Techniques in Hair Transplantation

In Follicular Unit Transplantation, follicular units can be extracted through two different techniques: Through Follicular Unit Strip Transplantation (FUS), the microsurgical dissection of follicular units out of a strip of donor material, and through Follicular Unit Extraction (FUE), where the follicular units are removed one at a time from the donor area.

Both techniques have pros and cons and are being performed in my clinic according to the indications and requests of each patient.

In facial hair transplantation Follicular Unit Extraction is often used in case of minor procedures such as reconstruction of scars, eyebrow transplant or beard reconstruction or the reconstruction of sideburns or temporal peaks.

For eyelash transplantation long follicular units are being used, which makes the extraction through FUE impossible. Therefore a small strip of hair is removed from the donor area, from where the long follicular units are being dissected and transplanted using the ‘Reverse Follicular Unit Insertion’ technique.

The key points of performing “state of the art” hair transplant surgery are:

  1. Planning
  2. Aesthetic hairline design
  3. Sufficient density

Key points in hair line design

Micro-irregularity along anterior boarder all hair lines have variable high, alternating with low, density spots along the anterior boarder of the hair line. This is called micro-irregularity.

Macro-irregularity and a wavy anterior boarder

All hair lines have an undulating non-linear anterior boarder. This is called macro-irregularity. A straight line is abnormal and looks unnatural.

Soft, ill-defined transition zone

All hair lines start soft and build density gradually over a few millimeters to a centimeter. A hair line that looks like a harsh wall is unnatural.


Following the natural angle and direction of hair

 The value of a natural and well positioned hairline and the significance of frontal hair volume in framing the face are frequently overlooked aspects of attractive facial proportion and overall facial aesthetics. When you will undergo a hair restoration surgery the surgeon will extensively discuss these aspects before designing the hair line. Therefore it is important to understand that the following aesthetic principles may be considered: An attractive and proportionate face has been defined by the “rule of thirds”. This principle states that in most attractive faces, forehead height should be one third of the total height of the face and approximately equal in height to the mid and lower face. The best balance of facial aesthetics exists when the face can be divided into three equal horizontal dimensions: from the chin to the bottom of the nose, from the bottom of the nose to the brow, and from the brow to the hairline (see the drawing below). If certain facial features are out of proportion to others, the overall facial harmony can be improved by bringing these aspects of the facial features back into proportion. 

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