Hair

transplantation

Introduction
Treatment option of hair loss are important and
growing in cosmetic surgery because of many
male pattern baldness and increased number of
female pattern baldness
Hair transplantation remains the gold standardnatural and undetectable look
We can use hair transplantation in cleft patient
or with facial lift technique etc. in oral &
maxillofacial surgery

History of Hair transplantation

1939 Okuda : first surgery in present method
(standard punch graft)
1959 Orentreich : donor dominance
1970 Orentreich, Ayres : minigraft, micrograft
1996 Rassman : emphasize the
follicular unit graft
Seagel : emphasize the microscope
present technique : composite graft
ex) micrograft + minigraft

Principle

Donor dominance
: key for successful hair transplantation
each hair follicle contains its own unique genetic makeup.
When transplanted to another site, its original genetic
properties are preserved regardless of the transplantation
site
The occipital area is the most desirable donor site for hair
transplantation (as it usually is genetically programmed to
grow hair for a lifetime)

Indication
Correction of baldness
Eyebrow reconstruction
Eyelashes graft
Beard or whiskers graft
Graft of scar area
-in cleft patient : lip area
-after facial lifting technique
-scar of scalp

Classification of alopecia

Androgenetic alopecia
- Male pattern baldness
- Famale pattern baldness
Alopecia areata
Telogen alopecia
Anagen alopecia

Androgenetic alopecia

< Male pattern alopecia >

A;M , B;C , C;O ,
D;U , E;MO , F;CO

< Female pattern alopecia >

Grade I, Grade II, Grade III

Anatomy of Hair
Infundibulum
Isthmus
Matrix
Hair shaft
-hair cuticle
-hair cortex
-medulla

Cycle of Hair

Anagen (3-7 yrs)

Catagen (1-3 wks)
Telogen (3 months)
0.35-4mm / day

(arector pili muscle;APM,

bulge(B), cortex(C), dermal
papilla(DP), epidermis(E), inner
root sheath(IRS), matris(Md),
outer root sheath(ORS),
sebaceous gland(S)

Anatomy of Scalp
a. Occipital m.
b. Subaponeurotic layer
c. Galea aponeurotica
d. skin
e. Subcutaneous fat
f. periostium
g. Cranial bone
h. Frontal m.

Donor site

Boundaries

Inferior margin : within a

margin of clearance of about
2.5 cm from the lateral and
inferior fringes of the
occipital hairline

Latral limit : vertical line extended

upward in the preauricular area
Upper limit : horizontal line drawn
from about 5 cm from the tops of
the external ears

5cm

2.5cm

Harvesting
the incision lines :
parallel the lines of minimum
tension line
(in order to avoid collagen
transection scarring)

parallel to the orientation of hair

follicles (in order to avoid
follicular transection)
ex) Taprering the ends :
trapezoidal pattern

Determining the nomber of

grafts needed
100 units or 200 hairs in 1X1cm area
on the occipital donor area
Densitometer
For example, 700-1500unit graft
7-15cm2 needed
for 1000 graft session 1.5X6.5cm or 1X10cm
if tight occipital scalp

Closure of donor site

simple one-layer closure
significant tension exists
modification of deep plane
fixation
To minimize scarring
-no more than 1.3cm width
-check for donor site
elasticity

Recipient site

Hair line
Transition zone :
anterior portion
-soft, irregular hair
Defined zone :
posterior portion
-more defined, dense
hair
Lateral hump

Recipient site angulation

Comparision : the angles of openings were
10[degrees], 45[degrees], and 60[degrees].
10 degree : denser, natural appearance
In most patient
acutely angled (10degree-30degree)

Operation

Anesthesia
Dental syringe 1% xylocaine with 1:100,000
epinephrine or more diluted solution
Block anesthesia
-supratrochlear n. supreorbital n.
-zygomaticotemporal n.
-auriculotemporal n.
-lesser and greager occipital n.
Tumescent anesthesia

Tumescence
Infiltration of solution below
the dermis
Good tissue turgor
(hardness)
Spread out the follicules
allowing minimal hair shaft
transection during incision
Lift the subcutaneous
tissue away from the
occipital artery

Transection of hair follicle

when punch is used
Cause of tumescence

Operation technique
Standard punch graft
: 20-30 hairs
Minigraft : 3-4 hairs
Micrograft : 1-2 hairs
Slit graft : slit shape
Follicular unit graft

A. micrograft,
B. minigraft
C. standard graft

Operation technique
Megasession : > 1000 follicular units
Maxisession : > 5000 follicular units
A typical session : 700-1500 follicular units
or 1500-2000 follicular units
Micrograft megasession

Follicular unit graft

Hair follicles did not

just grow individually
but often 2,3 or 4 hair
(average 2 hairs
-cochacian: 2.3
-oriental: 1.7 )

Average density :
1/mm2 or 100/cm2

Follicular unit graft

Natural undetectable look
Damage to hair follicle
( > minigraft, < single hair graft)
Lesser hair density
Less tissue insulation of follicle
Difficult technique

Operation

Operation

Operation

Operation
dilator

transplanter

Post-op. care
Complication :
inclusion cyst (ingrowth hairs) occuting im 10%
patient.
Post-op 3 weeks : transplanted hair fell out
Post-op 3-6 months : new hair coming out
Grow 1cm/month
Post-op 9months : the effect of hair transplantatn

Survival rate after follicular

unit transplantation
Few report about survival rate and fate of
micrograft In orientals (92%, in korea)
In korea, survival rate : 80-90 %
In Canada (6months)
- one hair micrograft : 82 %
- follicular unit graft : 113 %

Combination of face lift and hair

transplantation

Conclusion

The donor site routinely looks excellent even after

multiple procedures
Debate persists over whether the smallest grafts
are always preferable; however, in most cases
follicular unit micrografting is better
We can use hair transplantation in cleft patient or
with facial lift technique etc. in oral &
maxillofacial surgery