Robert M. Bernstein, MD,*† William R. Rassman, MD, ‡ Nazia Rashid, and Richard C. Shiell, MBBS
*College of Physicians and Surgeons, Columbia University, New York, New York
†New Hair Institute Medical Group, A Professional Corporation, New York, New York and ‡Los Angeles, CA
Dermatologic Surgery 2002; 28(9): 783-94.
© 2002 The American Society for Dermatologic Surgery
This is the first of a two-part series. Part I discusses the most common problems encountered in surgical hair restoration and presents general concepts in corrective work. Part II addresses the technical aspects of performing the actual restoration.
PART I: General Aspects of Repair and Basic Repair Strategies
Introduction to repair
Cosmetic problems produced by poorly executed hair transplants
Major limitations inherent in restorative procedures
Basic repair strategies
PART II: The Tactics of Repair
Why Follicular Unit Transplantation is the ideal tool for repair
Specific repair techniques
Removal and re-implantation
Special cosmetic problems
Repair of the donor area
An increasingly important part of many hair restoration practices is the correction of hair transplants that were performed using older, outdated methods, or the correction of hair transplants that have left disfiguring results. The skill and judgment involved in these repair procedures often exceed those needed to operate on patients who have had no prior surgery. The use of small grafts alone does not protect the patient from poor work. Errors in surgical and aesthetic judgment, performing procedures on non-candidate patients, and the failure to communicate successfully with patients about realistic expectations, remain major problems.
This two-part series presents new insights into repair strategies and expands upon several techniques previously described in the hair restoration literature. The focus is on creative aesthetic solutions to solve the supply/demand limitations inherent in most repairs. This article is written to serve as a guide for surgeons who perform repairs in their daily practices.
The repairs are performed by excision with re-implantation and/or by camouflage. Follicular Unit Transplantation is used for the restorative aspects of the procedure.
Using punch or linear excision techniques allows the surgeon to relocate poorly planted grafts to areas that are more appropriate. In special situations, removal of grafts without re-implantation can be accomplished using lasers or electrolysis. The key elements of camouflage include creating a deep zone of follicular units, angling grafts in their natural direction, and using forward and side weighting of grafts to increase the appearance of fullness. The available donor supply is limited by hair density, scalp laxity and scar placement.
Presented with significant cosmetic problems and severely limited donor reserves, the surgeon performing restorative hair transplantation work faces distinct challenges. Meticulous surgical techniques and optimal utilization of a limited hair supply will enable the surgeon to achieve the best possible cosmetic results for patients requiring repairs.