A Hair Transplant for a Younger, More Attractive, More Successful, More Approachable Appearance

Hair loss is a common phenomenon which will affect most of us, especially men, as we age. There are a few treatment options, particularly in the early stages. Medications such as finasteride¹ and minoxidil² can help to prevent any future hair loss. Aesthetic camouflages such as thickeners, specialized tattooing³, scalp micropigmentation, and hair systems are also available. Finally, there is hair transplant surgery.

Among men, one of the most common cosmetic surgeries is a hair transplant. Accordingly, a team of researchers from Johns Hopkins University has recently released a report which investigated some of the benefits received from investing in a hair transplant⁴.

The research team recruited 122 participants online to rate age, attractiveness, successfulness and approachability in men. The participants were shown 13 sets of photographs. Each set was composed of two images of the same man. In half of the sets, the photographs were before and after shots of a man who had received a hair transplant. The other set of photographs included two images of the same man who had not had a hair transplant. The participants who performed the rating were roughly half women and half men, between the ages of 18 – 52 years, with the majority being Caucasian with some post-secondary education.

After analyzing all of the ratings, the study authors concluded that a hair transplant could improve a man's general perception in all four categories (age, attractiveness, successfulness and approachability). Therefore this study seems to suggest that a hair transplant can deliver some very effective results. There are a few points to consider however. This was a small study, with only 13 men rated. Also important, the photographs that were used were not standardized for characteristics such as lighting and background. For instance in the example shown in the report, it is difficult to see the eyes in the pre-transplant image as the man appears to be squinting; however, they are open wide in the post-transplant image. Moreover none of the images included a man's smile as all images were of a neutral face. All of these variables could have affected the results of the study, although the authors are confident in their conclusions.

Overall, there are multiple treatments for hair loss. Hair transplant surgery probably requires one of the biggest investments but it can also be one of the more effective.

Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.

References

1. Gupta AK, Charrette A. The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride. J Dermatol Treat. 2014 Apr;25(2):156–61.


2. Gupta AK, Charrette A. Topical Minoxidil: Systematic Review and Meta-Analysis of Its Efficacy in Androgenetic Alopecia. Skinmed. 2015 Jun;13(3):185–9.


3. Rassman WR, Pak JP, Kim J, Estrin NF. Scalp micropigmentation: a concealer for hair and scalp deformities. J Clin Aesthetic Dermatol. 2015 Mar;8(3):35–42.


4. Bater KL, Ishii M, Joseph A, Su P, Nellis J, Ishii LE. Perception of Hair Transplant for Androgenetic Alopecia. JAMA Facial Plast Surg. 2016 Aug 25;

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Tools of the Trade

A wide range of tools, instruments and devices are used during a hair transplant. These instruments can include punches, robotic devices, suction-assisted devices and implanters.

Punches have been used in hair transplants since the 1930s. These instruments allow hair follicles to be released from their surrounding tissues. Punches can have a wide range of characteristics (e.g., shape, sharpness and size) that can influence their capabilities. Sharp punches, for example, can be inserted along the hair follicle, cutting the connecting tissues that hold the follicle in place. Unsharpened punches can help prevent trauma or deformation of surrounding follicles during harvesting¹. Excessive laxity (looseness) and the need for specific angles (e.g., curly hair) can increase the difficulty of punch extraction².

Robotic devices can also be used in hair transplant procedures. These devices contain sharp punches that cut around the follicle, making graft removal easy and fast³. Using robotic technology specific characteristics (e.g., follicle density, hair angle etc.) can be controlled by the physician⁴.This can help create high quality grafts and limit the time required for harvesting⁴. The ARTAS system is an example of such a device and is in use all over the world.

Suction-assisted devices can also assist a surgeon during a transplant. These devices are commonly used during follicular unit extraction (FUE) to partially or fully remove a hair follicle. Suction-assisted devices give physicians better control during harvesting, allowing punch penetration to be deep without increasing the risk of hair follicle injury⁵.

Implanters are also used during hair transplants. As the name suggests they are used to help implant harvested grafts. Sharp or dull implanters can be used in hair restoration procedures such as eyebrow and scalp restorations⁶.

If you have any questions about what type of instruments will be used during your procedure ask your hair transplant surgeon during your consultation.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Devroye J. Powered FU Extraction with the Short-Arc-Oscillation Flat Punch FUE System (SFFS). Hair Transpl Forum Int. 2016;26(4):129, 134–6.


2. Poswal A. Expanding needle concept for better extraction of body hair grafts. Indian J Dermatol. 2013;58(3):240.


3. Bernstein R. Integrating robotic FUE into a hair transplant practice. Hair Transpl Forum Int. 2012;22(6):228–9.


4. Harber R. Notes from the Editor Emeritus. Hair Transpl Forum Int. 2013;23(4):121.


5. Trivellini R. An Innovation in Suction Assisted FUE. Hair Transpl Forum Int. 2016;26(2):58–9.


6. Elliott V. Commentary on “FUE Graft Placement.” Hair Transpl Forum Int. 2016;26(2):56.

 

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Hair Transplant Terminology Cheat Sheet

To help you prepare for your upcoming hair transplant consultation, here is a cheat sheet of hair transplant options and techniques your hair transplant surgeon might suggest.

Follicular unit. Scalp hair grows in groups, with up to 4 hairs per group¹. These groups are referred to as follicular units. These follicular units contain more than just hair follicles but also contain nerves, blood vessels, collagen and muscle (erector pilorum)¹. Since these follicular units contain all the required material for survival and growth a fully intact transplanted follicular unit should flourish after being implanted.

Strip. Strip is a harvesting method that will likely be one of the first hair transplant options brought up by your surgeon. Strip is a term used to describe the removal of hair bearing skin from the back of the scalp. Follicular units are then removed from this strip through the use of a microscope and then implanted into the desired areas². You should be aware that a linear scar will be created if this method is used.

FUE. FUE stands for follicular unit extraction. It's a term that describes a harvesting technique that removes hair follicles directly from the scalp³. FUE can be used to transplant hair follicles into thinning areas as well as camouflage previous hair transplant scars^4,5.

The untouched strip. The untouched strip technique, a combination of strip and FUE, could be another option suggested by your surgeon⁶. This technique is quite an attractive option as you don't need your hair to be shaven to 1 mm in length to undergo this type of hair transplant. The strip part of this technique is very similar to the normal strip harvesting however FUE is additionally used above and below the strip border⁶. This can allow for better coverage and greater density⁶.

Non-shaven FUE. The non-shaven follicular unit extraction technique (NSFUE) may not be offered at all hair transplant clinics. In this technique the donor hair is cut short and hair follicles removed⁷. Hair follicles are then implanted in a similar fashion as the traditional FUE method.

SMP. Scalp micropigmentation (SMP) is not a hair transplant technique but it may come up as an option for those who may not meet hair transplant criteria. It's a tattoo technique that can give the impression of hair^8,9. SMP can help with camouflaging scarring and thinning areas^8,9.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Bernstein RM, Rassman WR. Follicular unit transplantation: 2005. Dermatol Clin. 2005 Jul;23(3):393–414, v.


2. Avram M, Rogers N. Contemporary hair transplantation. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2009 Nov;35(11):1705–19.


3. Dua A, Dua K. Follicular unit extraction hair transplant. J Cutan Aesthetic Surg. 2010 May;3(2):76–81.


4. Avram MR, Rogers N, Watkins S. Side-effects from follicular unit extraction in hair transplantation. J Cutan Aesthetic Surg. 2014 Jul;7(3):177–9.


5. Gho CG, Martino Neumann HA. Donor hair follicle preservation by partial follicular unit extraction. A method to optimize hair transplantation. J Dermatol Treat. 2010 Nov;21(6):337–49.


6. Crisostomo M. The Combined Technique (FUE + FUT) Without Fully Shaving Hair: Executive Untouched Strip. Hair Transpl Forum Int. 24(3):90–1.


7. Park J. Direct Non-shaven FUE Technique. Hair Transpl Forum Int. 2014;24(May/Jun):103–4.


8. Rassman WR, Pak JP, Kim J, Estrin NF. Scalp micropigmentation: a concealer for hair and scalp deformities. J Clin Aesthetic Dermatol. 2015 Mar;8(3):35–42.


9. Rose PT. Hair restoration surgery: challenges and solutions. Clin Cosmet Investig Dermatol. 2015;8:361–70.

 

 

 

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Is exposure to hair spray and other hair cosmetic products a problem?

Is hairspray popular? In a study using consumption data gathered in France, the frequency and amount of hair styling products was evaluated¹. It was found that 52% of women (294/565) used hair styling products like lacquers, gels, foams, waxes and sprays¹.  Of these hair styling products, the amount used per use for women was highest with hair spray as compared to the other styling products¹.

Is hair spray safe? Exposure to hair cosmetics can be evaluated with consumption data gathered from surveys and laboratory tests. Exposure levels of eleven hair cosmetic products (e.g., hair spray, shampoos and conditions) have been calculated in France based on the frequency of use, amount per use and body wieght². For women, between the ages of 15-39 years old, the exposure assessment found with styling foam was 4.6 times higher than their exposure assessment found with styling lacquer. Styling sprays and waxes were found to have exposure levels that did not exceed the maximum daily exposure rate established by the Scientific Committee on Consumer Safety (SCCS)^2,3. For those that may not know, the SCCS is a committee that is used in Europe to help assess health and safety risks of non-food consumer products (e.g., cosmetic products) and services (e.g., tattooing, tanning)⁴.

Can hairspray alter hair properties? A recent study demonstrated that hair spray can alter hair shine, the shine that occurs when light is reflected off the outer surface of the hair follicle^5,6. In this study, mannequin heads were treated with hair spray and placed outdoors to mimic the shine created by the sun. The mannequin hair was then judged by 15 individuals in a consumer study. As we would have guessed, the unsprayed mannequins had the least shine⁵. A volume lift hair spray showed the most shine and allowed for much thicker hair spray deposits to accumulate on the hair surface⁵.

If you would like to know more about hair spray or other hair cosmetic products be sure to ask your hair stylist at your next appointment.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Ficheux AS, Chevillotte G, Wesolek N, Morisset T, Dornic N, Bernard A, et al. Consumption of cosmetic products by the French population second part: Amount data. Food Chem Toxicol Int J Publ Br Ind Biol Res Assoc. 2016 Apr;90:130–41.


2. Ficheux AS, Morisset T, Chevillotte G, Postic C, Roudot AC. Probabilistic assessment of exposure to nail cosmetics in French consumers. Food Chem Toxicol Int J Publ Br Ind Biol Res Assoc. 2014 Apr;66:36–43.


3. Scientific Committee on Consumer Safety SCCS Opinion on decamethylcyclopentasiloxane (cyclopentasiloxan, D5) in cosmetic products [Internet]. European Commission. 2016 [cited 2016 Sep 1]. Available from: http://ec.europa.eu/health/scientific_committees/consumer_safety/docs/sccs_o_174.pdf


4. The SCCS Notes of Guidance for the Testing of Cosmetic Ingredients and their Safety Evaluation 9th Edition [Internet]. European Commission. 2016 [cited 2016 Sep 2]. Available from: http://ec.europa.eu/health/scientific_committees/consumer_safety/docs/sccs_o_190.pdf


5. Puccetti G, Thompson W. Effects of hair sprays on color perception: A hyperspectral imaging approach to shine and chroma on heads. Int J Cosmet Sci. 2016 Aug 17;


6. Guiolet A, Garson JC, Levecque JL. Study of the optical properties of human hair. Int J Cosmet Sci. 1987 Jun;9(3):111–24.

 

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