The ultimate hair transplant technique has to respect the only remaining limitation to the surgical treatment for hair loss, each patient has a fixed amount of good genetic hair from the sides and back of their scalp that can be used to transplant in the balding area.
It is of paramount importance that the hair transplant surgeon is entirely focused on ensuring every transplanted graft survives and grows. Any technique or procedure that ultimately increases the percentage of survival of the transplanted hair should be used. Conversely, any technique or procedure that decreases survival must not be used.
The techniques that maximize survival of the grafts during the hair transplant are as follows:
Having a doctor (not a technician),
who is highly trained, perform the hair transplant.
physician can legally perform hair transplants, even if they have
little or no training. It is of utmost importance that any doctor
performing hair transplants should have formal training under the
strict guidance of a residency or fellowship program. Taking a
weekend course on hair transplants or "on the job" hair transplant
training at one of the big hair transplant clinics is inadequate.
Over the past ten years there are many doctors that have tried to
automate the hair transplant process (in order to perform two or
three hair transplants a day); in doing so, they have effectively
taken the physician out of midst of the hair transplant procedure
and replaced him with a technician (who performs the hair transplant
unsupervised). I fail to see the quality in performing the hair
transplant in this style and believe the doctor should be doing the
hair transplant surgery.
Being meticulous and not rushing the hair transplant procedure.
Typically a hair transplant lasts four to seven hours, therefore, if
the hair transplant physician is going to be involved in every step
of the hair transplant process he can perform only one hair
transplant procedure a day.
Natural Hair Grouping Transplants.
Hair does not just come out of the scalp individually, one by one,
but actually grows naturally in groups of one to four hairs with a
fibrous sheath surrounding them.
Since that is how God designed everyone’s scalp, that is how we do a
hair transplant. We perform hair transplants with the single hair
groups on the hairline and the natural groups of three and four
hairs farther behind for density. The benefit of performing
the hair transplant with the individual "natural hair groupings" is
the completely natural look we achieve and a higher survival rate of
the transplanted grafts.
try to obtain a natural look, many doctors now perform transplants
with what is called "single hair micro grafts." They separate the
"natural hair groupings" into single-unit hair grafts and transplant
the hairs individually. By separating the natural groupings of hair,
the transplant surgeon is going against nature. A study published in
the Journal of Dermatologic Surgery showed that the survival and
quality of these grafts markedly decreases. (Follow this link for
photos and results of this study) The best alternative is to mimic pattern
as God designed it, instead of trying
to change it.
The photos below shows patient immediately post-op who had "Single
Hair Micrografts" transplanted on the left side of the patients
Vertex and the "Natural Hair Groupings" Grafts transplanted on the
right side of the patients Vertex.
Using the Stereoscopic Microscope in order to dissect out the grafts.
stereoscopic microscope is probably the most important innovation in
hair transplants. The "natural hair groups" must be preserved intact
during dissection to insure increased survival and growth. Many
doctors dissect with the naked eye or with minimal magnification.
That leads to increase transection and destruction of the hair. When
dissecting the donor hair without the stereoscopic microscope it is
nearly impossible to ensure that the "natural hair groupings" will
For a balding man seeking a transplant, his most precious commodity is his
“hair bank," hair that is available as a source for
transplants The use of the "stereoscopic microscope" to
dissect the grafts enables me to visualize each and every individual
"natural hair grouping." By using the "stereoscopic microscope" the
trauma to the surrounding hair is greatly reduced and our patients receive
superior quality grafts with a much higher incidence of survival. I
can now achieve survival rates of 95 to 100 percent, as compared to other
techniques where the survival rate is much less. The "stereoscopic
microscope" also enables us to trim excess tissue away from the hair
follicle, therefore, smaller incisions can be made, which enables us to pack
the grafts closer together to give a denser look.
Hairline design and graft placement techniques.
design of the hairline is crucial to the overall look of
naturalness. A physician could use all the latest techniques and
technology but still create unnatural looking hair transplant
because they do not understand the aesthetics of a natural human
hairline. There are five important area of concern when creating an
aesthetically natural hairline and frontal forelock.
anterior (or central) starting point of the frontal hairline:
Many hair transplant surgeons (or their technicians) place the hairline too low on the forehead, which will never look natural as the patient ages. Particularly with younger hair transplant patients who have more extensive baldness, the hair transplant surgeon needs to create a more conservative pattern that will look natural now and twenty years from now.
The lateral frontal hairline:
Many hair transplant surgeons (or their technicians) design too wide
of a frontal hairline can create the look of an unnatural comb-over
The angle of the hair exiting the scalp:
angle of the hair gets more acute at the more anterior (frontal)
part of the hairline. Many hair transplant surgeons (or their
technicians) create the incision so the hair comes out perpendicular
to the scalp, which is not aesthetically pleasing and does not cover
the scalp as well. This also looks unnatural since your hair
would not normally grow in this direction.
The irregularity of the frontal hairline:
human hairline is naturally very irregular. It is a common mistake
of hair transplant surgeons to make the hairline too symmetrical and
too linear. The human eye is naturally drawn to lines, which will
draw unnecessary attention to the hairline and make the patient
self-conscious. An irregular hairline is natural and does not draw
attention to it.
Direction of the incision
hairs in a follicular unit typically sit side by side when looking
at hair from front to back. This is a cosmetic benefit because the
hairs are in a row instead of lined up behind one another, which
gives a thicker cosmetic result. Therefore, the incision with the
needle should be placed with the long axis going from ear to ear
(coronal incision) versus from front to back (sagittal incision).
Since hairline design is so important to the overall result, it is
vitally important that your hair transplant surgeon has been
properly and formally trained in the art of hair restorations. Never
let a technician design your hairline.