S432: Hair Transplantation and Micrografting for Oral and Maxillofacial Surgeons

Abstract

Hair transplantation is the most commonly performed cosmetic procedure for facial enhancement. Its efficacy is based on over forty years of study, which began with Dr Norman Orentreich’s original paper on the theory of “Donor Dominance.” In this paper, he noted that grafts taken from hair-bearing areas on the back and sides of the scalp would become: “Donor Dominant” and grow at recipient sites on the front and top of the scalp. These grafts, if properly selected and taken, could then continue to grow hair for the rest of the patient’s life. A complete understanding of male pattern baldness is needed to have a basic overview of which patients are candidates for hair transplantation. There are over seven categories of male pattern baldness in which hair loss is both genetically and hormonally (androgens) controlled. Similarly, areas of the scalp (back and sides) on the same individuals, who have male pattern baldness, have the genetic predisposition to continue growing for life. However, in assessing candidates for transplantation, potential donor areas that exist must be sufficient to cover the balding or thinning areas completely; and, certainty should be evaluated for hair density, in order to achieve the most favorable cosmetic results. The procedure utilized in this discussion will be punch grafting and critical to its success is careful staging of transplantation so that all grafts receive optimum blood supply. Equally important is hairline placement, which is drawn in relationship to the concept of facial thirds. Studies of punch grafting techniques have supported the fact that donor grafts must be taken along the hair shafts to optimize the number of growing hairs in each graft. Hair direction, as well as the selection of proper punch diameter size, is also critical in achieving optimum cosmetic results. Over the past several years, the most refined method of hair transplantation involved the placement of micro and minigrafts, which can be utilized to completely correct areas of alopecia and/or further enhance the frontal hairline. Micrografts contain from one to three hairs, minigrafts from four to eight hairs, which produce a more delicate result, more closely resembling hair growth prior to balding. These grafts are usually taken from a donor strip. Through meticulous microsurgical technique, single hair follicle may also be used. Additional grafts can be placed throughout the transplanted area in order to blend hair and achieve the fullest appearance. This virtually eliminates the “tufted” look often created by individuals unfamiliar with the true art of hair transplant surgery. Lastly the postoperative use of medication, proper bandaging and careful cleansing of each graft in the immediate postoperative phase insures virtually 100% graft survival.