follicular unit transplantation (hair transplantation) for alopecia

Last edited 08/2023 and last reviewed 09/2023

Hair transplantation involves relocation or transfer of hairs from the occipital area to the bald area.

• follicular unit hair transplantation is a surgical treatment of baldness in which follicular units of hair, (consisting of naturally occurring bundles of hairs), are dissected under a stereomicroscope and transplanted in the bald area so as to give natural look
  • follicular unit transplantation preserves the normal pattern of the patient
    • follicular units allow graft placement in smaller recipient sites, as the units have roughly the same size irrespective of the number of hairs in them; so dense packing is possible and this yields satisfactory cosmetic appearance
    • method is presently considered the gold standard method of hair transplantation
    • can be performed in both male and female patients, although the outcomes appear better for men (1)
    • patients need to have sufficient donor hair - the best site is from the neck region of the scalp (1)
    • outcomes are variable, and depend to a large extent on the skill / experience of the surgeon (1)
    • treatments are very expensive and patients need to give considerable thought before having such a procedure performed
      
      
• mini-micro-grafting is a method hair transplantation involving randomly assorted groups of hairs, with out consideration of their natural configuration of follicular units, under loupe or naked eye examination. Mini-grafts consist of 4-5-6 hairs while micro-grafts consist of 1-3 hairs
  
  
• punch transplantation is a method of hair transplantation using punch grafts extracted from occipital area and transplanted in to recipient sites created by punches. This method gives ugly cosmetically unacceptable results and should no longer be used

Rationale for hair transplantation:

• occipital area is unaffected by balding process and the hairs in this region last a life time; i.e. they are permanent
  • since male pattern hair loss shows donor dominance, they can be relocated to the bald area where they will grow in a normal pattern

Indications:

• accepted indications include androgenetic alopecia both in males and females. In females, the procedure should be undertaken after appropriate investigations to rule out underlying causes such as iron deficiency, thyroid disorders, other hormonal imbalances etc

Most patients will need concurrent medical treatment since the process of pattern hair loss is progressive and may affect the remaining hairs

Reference:

• Primary Care Dermatological Society. Alopecia (Accessed 22/8/23)