Hair Transplant

Synopsis: When follicular unit transplantation was still in its infancy, there were many detractors in the hair transplant community. This paper defended the procedure and explained its superiority over other hair replacement techniques in producing the best short and long-term cosmetic results.

Synopsis: This section, published in a textbook for professional estheticians, explains basic concepts of follicular unit hair transplantation in easy-to-understand terms.

Synopsis: This article uncovers an attempt by the proponents of slot grafting to rename this technique (which produces poor cosmetic results) and call it “follicular unit coupling,” so that unwary patients will think that it is actually a variation of follicular unit transplantation.

Synopsis: This short paper summarizes the article that advises to physicians to limit the use of adrenaline when performing large hair transplant sessions and it explains various practical ways to accomplish this.

Synopsis: This paper argues for standardization in the classification of various hair transplant techniques in order to facilitate communication between hair restoration surgeons and their patients and to aid in scientific research.

Synopsis: As the twentieth century drew to a close, this paper looked into the future to try to discern the direction that hair transplantation was headed in the next millennium. Particular areas of interest were; the follicular unit/mini-micrograft controversy, graft storage mediums, how to maximize the donor supply, methods to enhance wound healing, automated devices, lasers, new medications, cloning and genetic engineering.

Synopsis: This editorial cautions that new instruments made to cut the donor strip rapidly, by placing the strip on a grid of knives, cause unacceptable levels of graft damage. The author advises that these devices should not be used in surgical hair restoration.

A New Surgical Instrument For the Automation of Hair Transplantation WILLIAM R. RASSMAN, MD, Los Angeles, CA ROBERT M. BERNSTEIN, MD, New York, NY Dermatologic Surgery 1998; 24: 623-627. Background As hair transplantation evolved into a procedure in which large numbers of very small grafts are moved in a single session, new problems have emerged.

Synopsis: The “Carousel” is an automated device used for hair transplantation that simultaneously makes recipient sites and inserts grafts. The instrument can hold up to 100 grafts at time. In theory, the instrument could decrease the total operative time and eliminate some human factors that contribute to graft injury during the hair restoration process. The Carousel, however, was limited in that very close graft placement was not possible and it could not account for the great variability in the human scalp that sometimes rendered the device ineffective.

Synopsis: Dr. Bernstein heads a group of twenty-one hair restoration surgeons in an attempt to standardize the classification of follicular unit transplantation and other small graft procedures, including various technical aspects of graft harvesting, graft dissection, and placement. The goal is to standardize the nomenclature, and formally describe other factors in the surgery, so that communication between physicians and patients may be enhanced and different hair replacement procedures may be examined and compared.

Synopsis: A satire on the perceived resistance of hair transplant surgeons to accept new ideas and adapt new technologies.

Synopsis: This book explains, in layman’s terms, the causes of hair loss, the way it is diagnosed and how androgenetic alopecia is treated – using medical therapy or surgical hair restoration. The book focuses on Follicular Unit Transplantation, but covers a wide range of topics from the emotional aspects of hair loss to steps one should take when considering hair transplant surgery.

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Synopsis: This article acknowledges the wide variability in the anatomy of follicular units, but challenges the notion that using grafts larger than naturally occurring follicular unit is advantageous, if it necessitates using larger recipient wounds.

Robert M. Bernstein, MD, New York, NY William R. Rassman, MD, Los Angeles, CA Dermatologic Surgery 1998; 24(8): 875-880. Background The increasing importance that hair transplant surgeons are placing on maintaining the integrity of the naturally occurring follicular unit, has generated great interest in finding the ideal method of graft dissection. Objective The present study

Synopsis: This was the first objective study that showed that using stereo-microscopic techniques to dissect follicular unit grafts, was superior to loop magnification in preserving follicular units and reducing the transection of follicles.

Synopsis: This editorial reviews a study suggesting that ATP can be used to increase the life of grafts while they are being held outside the body during a hair transplant.

Synopsis: This paper traced the beginnings of Follicular Unit Hair Transplantation from Headington’s histologic description of the follicular unit, Limmer’s single strip harvesting and stereo-microscopic dissection and then Bernstein’s idea to use the follicular unit as the sole graft type in the hair restoration process.

Synopsis: This writing stresses the importance of objective scientific measurements in patient evaluation and surgical planning prior to a hair transplant. Specifically, it explains, in mathematical terms, the greater contribution of hair shaft diameter as compared to the number of hairs in the appearance of fullness.

Synopsis: An editorial that challenges the assumption that insufficient blood supply in a hair transplant is the main contributor to delayed growth.

Synopsis: This editorial challenges those who claim to not have seen delayed growth to look more carefully, since large-graft hair transplants interrupt the blood supply to a greater extent than using large sessions of very small grafts.

Robert M. Bernstein, MD, New York, NY William R. Rassman, MD, Los Angeles, CA Dermatologic Surgery 1997; 23(9): 785-799. Background Follicular Transplantation is a method of hair restoration surgery which uses hair in its naturally occurring groups called follicular units. Using the follicular unit exclusively in the transplant, the surgeon can create hair patterns that

Synopsis: This article focuses on various aesthetic aspects of follicular unit hair transplants including hair distribution, density, hairline design, and temple and crown restoration. It also examines racial variations that can affect the hair restoration. Together with the 1995 paper, these paired articles laid the foundation for Follicular Unit Hair Transplantation.

Robert M. Bernstein, MD, New York, NY William R. Rassman, MD, Los Angeles, CA Dermatologic Surgery 1997; 23(9): 771-784. Background Follicular Transplantation is a method of hair restoration surgery which uses hair in its naturally occurring groups called follicular units. By using the follicular unit exclusively in the transplant, the surgeon can move extensive quantities

Synopsis: This landmark paper details how a patient should be evaluated for Follicular Unit Transplantation, stressing densitometry as a means of assessing both miniaturization and donor supply. It also provides guidelines for the planning of the first and subsequent hair transplant sessions and discusses the management of patients with diffuse androgenetic hair loss.

Synopsis: This short article describes the design for a wall-mounted placing stand that can store, chill and protect grafts while they are waiting to be placed into the scalp during the hair restoration procedure.

Synopsis: Hypothesizes the possible causes of delayed growth following a hair transplant procedure. It differentiates between physiologic factors that cause normal variations in the growth cycle and those due to graft injury that can possibly be prevented by meticulous surgical techniques.

Synopsis: A short paper that describes the cause and treatment of the occasional itching that follows a hair transplant procedure.

Synopsis: This writing explains the rationale for using large numbers of grafts in surgical hair restoration. It discusses the advantage of megasessions in conserving the donor supply, increasing patient satisfaction, and providing greater flexibility to the surgeon in sorting and distributing small grafts.

Synopsis: This was the first paper to challenge those promoting laser hair transplants and who claimed that lasers would be the future in surgical hair restoration. The publication stressed that lasers caused damage to the recipient area and could result in scarring and poor growth. It explained why lasers were, in fact, inferior to cold steel techniques in making recipient sites.

Synopsis: This publication, written when scalp reductions were at the height of their popularity, cautioned that scalp reductions caused unnecessary scarring, used up precious donor reserves and caused more cosmetic problems than they solved. It suggested that, with the advent of the more robust follicular unit hair transplantation, scalp reductions should not be used in the treatment of androgenetic hair loss. This publication, along with the 1993 paper of O’Tar Norwood, played a critical role causing the rapid decline in the use of scalp reductions in hair restoration surgery. Fortunately, this once common procedure for male pattern alopecia is now rarely used.

Robert M. Bernstein, MD, William R. Rassman, MD, Wojciech Szaniawski, MD, Alan J. Halperin, MD SUMMARY of Follicular Transplantation. International Journal of Aesthetic and Restorative Surgery 1995; 3(2):119-132. Follicular Transplantation culminates more than 30 years of hair transplant evolution – from large plugs to the much smaller mini-micrografts. Its development, however, stems from a very

Synopsis: This was the first paper on Follicular Unit Transplantation. This publication introduced into the medical literature the idea of using individual, naturally occurring follicular units exclusively in the hair transplant procedure and stressed using large sessions to maximize the aesthetic outcome. The paper defined the various components of Follicular Unit Hair Transplantation, explained the anatomic and physiologic advantage of using follicular units in the procedure and described how follicular units could be used safely in large numbers to complete the hair restoration as quickly as possible. This publication was instrumental in having hair restoration surgeons shift from the older mini-micrografting techniques to the cosmetically superior technique of using follicular units.