Follicular Transportation – Part 3

Remove Distinction

The following factor in planning the follicular transplantation is the elimination of distinction. Now we have already gone to nice lengths for example how eliminating distinction on the “micro” degree is essential, i.e. eliminating the distinction between the person graft and the encompassing pores and skin. It’s equally essential to get rid of distinction on the “macro” degree, i.e. between one a part of the scalp and the opposite. Some of the hanging options in regards to the balding course of is that virtually all the Norwood Class A sufferers look aesthetically worse than their common Norwood counterparts. In reality, most Norwood Class A sufferers look worse than sufferers within the subsequent larger Norwood Class, regardless of the truth that these sufferers have extra hair. Thus, a Norwood Class 4A usually appears worse than a Class 5, and a Norwood Class 5A usually worse than a Class 6. Clinically, we discover that the Class A sufferers are sometimes probably the most distraught over their hair loss and profit most from the hair transplant process.

The rationale for that is easy. Within the Class A affected person, there may be the best distinction between the hair bearing space and the completely bald scalp. Curly or wavy hair will increase the medical look of density. Within the common Norwood courses, a curly or wavy haired affected person will look much less bald, as a result of any slight protection on prime might be magnified by the character of the hair. In contradistinction, curly or wavy hair will make the Class A affected person look extra bald, as a result of on this affected person it’ll intensify the distinction.

The identical reasoning helps to elucidate why an older affected person appears higher as a Class 6 than a youthful affected person. The youthful affected person has had patterned androgenetic results inflicting hair loss within the bald space. His donor density is basically unchanged. The older affected person, nevertheless, has had hair loss on account of each patterned androgenetic balding in addition to loss as a result of getting old course of itself, the latter affecting the “everlasting zone”. As well as, the older affected person has the next diploma of miniaturization within the donor space, which additional reduces the distinction.

Moreover, the youthful affected person with larger donor density will look extra bald than his Norwood counterpart with decrease density. In sufferers of all ages the place the bald space is simply too in depth to be lined by adjoining hair, the affected person’s beauty look is usually enhanced by retaining the hair quick, which is simply one other technique of lowering the distinction between the 2 areas. Happily, the upper the density of the everlasting zone, the more severe the bald areas look as compared, however the extra hair there may be obtainable to transplant. In a way, hair transplants don’t add hair, they lower distinction by shifting hair round.


The one most helpful clue to correct angulation is to look at the affected person’s current hair. Even in very bald areas, just a few vestigial hairs will usually point out the unique orientation of the terminal hair. When this data is just not obtainable, the most secure path to comply with, except for the crown, is usually ahead. Nearly all of hair anterior to the crown factors ahead with the angle turning into extra acute anteriorly. The path of the frontal hairline can be ahead, quite than radial, and solely deviates considerably from this as one approaches the temples. Horizontal placement of the frontal hair is normally acceptable, whatever the slope of the brow.

Follicular implantation offers nearly limitless freedom in selecting the angle at which the long run hair will emerge from the scalp. It is because the mechanical forces going through the bigger grafts positioned at acute angles don’t have an effect on the follicular implant. The fragile swirl of the crown, the abrupt directional modifications of the cowlick, and the sharp angulation of the temples, can all be re-created with follicular implants. The problem is just not merely creating these angles, however observing the myriad of patterns seen in nature in order that this selection will be duplicated for our sufferers.


In nearly all circumstances of balding, there’s a rationing of donor hair as a result of necessity of masking an ever increasing recipient space with a a lot smaller, however finite, donor provide (Desk 3). We attempt to evenly area the person models in a random quite than grid-like sample and all the time attempt to enhance the density within the areas of beauty significance. In doing so, we keep in mind the adage “To cowl a baseball subject with grass, use seed quite than sod….., and should you solely have a restricted quantity, use it within the infield.”


We started this text by stating that “Follicular Transplantation is the logical finish level of over 30 years of evolution in hair restoration surgical procedure”. Though working on the follicular degree could also be an finish level with regard to measurement, it not at all implies that our work is full. We really feel that 4 exiting new areas deserve point out.

The primary is using ultra-pulsed CO2 laser programs. The main benefit that lasers are presupposed to have over conventional slit and punch grafting is that they will create a slit whereas on the similar time eradicating recipient tissue, like a punch. In follicular transplantation, the implant is already trimmed of extra tissue, subsequently, that is of little worth. As well as, the laser slit is way too giant to understand the tiny follicular implant. Most significantly, the laser seals the microscopic vasculature whereas eradicating tissue. It’s the relative preservation of this essential recipient blood circulate that makes follicular implantation such an interesting course of and permits for the survival of in depth numbers of implants. As laser know-how improves and the problems of spacing and thermal harm have been adequately addressed, the benefit of quickly producing giant numbers of uniform slits could make the laser a extra worthwhile software.

The second is video-imaging. The video-imager9 is definitely a complicated densitometer, and due to its very excessive decision (as much as 200X) and its photographic capabilities, it’s a means by which implants will be assessed for bodily injury, hair counts will be extra correct, and the query of graft survival and yield will be addressed in a scientific means.

The third is cloning. Though nonetheless in its infancy, this system offers rise to the chance that the hair follicle could also be cloned with minimal surrounding connective tissue to provide the best follicular implant. Apart from having a limiteless donor provide, the surgeon may customise the scale of the follicular unit to provide the right stability between density and naturalness within the varied elements of the recipient scalp.

Lastly, the realm of automation ought to have the best impression on hair restoration surgical procedure within the close to future. Follicular transplantation is a labor-intensive process making enormous bodily calls for on the hair transplant surgeon and employees. Instrumentation presently being developed will streamline the complete course of from the harvesting of the donor strip, to the insertion of the implants. With certainty, these future developments will enhance the pace and reduce the manpower required within the hair transplant course of. If they will additionally enhance the standard of our outcomes, we may have a greater, extra inexpensive remedy to supply our sufferers.


Follicular Unit – the unit of tissue moved within the follicular transplantation course of, consisting of a hair follicle, related hair shafts and peri-folliculum.

Follicular Implant – the follicular unit that has been positioned in a recipient web site created by a puncture wound simply giant sufficient to accommodate it.

Follicular Transplantation – a way of hair restoration surgical procedure by which follicular implants are harvested, ready, and positioned in accordance with long-term strategic planning of design to maximise

the beauty profit to the affected person all through his lifetime.

Grafts – pores and skin and hair moved within the hair transplantation course of wherein the transplanted tissue accommodates

roughly the identical ratio of follicles to pores and skin current within the donor space.

Mature Hairline – the grownup hairline that has not but proven the results of genetic balding. On the midline

of the brow, it typically begins 2 cm above the uppermost forehead wrinkle.

Modified NoKor – an ordinary 18 gauge NoKor needle that has be modified in order that the blade is 1 mm in

diameter. Its particular use is for the creation of single hair recipient websites in sufferers with hair of common diameter and for one and two hair models in sufferers with fantastic hair.

Miniaturization – the progressive diminution of hair shaft measurement usually related to the lack of pigment

on account of genetically decided results of androgenic hormones on the hair follicle.

Pure Hair Groupings – the variety of hairs naturally rising collectively as a result of anatomic fusion or

affiliation of particular person hair shafts. These hairs could share anatomic buildings and emerge from a single or adjoining follicular orifices.

Unique Hairline – the teenage or adolescent hairline which is usually flat, i.e., doesn’t present bitemporal recession.


1. Headington JT: Transverse Microscopic Anatomy of the Human Scalp. Arch Dermatol 1984; 120:450.

2. Rassman WR, Pomerantz MA: The Artwork and Science of Minigrafting. Worldwide Journal of Aesthetic and Restorative Surgical procedure 1993; 1:28-29.

3. Stough, DB: Worldwide Society of Hair Restoration Surgical procedure, Third Annual Assembly 1995; Verbal Communication.

4. Haas AF, Grekin RC: Antibiotic Prophylaxis in Dermatologic Surgical procedure. JAAD 1995; 32:155-164.

5. Salasche SJ, Bernstein G, Senkarik M. Surgical Anatomy of the Pores and skin. Norwalk, Connecticut: Appleton and Lange, 1988 pp 176-177.

6. Rassman WR, Carson S: Micrografting in Intensive Portions, The Perfect Hair Restoration Process. Dermatologic Surgical procedure 1995; 21:306-311

7. Larson PO: Topical Hemostatic Brokers for Dermatologic Surgical procedure. J Dermatolgic Surg. Oncol. 14:6 1988.

8. Marritt E, Dzubow L: The Remoted Frontal Forelock. Dermatologic Surgical procedure 1995;21523-538.

9. Transplant Videografting System of the Skilled Hair Institute; displayed on the Worldwide Society of Hair Restoration Surgical procedure, Third Annual Assembly 1995.

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