Philosophy and technique in hair restoration surgery

Abstract

Hair restoration surgeons can now evaluate the results of 25 years of hair restoration techniques. With the advent of total micrografting and a sharp decline in scalp reduction procedures, a new era of hair restoration has begun. These changes call for a reevaluation of patient selection and procedure planning. Surgeons need no longer to struggle for coverage of the entire bald scalp, because new techniques use the visual qualities of hair and varying design patterns to create the optical illusion of more hair than is actually present. The creation of a high, mature, static hairline with prominent frontoparietal recessions and a thin, albeit natural, look has revolutionized the way hair restoration surgery is approached. This new approach affects philosophic issues, candidate selection, hairline design, and surgical technique. The main impetus for recent changes in hair restoration surgery has been twofold: (1) the use of one to four hair grafts, which allows a natural, undetectable hairline, and (2) the transplantation of large numbers of these small grafts during a single session. Older techniques were milestones in their time but were often unnatural in appearance, disfiguring, and did not address long-term concerns. Newer philosophies and techniques are geared towards naturalness and undetectability for the lifetime of the patient. The driving force that has led to the use of smaller grafts and a more natural product has been a study of outcome assessment of previous hair restoration procedures. Instead of short-term goals, the surgeon and patient are now beginning to consider the long-term outcomes of various techniques and procedures. A cosmetically pleasing, long-lasting, undetectable transplant has become the ultimate goal regardless of how dense or complete the transplant is. In our reevaluation of the philosophies and techniques in hair restoration surgery, we address each aspect of the process leading to the desired final product — a natural, undetectable transplant that withstands the test of time.