The Use of Body Hair with Scalp Hair for “Combination Grafting” to Enhance Visual Density of Hair Transplantation
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VOLUME 28 I NUMBER 6 NOVEMBER/DECEMBER IN THIS ISSUE The Use of Body Hair with Scalp Hair for “Combination Grafting” to Enhance Visual Density of Hair Transplantation Why I Switched to and Increase Coverage in Advanced Alopecia a Multiphasic FUE Device Anil Kumar Garg, MBBS, MS.MCh, FISHRS I Indore, India I [email protected]; Seema Garg, MBBS, MSc I Indore, India Case Report: Those ABSTRACT pesky dots. What are Introduction: Hair transplantation is becoming the most common cosmetic procedure for men across the they? world with demand for higher density and treatment of extensive hair loss. This requires a higher number of donor follicles. Beard and body follicles can be used in addition to scalp hair as donor in suitable patients. Objective: To demonstrate the use of body hair to increase the visual density and for better coverage New ISHRS Website for higher grades of androgenetic alopecia (AA). Offers Improved Method & Material: Sixteen patients were selected due to the availability of body donor hair and con- Design, Functionality sent for body hair harvesting was taken. The beard was the first preference and then chest and abdominal follicles were used in combination with scalp hair follicles to treat Norwood grade IV and above. Beard and body hair were harvested using the follicular unit excision (FUE) technique. Post-operative pictures Black Market Awareness were taken and patient satisfaction, doctor’s observation, and global photographic evaluation was done. Campaign Update Results: Following hair transplantation, patient photographs were taken at 4, 8, and 12 months. The results were assessed on the basis of global photography. The use of body hair combined with scalp hair Review of the 2018 greatly enhanced the visual density, leading to better coverage in even higher grades of hair loss. ISHRS 26th World Conclusion: “Combination grafting” is a good method to use to treat higher grades of hair loss as well Congress/Hollywood as to enhance the results of hair transplantation in suitable patients. Key words: combination grafting, FUE, Norwood grade INTRODUCTION Hair transplantation is becoming a very popular procedure. The demand for higher density coverage with a normal appearance is increasing. This requires a higher number of donor hair follicles. The biggest limitation of the hair transplant procedure is the discrepancy between demand and supply. Beard and body hair are a good source of donor hair follicles.1,2 We use “combination grafting” in which scalp hair follicles are transplanted with body hair follicles. Combination grafting is a similar procedure to mixed grafting in which multifollicular units (MFUs) are mixed with follicular units (FUs). This not only increases the total number of donor hair follicles but it also enhances results because of the higher diameter and visual density of beard hair. Although body hair other than the beard is thinner, it certainly adds to the coverage value and is better than scalp micropigmentation. Beard hair typically is thicker and curlier, giving higher visual density, and is used in the forelock and mid-scalp area. Beard, chest, and other body areas are non-scalp sources of donor hair follicles and their growth is androgen-dependent, which is an advantage in androgenetic alopecia. OBJECTIVE We used a combination of body hair follicles and scalp hair follicles to enhance the visual density of hair transplantation and provide better coverage for higher grades of scalp hair loss. Ø PAGE 221 November/DecemberNovember/December 2018 2018 HAIRHAIR TRANSPLANT TRANSPLANT FORUM FORUM INTERNATIONAL INTERNATIONAL 217 VOLUME 28 I NUMBER 6 I NOVEMBER/DECEMBER TABLE OF CONTENTS HAIR TRANSPLANT FORUM INTERNATIONAL is published bi-monthly by the 218 President’s Message International Society of Hair Restoration Surgery 219 Co-editors’ Messages First-class postage paid Milwaukee, WI and additional mailing offices. 224 Why I Switched to a Multiphasic FUE Device POSTMASTER Send address changes to: 228 Case Report: Those pesky dots. What are they? Hair Transplant Forum International International Society of Hair Restoration Surgery 230 Medical & Professional Ethics: Spotlight on Cosmetic vs 303 West State Street Non-Cosmetic Hair Transplant Surgery Geneva, IL 60134 USA Telephone 1-630-262-5399 233 New ISHRS Website Offers Improved Design, Functionality U.S. Domestic Toll Free 1-800-444-2737 Fax 1-630-262-1520 235 Black Market Awareness Campaign Update 236 Letters to the Editors President Arthur Tykocinski, MD, FISHRS 239 Review of the 2018 26th ISHRS World Congress [email protected] Executive Director Victoria Ceh, MPA 256 Message from the ISHRS 2019 World Congress Program Chair [email protected] 256 Message from the ISHRS 2019 World Live Surgery Workshop Chair Editors Andreas M. Finner, MD, FISHRS Bradley R. Wolf, MD, FISHRS [email protected] 260 Classified Ads Managing Editor & Cheryl Duckler, 1-262-643-4212 261 Calendar of Events Advertising Sales [email protected] Controversies Russell G. Knudsen, MBBS, FISHRS Cyberspace Chat Robin Unger, MD Difficult Cases/ Marco Barusco, MD, FISHRS Complications Hair’s the Question Sara M. Wasserbauer, MD, FISHRS Hair Sciences Vlad Ratushny, MD, PhD How I Do It Timothy Carman, MD, FISHRS Literature Review Aditya K. Gupta, MD, PhD, FISHRS Nicole E. Rogers, MD, FISHRS Medical & Gregory Williams, MBBS, FISHRS Professional Ethics Meeting Review Rachael Kay, MD The views expressed herein are those of the ISHRS a guaranty or endorsement of the quality or value Copyright © 2018 by the individual author and are not necessarily those of the of the advertised product or service or of any of the International Society of Hair Restoration Surgery, International Society of Hair Restoration Surgery (ISHRS), representations or claims made by the advertiser. its officers, directors, or staff. Information included Hair Transplant Forum International is a privately 303 West State Street, herein is not medical advice and is not intended to published newsletter of the International Society of Hair Geneva, IL 60134 USA replace the considered judgment of a practitioner with Restoration Surgery. Its contents are solely the opinions respect to particular patients, procedures, or practices. of the authors and are not formally “peer reviewed” Printed in the USA. All authors have been asked to disclose any and all before publication. To facilitate the free exchange interests they have in an instrument, pharmaceutical, of information, a less stringent standard is employed cosmeceutical, or similar device referenced in, or to evaluate the scientific accuracy of the letters and otherwise potentially impacted by, an article. ISHRS articles published in the Forum. The standard of proof makes no attempt to validate the sufficiency of such required for letters and articles is not to be compared disclosures and makes no warranty, guarantee, or other with that of formal medical journals. The newsletter representation, express or implied, with respect to the was designed to be and continues to be a printed forum accuracy or sufficiency of any information provided. where specialists and beginners in hair restoration To the extent permissible under applicable laws, ISHRS techniques can exchange thoughts, experiences, specifically disclaims responsibility for any injury and/or opinions, and pilot studies on all matters relating to hair damage to persons or property as a result of an author’s restoration. The contents of this publication are not to statements or materials or the use or operation of any be quoted without the above disclaimer. ideas, instructions, procedures, products, methods, or The material published in the Forum is copyrighted dosages contained herein. Moreover, the publication and may not be utilized in any form without the Official Publication of the of an advertisement does not constitute on the part of express written consent of the Editor(s). International Society of Hair Restoration Surgery 218 HAIR TRANSPLANT FORUM INTERNATIONAL November/December 2018 President’s Message Arthur Tykocinski, MD, FISHRS I São Paulo, Brazil I [email protected] The Future of the Hair Transplant Industry After continuous evolution in 1. Communicate to the public about what the black the hair transplant procedure market is and the harm it can cause to unknowing over the past three decades, we patients. There is nothing better than getting are now facing a dilemma: super information directly from the source: stories from high-quality clinics on the one side, offering an artistic and patients damaged by the black market clinics. If you artisanal hair transplant that makes us really proud, and on have patients suffering the consequences of a black the other side, we have the “industrial scale, assembly line” market procedure, we encourage you to ask them hair transplant clinics. The latter has been under the radar to help us by sharing their story. Please email us at for a while, but now the bad results are surfacing…mainly in [email protected]. We need to record Europe and around the Mediterranean, but soon, they will these personal experiences. Please contribute! be seen everywhere. 2. Communicate to other medical societies. Most physi- What we’re seeing is just the tip of the iceberg; soon all cians around the world have no idea that this problem this will be discovered by the public and can affect HT exists. We must inform them. The ISHRS is preparing credibility worldwide. The low-quality HT has many faces: a PowerPoint presentation for our members to use to 1) the assembly lines—where 10, 20, or more HTs are done share this information with any other medical society per day, and/or 2) the untrained doctors who supervise a for which they will give a lecture. It is important not procedure they don’t know, which is entirely an unethical only to alert prospective patients but also to inform practice; yes, that’s correct: a surgeon who is legally respon- physicians “outside HT” so they don’t unknowingly get sible for a procedure that he/she doesn’t have expertise in trapped by companies irresponsibly offering them easy and is blindly trusting the work offered by techs who are money through unethical behavior.