Commentary on: use of nape and peri-auricular hair by follicular unit extraction to create soft hairlines and temples: my experience with 128 patients.

Abstract

For many professionals, as well as the lay public, the results of hair transplantation still evoke images of a pluggy or doll's hair appearance. However, the standard of care today is to create a hairline that appears completely natural and not surgically created. Advances which have led to this current expected level include improved instrumentation, clinical observation of normal hairlines, and recognition of the different qualities of hair that reside in the safe donor area (SDA). Another recent advance in the field of hair restoration surgery is the donor harvest technique known as follicular unit transplantation (FUE).1-4 The primary advantage of FUE is the absence of a donor site scar following traditional strip excision. While there are several additional advantages to the FUE technique, the ability of a patient to wear a short hair style without a concern for donor scar visibility is the major reason patients choose this approach. Another important concept of hair restoration surgery which is germane to this article is the “variable” permanence of the most inferior aspect of the SDA. The concept of donor dominance, which is the principle reason transplants work, was originally described by Oreintreich,5 who demonstrated the “permanence” of occipital and temporal hair (ie, the donor fringe or SDA) when transplanted into areas of alopecia. Not recognized at the time of Orentreich's original description, but addressed by Unger and Cole6 and recognized by others subsequently, is the often progressive nature of hair loss in the SDA from the bottom up. Dr Umar7 has focused this article on the use of nape and …