Hair Transplant - Technical Info

hair-grafts

There are many aspects that make up a successful hair transplant result. The skills of the Doctor and their technician team is one major aspect. The skills required overlap between medical ability and understanding and an artistic bent. Both can be learnt to an extent but the best results are achieved when there is an innate understanding and skill.

Hair Line, Artistry and Design

hairlines 1The front hairline is generally considered to be the most important aspect of a hair transplant. This is because it frames the face. It will change the appearance of the person most dramatically. Hairline planning can be a compromise between the patient and the doctor.  On occasions, people have a tendency to want the hairline too high or too low.

A low rounded adolescent hairline will look fine on a younger man. But, not the facial features of an older man. The younger man still has vivid memories of their original hairline.  Often there is a desire to create the same appearance. A middle-aged man may fear that an aggressive hairline may seem unnaturally low for his age.

Temple point recreation and the flat look hairline are becoming more common. But it must be within the boundaries of nature. The apex is always the lowest point of the hairline.

When designing a hairline with minimal recession one has to understand the principles of the hair transplant. The amount of FU required and the density that looks natural.

Single hair follicular units are placed along the front zone. Then, further back two, three and four hair follicular units. The single hair units are placed closer together to mimic nature.  This will provide a natural progressive increase in density. Opposed to a flat, straight block, or wall of hair.

Crown Design & Graft Placement

the-crownSometimes it may be felt the crown is the neglected area.  Some like to make a demarcation line. But it’s not that easy to measure. Probably easier to measure the hairline, frontal third, mid-section and then crown as regions. The crown opens on all sides. From the frontal and sides to dropping at the back. In some cultures, the area expands further, expanding down each side and back. A small crown can easily be a circle say, 6×6.  To measure, for those proficient in maths the PY equation applies. This calculation is designed to give the values of a circle.

This makes it hard to treat the crown. Where to start, and how many grafts to use. How to place the grafts and whether the surface area will expand.  If the crown opens by 1cm the surface area has dramatically altered.

Should you start working in the crown first? You must be mindful not to “backload” their head of hair. Concentrating on the crown and not addressing the frontal loss.

In conclusion, crown work and artistic design go together. In some cases, the crown can be hard to treat, especially in younger candidates.

hairline-graft-placement

Recipient Sites

This is vital to the look of a hair transplant result.  The doctor is careful to assure that the grafts will grow out in a natural direction. Including angle, orientation, and pattern of growth. Attention is taken to avoid damage to surrounding hair.  At the same time, place a density that can blend with the surrounding hair.

The recipient sites are made in close proximity to each other.  The angle and direction of the slit are dependent on the position in the recipient area. Also, the number of hairs in the graft. The grafts are placed with magnification to ensure correct graft care.  Not to place the graft too deep or crush the bulb whilst handling. The trimmed grafts have very little volume other than the functional follicle.

Both the length and the depth of the slit are important for the hair transplant. The microcirculation is just beneath the hair follicle.  If the incision is too deep this can be damaged. It is essential to minimise trauma to the surrounding tissue. If too aggressive, damage can occur to the surface of the scalp. As a result, creating a ridge or cobblestoning over the scalp. Resulting in an unnatural ripple left through poor slit making.

With precise placement, it is now possible to create a higher density of hair than in previous years, and this will give a much more pleasing result for the patient.

Dense Packing

This is the art of placing the follicular units close enough together to ensure a natural result/density in one pass; for example, the design of the hairline not having large gaps between each hair and having to place in between at a later date. The number of follicular units placed will alter dependent on certain factors, hair characteristics, hair shaft quality, ethnic origin, hair colour, curl, and your existing hair density. Dense packing is a great skill, being able to successfully place the follicular units close together without compromising the growth of each hair; the angle of the site and the size of the gauge used will all affect the result.

Follicular-Units- 2 and 3 hair

Splitting Follicular Units

The word “graft” is commonly used to refer to the quantity received from a hair transplant. A graft can simply be skin tissue, it does not correctly represent the reality of what has been transplanted.  A graft should represent an intact Follicular Unit, being from one to four hairs and with a hair transplant this equates to an average of 2.2 hairs per graft, so 3000 grafts being approximately 6600 hairs.

Splitting of hair groups does sometimes occur on a small scale and does not alter the ratio of 2.2 hairs per graft/unit. But if splitting increases the hair number does not change but the number of grafts increases. This can affect the result achieved and if paying per graft increase the cost without justification.

transection

Transection

Can occur with either FUT or FUE although more discussed with the FUE technique as there are a greater possibility the transection rate increases out of control. There can be a number of negative effects if a hair unit is split, or “transected”, for example, take a 3 hair unit is split into 2 and 1 hair, this would then make up 2 “grafts” instead of 1.

Transection can also kill the hair by damaging the follicular unit. By splitting follicular unit vital growth or survival factors of the unit could be damaged or lost, protective fatty tissue around the unit, genetic information, muscle receptors, and other glands may be missing or damaged. Leaving a partial follicular unit in the donor has no real benefit to the patient and often can later miniaturise due to trauma anyway.

There is usually no reason to split the graft with FUE as by the nature of the technique the hair units can be cherry-picked from around the scalp and enough single hair units, for example, can be found for hairline work, splitting and leaving hair in the donor can be detrimental and of no benefit and also reduces the hair count per graft so the patient loses out on their natural number groupings.

Shockloss

Loss can occur to the native hair in the recipient area and sometimes but less common in the donor area, “shock loss”. The medical term for shock loss is effluvium, meaning shedding. This can occur when grafts are placed in an area which has hair; there can be some trauma and tissue reaction to the surgery that can cause the existing hair to shed prematurely. Shock loss usually affects the miniaturised hair nearing the end of its lifespan and is most likely to be shed at some point in the near future. Some healthy hair will be shed, but it invariably regrows. Shock loss is more common when a large session is performed through thinning hair. Shock loss can also occur in the donor area, more so with larger strip procedures, it is certainly less common, but can still occur.

For most patients, effluvium is not a major issue and should not be a cause for concern; their hair looks a little thinner or loses body and lustre. This is generally during the first months post the transplant when the transplanted hair is still in the dormant phase.

It is easier to place grafts around hair that is shaved but this does not mean shock loss does not occur; it is just not as noticeable as the hair is shaved. Incisions must be customised to the individual patient; if you limit/customise the size of the incision site, and limit the width and length of the tool used to make recipient sites then you can greatly reduce the chances of shock loss. There are a number of factors that can help reduce the effects of shock loss, smoking/drinking in the coming days to the procedure. In general, the more miniaturisation one has the more likely will be shedding from surgery. In addition, the number of grafts placed in one surgery and the proximity in which they placed to one another will increase the trauma to surrounding follicles.

Checking The Grafts Under Magnification

The two techniques for harvesting hair differ in respect with the Strip technique the FU are intact in the donor strip whereas FUE the FU‟s are individually removed so already separated from each other, this means no need for dissecting and generally means less trimming of the graft is required.

With Strip the FU‟s remain in the donor strip, this strip is placed in a holding solution to protect the tissue. The strip is divided into smaller sections and then into the individual units by the tech team. Aside of this process is to trim off any excess fatty tissue around the unit, this ensures the grafts are thin so can be placed close enough together to dense pack as well as to stop unnatural pitting or ridging of the skin in the recipient area.

This process within the hair transplant procedure must be carried out under stereo microscopes and by skilled technicians with precision and accuracy. Some hair types are harder than other to dissect even under microscopes, blonde or white hair or very fine hair make this more challenging.

This excellence to precision during the process is vital; each follicle unit harvested for transplant must be preserved and prevented from being damaged as this would compromise the overall result.

Learn more about Follicular Unit Transplant (FUT) and Follicular Unit Extraction (FUE)
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