MIAMI BEACH Modern-day hair transplantation yields high patient satisfaction and a low risk of side effects, according to a presentation at a symposium sponsored by the Florida Society of Dermatology and Dermatologic Surgery.
Dermatologists who offer hair transplantation must battle the legacy of poor techniques and suboptimal outcomes from previous techniques. With more advances in technology, donor hair density is the only limiting factor, said Marc R. Avram, M.D., of the department of dermatology, Weill Cornell Medical Center, New York.
Even though consistent, natural-looking results are now the rule rather than the exception, practical tips can help optimize outcomes. Dr. Avram recommends using polarized light with magnification for both donor and recipient zones. Other keys to success include thorough staff training and good office ergonomics because the work is labor intensive. Dr. Avram said it takes three to five assistants 40-60 minutes to create 1,000-1,500 follicular grafts. Each graft unit consists of one to four hair follicles.
Physicians employ elliptical donor harvesting for more than 95% of patients. An elliptical donor strip of hair is taken from the back of the scalp. The width of the ellipse should be no greater than 1 cm and should be longer rather than wider, Dr. Avram said. Exercise care when working on the area behind the ears and below the occipital protuberance because of higher risk of broad or hypertrophy scarring. Place the blade into subcutaneous tissue and check the angle of the blade every 2-3 cm to monitor transaction of hair follicles; the angle of hair follicles can change across the back of the scalp, he added. Undermine the graft only if necessary.
Less common is 1.25-1.5 mm punch harvesting. Fewer than 5% of patients are potential candidates. People with limited hair loss in the recipient site (from a trauma or scar) or those with limited donor tissue because of a history of multiple surgeries are typical candidates for this technique.
Patients can resume normal activities immediately after the procedure but should avoid heavy exercise for 1 week. Patients are instructed to wear an overnight dressing and take oral antibiotics for 5 days. Dr. Avram also prescribes Tylenol 3, one to two tablets every 4-6 hours as needed and instructs patients to call if pain or discomfort persists beyond the first night. He also typically prescribes prednisone 40 mg to be taken for 3 consecutive days.
Special considerations for women undergoing hair transplantation include an increased risk of telogen effluvium and a more unpredictable donor region. All three hairlinesthe frontal, temporal, and posteriorgenerally remain intact in women. So the goal of hair transplantation in this population is to increase hair density within these stable hairlines.
The future of hair transplantation will feature improved instrumentation, robotics, and cloning, Dr. Avram said. For example, lasers will be able to separate one to three hair grafts with zero transection. Robotics may assist implantation. And if hair cloning becomes a reality, it will alleviate the limiting factor of donor hair density.