Hair today, hair tomorrow

And thanks to technical improvements and the current availability of specialized traveling per diem assistants, adding hair transplantation to one's practice is probably easier than many dermatologists think, according to an expert.

"Hair transplanting used to be a very complex procedure," says Walter Unger, M.D., clinical professor of dermatology, Mount Sinai School of Medicine, New York, and adjunct professor of dermatology, Johns Hopkins School of Medicine.

However, Dr. Unger says that transplanting with "follicular unit" grafts - consisting of one to four follicles as they emerge naturally from the scalp - for all transplant areas, has simplified the process.

"Basically," he says, "one cuts out a strip of skin and, under a microscope, dissects out the naturally occurring single hairs and small groupings of two to four hairs."

Transplanting these follicular units results in a natural looking appearance in a bald area - or an area destined to become bald - after a single session, he adds.

Evolving to meet the hype

"Initially," Dr. Unger reveals, "I was one of the major critics of that procedure because the hype that surrounded it didn't match what could be done."

Proponents were touting its virtues 15 years ago, he says, "But in my view, many surgeons were killing a lot of hair."

But Dr. Unger says that, over the past five to 10 years, physicians have perfected the procedure.

Now, he tells Dermatology Times, "It's as good as it was once claimed to be. All the important questions surrounding it have been answered."

With the use of essentially only one type of graft, the average practicing dermatologist, with proper training, can learn how to employ these grafts. With the right team of assistants, he or she can add follicular unit transplanting to his or her practice, he says.

"It is as simple as treating one area once, and it produces a natural result with very good growth if one uses reasonable numbers and densities of follicular units," Dr. Unger says.

Some simple rules

The only obligatory component is finding the right technicians to assist in the procedure, he adds.

"Luckily," Dr. Unger says, "in many localities, such traveling technicians can be found and are available on an as-needed basis."

As for the procedure itself, he says one needn't transplant more than 25 to 30 follicular units per cm² per session in order to get adequate density.

"If one does less," he cautions, "it may be a little too thin. If one does more, it looks wonderful, but there's a limited amount of hair available to move around."

The more grafts used in one area, Dr. Unger explains, the fewer will be left in reserve for other areas - including those that might develop as the balding extends over time.

Regarding which areas to treat, Dr. Unger says this concept also has been streamlined. In particular, he says that hair transplant specialists now consider an average-sized bald area to be composed of the following three areas: