Evolution of hair transplantation
Introduction:
Hair transplantation has gone through a big revolution with the pioneers in this field. To achieve a good cosmetic result in hair transplantation, a natural-looking hairline with adequate density shall be established. There are numerous modifications of defined techniques with each one explaining and suggesting verified solutions.
This note describes the available options in hair loss surgery and the concepts of non-surgical approaches, and an experience is shared with a few patients grafted via direct hair implantation (DHI) method. Moreover, to us, this is the only study demonstrating the opening of the nests with sliced razor blade just before the implantation of the hair follicles. Thus, the evolution with the future of hair transplantation is summarized as well. Moreover, this article focuses on the surgical techniques. The medical management of hair loss is out-of-scope.
Methods:
Between January and December 2014, hair transplantation was carried out in 207 patients. The patients with beard and/or moustache transplantation, multisession transplantations and female patients were excluded. The harvested grafts out of the scalp were also not evaluated.
All the procedures were carried out under local anesthesia. The hair was cut 1-2 mm in length. Micromotor system was used in the harvesting of the hair follicles. This system consists of punches attached to the hand-piece of the micromotor system (1500-3000 rpm). Punches were chosen according to the diameter of the follicles ranging between 0.8 and 1.2 mm. Harvesting of the follicles was handled in supine position. With the aid of the sharp punch attached to the motorized system, the follicle was detached from the surrounding tissue (approximately 3-4 mm in depth=deep dermis layer). Later on, it is released manually with fine-curved microforceps produced for this purpose. Temporooccipital region was used as donor site.
The harvested grafts were aligned in Petri dishes with cooled saline (4 °C). A dressing is made with sterile saline coated gauze to the donor area and the patient was turned to the supine position.
In follicular unit extraction (FUE) technique, razor blade that was cut into pieces was used to open the nests in vertically-oriented fashion that are to be grafted . With this, we aimed to diminish the incarceration of the implanted follicles. However, in DHI technique, the grafts were loaded to the DHI pens with one charged staff for this purpose. The implantation of the follicles was carried out in accordance with the natural hair angles by the author under loupe magnification .