Dermatologic Surgery, Volume 23, Number 9, 1997, Pages 771-784

Follicular Transplantation: Patient Evaluation and Surgical Planning
Robert M. Bernstein, MD
William R. Rassman, MD

BACKGROUND Follicular Hair Transplantation is a method of hair restoration surgery which uses hair in its naturally occurring groups called follicular units. By using the follicular unit exclusively in the transplant, the surgeon can move extensive quantities of implants in a single session to complete the hair restoration in as few sessions as possible.

OBJECTIVE. To briefly review the salient features of Follicular Hair Transplantation, to discuss how the patient should be evaluated for the follicular transplant procedure, and to provide guidelines for the planning of the first and subsequent transplant sessions. This paper will examine: 1) ways to anticipate future hair loss, 2) how to assess donor reserves, 3) what can be accomplished in a single transplant session, 4) how to plan for subsequent sessions, and 5) how to manage the patient with diffuse androgenetic alopecia.

METHODS. Follicular Hair Transplantation is performed according to techniques detailed in a previous publication (Bernstein et al. Int J Aest Rest Surg 1995;119-32).

RESULTS. Excellent cosmetic results can be achieved when there is meticulous attention to transplanting intact follicular units, when the extent of balding is accurately assessed, and when the finite nature of the donor supply is respected.

CONCLUSIONS. Because of their small "physiologic" size, follicular implants enable the surgeon to transplant large numbers in a single session. Follicular Transplantation will greatly increase the benefits of the hair restoration procedure when the patient is thoroughly evaluated and when the procedure is undertaken after careful short and long-term planning. © 1997 by the American Society for Dermatologic Surgery, Inc. Dermatol Surg 1997;23:771-784).

Robert M. Bernstein, M.D. Assistant Clinical Professor of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY William R. Rassman, M.D.

Principal author: Address: 2150 Center Avenue, Fort Lee, NJ 07024 Fax: 201/585-0464 Tel: 201/585-1115 E-mail: [email protected]

Work performed: New Hair Institute, 9911 West Pico Blvd. Los Angeles CA 90035 and 2150 Center Avenue, Fort Lee, NJ 07024

Address correspondence and reprint requests to: Robert M. Bernstein, M.D., 2150 Center Avenue, Fort Lee, NJ 07024 or William R. Rassman, M.D., 9911 West Pico Blvd. Los Angeles CA 90035

The concept and technique of "follicular transplantation" has been described by these authors in a 1995 publication 1 . This article briefly reviews the salient features of follicular transplantation, discusses how the patient should be evaluated for the follicular transplant procedure, and provides guidelines for the planning of the first and subsequent transplant sessions. This article will address those patients whose balding patterns fall under the major Norwood Classifications 2 as well those with diffuse androgenetic alopecia. (Please refer to reference 1 for a more detailed description of follicular transplantation and its glossary for the clarification of specific terms. In addition, it is important to be familiar with the Norwood Classification of male pattern baldness, as this will be used frequently in the following text.)

Hair restoration surgery is the single most common cosmetic surgical procedure performed in men in the United States today and is still growing at a substantial rate. Of all cosmetic procedures in men, hair restoration surgery has the potential to produce the most dramatic change in one's appearance. However, in no other form of cosmetic surgery, has the road to achieving a desired result been more difficult for the patient. Since hair is so visible, the cosmetic problems produced by earlier surgical procedures which resulted in partial, incomplete, or distorted appearances over multiple-staged sessions, often outweighed the long-term benefits.

The protracted course of traditional transplant surgeries that included 2 to 5 mm grafts, scalp reductions, or flaps, used alone or in combination, often produced significant disfigurement. Often, this process represented such an inefficient use of the patient's time, money, and most importantly his finite donor supply of hair that the work was never actually completed. In the patient who may already have had compromised self-esteem from hair loss, this often had a devastating effect on his overall well-being. In Follicular Transplantation, large numbers of very small follicular implants are used to provide the best possible cosmetic results in the fewest numbers of sessions with the least disruption in the patient's lifestyle.

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