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· Abstract · Who is a Candidate? · Laser Hair Removal · Electrolysis · Punch Removal · Donor Site Repair · Treatment of Surgical Scars · Results and Conclusions · References · Home · Back to HT Website |
BACKGROUND: Implanted hair follicles,
like zucchini seeds in Hawaii, generally take and grow well. This can
be desirable or undesirable, depending on the skill and aesthetic eye
of the surgeon. Older methods employing larger grafts often produced
pluggy, bristle brush, or "Barbie doll" hairlines that were unsightly
and conspicuous. OBJECTIVE: Since patients possessing these outcomes often seek corrective measures, a search was undertaken to uncover effective, corrective repair methods. Unfortunately, relatively little has been published on this subject in the past. METHODS AND RESULTS: Discussion will center on recipient site repair, donor site repair, and scar repair. Recipient sites can be improved with a combination of laser ablation, electrolysis, punch removal, and fill-in micrografting. Donor sites can be improved by re-excision, undermining, tissue expansion, and layered closure. Scalp scars may be improved by punch excision and micrografting. Surgical scars can also be improved by excision and micrografting. CONCLUSIONS: Satisfactory improvement for untoward hair transplantation outcomes may be obtained with one or more corrective procedures in many patients. The best hair transplants are virtually undetectable. The worst, and even the below-average, serve to discourage potential patients and cast a negative impression toward the specialty of hair replacement surgery. These problems can result from plugs, minigrafts, scalp reductions, wide donor harvesting scars, use of wrong-sized grafts for that particular patient, and inattention to factors such as color match, distribution, density, and coarseness. Balding is natural, and in this instance one starts at "ground zero". However, untoward results from visible grafts or scars are not natural - in this case, one is starting with a "negative number" or disadvantage. Many examples have been presented in the literature with beautiful results from virgin bald cases. Much has been written about newer hair transplantation techniques such as follicular grafting, rapid graft preparation, and rapid graft implantation. However, surprisingly little has been discussed about the difficult science of hair repair surgery. The author would like to share with you observations gained from twelve years of hair repair surgical experience (Ref 1, 2). It has become obvious, from many surgical situations, that one cannot simply camouflage plugs with micrografts or minigrafts placed in front of them. (Ref. 3). - click to enlarge photos -
Rather, one must do something to thin the plugs or larger minigrafts before attempting to hide them - in other words, these larger grafts must be converted to finer grafts or micrografts. Alternatively, one can remove the larger grafts altogether. The surgeon can utilize the "visual unit" concept to visualize these repair techniques. A study of naturally occurring vegetation facilitates comprehension of this concept. Each clump, or group of hair follicles, whether it contains 1, 3, or 20 hairs, (or each tree trunk or shrub, whether it contains one large branch or 20 small branches) represents one visual unit. Visual units that are small and closely spaced blend well together, whereas dense or widely separated visual units remain stark and coarse. A privet hedge, even though containing a much smaller cross sectional area than that possessed by larger trees or branches, still appears so dense that one is unable to see through it. Therefore, a given area may generate the "illusion of density" even though it contains hairs that are not greater in number, but rather more widely distributed. - click to enlarge photos -
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