The whole game of hair transplant is played keeping in mind the availability of anagen hairs, duration of the anagen phase of a graft being harvested, and maintaining hair in the anagen phase.
And no better example to understand anagen hair than in the case of Rapunzel. It is said that her hair cycle was jammed. As the story goes, her hair cycle was arrested at the anagen phase till the time the story was written by Brother Grimm.
If you understand this underlying philosophy, no concept of a hair transplant will be difficult for you to understand, be understanding great results, why mediocre results happen, why 2 results do not match and why hair transplants fail.
In my clinic, we have had a manifold increase in numbers of patients in whom hair transplant is being done over the past 10 years. Partly it can also be due to the fact that we are doing greater numbers of extensive bald patients. Other reasons are the increased number of revision cases for FUE done elsewhere.
You can see the results of our clients in the link to the relevant playlist-
Patients often say that God has played a joke on me. I have no hair on my scalp but there is not an inch of space on my body that does not have layers of hair. And I often jokingly tell them that all the hair that fell off their head took root on the body!
“God giveth & He taketh away” is so true for hair transplant
The advantage of FUE is the ability to extend the scalp donor to other areas in the body where hair is reliable and of good quality.
So hair from different areas of the body have different characteristics.
The differences lie in-
3. Growth cycles- length, Anagen /Telogen Ratio, A:T relative duration (Rapunzel)
4. Speed of growth
6. Early graying in beard, chest
All hairs are not born Equal. They have a hierarchy amongst themselves and this is determined by- yes you are right, the duration of their Anagen phase.
So what is the anagen phase of the hair cycle-
The length of the anagen or growth phase differs from one location to another and this determines their hierarchy-
So what is their individual duration of the anagen phase?
However, we have found with experience that only the following are reliable-
So with this overview, I seek to answer the 5 most commonly asked questions by my patients concerning BHT-
When do you do BHT?
1. Extensive baldness
2. Patients desirous of getting maximum coverage & density Extensive baldness
3. Revision cases with relative lack of scalp donor hair
4. FUT scar revision
5. Using nape of neck hairs for refinements- for temple points, eyebrows and revision of harsh hairlines.
Is everyone a candidate for a BHT procedure?
However, not everyone is a candidate for a hair transplant. You need to be hirsute to some extent which means you should possess robust quality and the spread of terminal hairs in the body is essential to consider BHT.
We target only Terminal (non-vellous) hair. Most people have very fine hairs and in lesser density than 10 per sq cm in which cases it is not possible to harvest due to restrictions.
How is the donor area prepared for BHT?
In the beard hair finding anagen hairs is not a problem, but for the chest harvest, we need to wet shave the chest 3 days before the procedure so only robust anagen hairs grow back. These hairs in the early and middle anagen phases are more able to withstand the rigors of harvesting than hair which is preparing to enter the catagen phase. Some people also prepare the area with Minoxidil but this is fraught with danger since they are artificially maintained and if the effects of Minoxidil stop after a hair transplant, the gains will be lost. However, the advantage is that it allows more grafts to be available in the anagen phase than in the telogen phase, increasing graft numbers.
Why cannot you take hair from the arms and legs?
If a person has good quality terminal (non-vellous) hairs in these areas, it’s all well. But most have only vellus hairs in these areas which are so thin that even if they survive the transfer, they will be hardly seen since they are downy in nature. So everyone is not a candidate for a hair transplant.
Does it leave scars?
Healing of donor areas can leave white dots, which are hypopigmented, tiny but flat, and insignificant scars that are hardly visible in Caucasian patients but may be more visible in patients with darker skin. Though even in darker skin, the incidence of scarring is less than 1%, we feel safe to harvest from the shadow area as shown here.
In Caucasians though, we are more adventurous can have been able to harvest up to 3000-5000 beard grafts including from the anterior neck.
When can I share after a beard BHT procedure?
On the third day itself. Beard heals faster than the scalp. Shaving will clean up the donor area and will decrease scar formation by removing crusts.
How many grafts can you get from the chest?
The chest usually allows anagen hair of quality from the area between the 2 breast mounds including from over the sternum. The number is usually 500-600. Any increase of harvest may in most individuals lead to harvest of weak grafts which may not withstand transfer.
Why is the cost of grafts higher?
This is since firstly the body grafts take almost 3 times as much time and effort as scalp grafts and also disposables required for this procedure are costlier and more varied than for scalp grafts.
The procedure of harvesting f 1000 beard grafts takes double the time as 3000 scalp grafts and is far more laborious and takes a toll on the body.
The skin of the body being loose and not stretched like in the scalp does not help.
Does body hair grow longer on the scalp?
Yes. This is in contravention to Orentreich’s Theory of donor dominance. It has been seen with the increasing use of body grafts today that the transplanted body grafts slowly acquire characteristics of scalp hair in terms of caliber, texture, and color, and curl.
Do other doctors do the procedure at your Clinic?
The breed of doctors doing extractions is almost extinct today. However, when you are here and from your friends who have had a procedure with us, you will find that all extractions are done by personally. No other person, doctor or otherwise, is empowered to do the important procedures of Graft Extraction at my Clinic.
Is the procedure of BHT painful?
Not if adequate anesthesia is given after applying Emla cream. Also, the speed of harvest is essential since the concentration of anesthesia mixture used here is not long-lasting as in the scalp?
Can the scalp and body grafts be done in a single day?
If it is Scalp and body graft procedure, yes it can be done in a single day.
However, if the chest is also to be done, the procedure needs to be done on 2 days to avoid the development of adverse effects of anesthesia. Cosmetic procedures are 0 Error safety procedures have to be strictly implemented.
To conclude, in preselected hirsute patients, BHT to the head can be a viable technique to produce cosmetically acceptable results when adequate scalp donor hair is not available.
Beard and chest grafts are most commonly done since we have a much better experience with them as compared to other available sites for BHT harvest.
image credit: Tangled movie.