Hair Transplant Surgery - Scientific Papers

REAL NATURAL APPEARANCE OF THE FIRST FRONT LINES
AUTHOR: ANTONIO RUSTON M.D.

INTRODUCTION: After the development and sophistication of the techniques of hair transplant, much has been said about Megasessions, Density, etc.. and we have left a little aside an item that from my point of view, continues being the most important one in this surgery:The real natural look of hair transplant results. Unfortunately, there is still a big resistance of the general population for the hair transplant surgery due to the fear of artificial and unaesthetic results, moreover the design of the first front lines and the refinement of the 4/5 first lines, are crucial, so that it no longer carries this stigma.

OBJECTIVE: In this paper the author will try to show some aspects and strategies that he has been adopting in the last years and that must be consider to obtain really natural results in the first front lines and what can be offered to the patient in terms of natural appearance, depending on each case.

MATERIALS and METHODS: The most adequate surgical strategy, should first of all, take into consideration the type of hair of the donor area. As we know, thinner, fair (light) and soft hair, confer more natural appearance to the final result than thick and dark hair (black, dark brown,..). The first thing that we have to analyse is the type of hair of the donor area. There are patients who have a more refined (thin) hair in all donor area (1), others just in the lower part (close to the nape) and that goes thickening as we go up to the top (crown) (2). However, there are some who do not have this type of refinement in the donor area, which means, since the first lines (close to the nape) the hair is thick and dark (3). In these cases it is our obligation to explain that its natural appearance will be a little bit impaired and we will have to use other “tricks” such as: higher inclination of the grafts in relation to the scalp in the first front lines, which means, lesser angle of inclination between transplanted hair and scalp and higher hair density in the 2/3 first hair lines , so the transitions between the hairs and the scalp hardly can be seen , because in these cases they generally present small hypocromics(light) spots and also to disguise the difference of the texture since these hairs are thicker than the more refined hairs needed for these first lines. Another strategy is to make longer the removed donor area as much as possible in order to remove some grafts from the temporal region because in many cases this is the only area where thinner hairs can be found. In case 2 we must, during the removal from the donor area, reserve some hairs from the lowest portion , in order to make the grafts which will be used in the first front lines, since they are more sophisticated. In case 1, when there is a fine and thin hair in all donor area, these procedures are not so necessary so we can remove the donor area wherever we desire. Secondly, we must always remember that the angle of the grafts in relation to the scalp should be obeyed and finally we have to break the straightness of the first front hair lines, transplanting some sophisticated single hairs hamdomly (which are removed close to the nape or the temporal region). Throught analising the natural scalps (without baldness) we could verify that the angle of those hairs are not homogenous, I mean, not all hairs of this area follow the same inclination.Density should reach its maximum just after the forth line to create a transition zone to simulate as close as possible to nature.

DISCUSSION/ RESULTS – The author will show, with the help of pre and post operative results, comparison with non bald scalps, drawings and videos the difference of refinement of the first front hair lines, depending on the type of hair of the donor area and what to do to naturalize to the maximum each case, the best design for each case and how to achieve a real natural appearance of the first front lines.

CONCLUSION – The more refined, thin, fair (light) and “soft” the hair of the donor area is, greater the natural look and sophistication of the first front lines are. However we can, through adequate strategies to each case, provide the most natural result as possible, having in mind that even being a strategist as we can, there will always be slight differences and we must point them out to our patients as well as alert them to this fact.