmer BL. The density issue in hair transplantation. Dermatol Surg. 1997;23:747–50.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We would like to extend our deepest gratitude to Dr. Walter Unger who not only provided representative clinical photographs for the chapter but also generously assisted in the preparation of the manuscript.

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Correspondence to David H. Ciocon .

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Unaeze, J., Ciocon, D.H. (2012). Hair Transplantation. In: Alam, M. (eds) Evidence-Based Procedural Dermatology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-09424-3_22

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  • DOI: https://doi.org/10.1007/978-0-387-09424-3_22

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