Body Hair Transplant

This term essentially means using the hairs from the parts of body other than the scalp and transplanting them on the scalp/head.

Generally for the purpose of hair transplant the donor is taken from the head or the scalp itself but in patients where the option of donor from scalp is very limited or there is not enough graft available from head/scalp, then donor from certain areas of body can be used for the purpose of transplantation on head.

Hairs most commonly are taken from beard followed by upper chest, upper back, abdomen, armpits, forearm, legs.

• Indications for using body hair for hair transplant
• Hair loss is of advance stage, where scalp donor graft follicles is inadequate for providing full coverage
• Scalp donor is used up or exhausted due to previous hair transplant surgeries, with inadequate coverage of the bald area.
• In combination with scalp donor hair where body hair are mixed with scalp hair to improve the density and provide proper cosmetic result
• Fine body hair can be used for temporal area, for eyebrows and for hairline
• Inadequate donor area or donor follicles are not present due to scarring alopecia or burns

• Pre-operative planning

Once the stage of baldness is determined and a number of grafts that are required is calculated then the next step is to identify the donor area sites. The doctor should have an approximate estimate of the number of grafts to be harvested from each donor site. One should plan accordingly which follicles to be transplanted in which area so as to have the best possible result with the body hairs. However, it is always preferable to mix hairs from different donor areas with scalp hairs to have better cosmetic results. The hairs in the recipient area should match the donor hair in terms of calibre, texture, color, and curliness.

When body hairs are to be used for hair transplant then one needs to identify the hair in the anagen phase of the hair growth cycle. The hair in the early anagen phase or that in the telogen phase are generally not suitable as donor for transplant. The growth period for most body hair is shorter as they are in telogen phase mainly and the anagen phase is shorter as compared to the scalp hair. We advise the patients to shave the beard 3 days before the procedure and for other body hair we suggest them to shave the donor area like chest 5-7 days before the hair transplant. This helps in identifying the anagen phase hair. Some surgeons also use minoxidil as pretreatment to increase the diameter of the hair and to alter the growth cycle of the hair but this may require a long-term treatment.

• Use of Body Hair Transplant:
• In combination with classic hair transplant for achieving greater density in patients having weak donor area on scalp
• For filling large areas of bald patch
• For correction/ repair hair transplant

It is very important to understand the characteristics of donor hair and recipient area. For the hair line we generally use scalp hair and as one goes back the scalp the scalp donor hair follicles are mixed with donor follicle from other parts of body to provide adequate density and coverage of the scalp.

Generally, beard is the preferred donor after the scalp as the thickness of hair is more favorable than the hair from other areas and the beard hair grows more consistently and longer when compared to hairs from other donor areas.

For the body hair transplant the number of graft required may be more as the body hair follicle generally provide one hair per follicle. The pattern of growth of hair in different parts of body are different. The growth phase is longest in case of scalp hair followed by beard. Body hair donor area should be identified depending on the recipient site, for example the finer hairs can be used in areas where soft fine hairs are required like temporal area or hairline.

We advise the patient to come on the day of the surgery and not to shave the beard for 3 days and if the chest is to be used then not to shave it for 5 days before the surgery. This helps to identify and extract anagen hair, which improves the overall yield. The chest and back being more sensitive areas so proper and long term local anesthetic should be infiltrated, one may use some sedation also to come the patient more comfortable. The finer diameter of punches is used for different areas of body to harvest the donor in case of body to scalp hair transplant. One should also know that the depth at which the hair follicle lies is also different in different parts of body, this also be helpful in proper extraction of follicles.

One of the important factor to know is that there is different angle and orientation of the hairs in different areas of body so it of importance that they are properly extracted keeping this in mind otherwise transection may happen leading to the wastage of the follicles. Healing of the donor area depends on the which area was utilized to extract the follicles. Beard area generally heals by the end of first week after the surgery, the chest area usually takes around 2 weeks to heal. Regarding the recipient area the transplanted hairs first undergo shedding starting at 3 weeks and then new hair growth starts around the end of third month and results starts becoming more visible by end of 5 months of hair transplant. One common problem which may be encountered after body hair transplant is wide spots at the region from where the donor grafts are harvested. This is due to the hypopigmentation at these sites. This is more commonly seen on the chest area rather than back.

Body hair transplant is an advance procedure and so it is comparatively a lengthy surgery. It requires highly experienced and skilled surgeon to perform these types of advanced hair transplant procedures. If the donor is not properly selected and it don’t blend with the recipient area then this may lead to a compromised result. Dr. Sangay with years of experience has been providing desired results with as she knows which donor graft to be used where and how to mix body hair with scalp hair to provide better density results.

• Procedure

Anaesthesia
Infiltration of the local anaesthesia is generally used once the donor area is marked and defined. A tumescence mixture of local anaesthesia is used to have the adequate turgor of the tissue. This also helps in harvesting over a larger area without exceeding the limit of the local anaesthesia dose as the tumescent mixture is low concentration with more volume. Some surgeons prefer using longer-acting local anaesthesia medicine. One can use premedication which may relieve the anxiety and also make the patient more comfortable.

Extraction
This step can be performed using either manual punches or motorized FUE instruments. For the body hairs, comparatively finer punches are used like 0.7 to 0.9 depending on the site and calibre of the hair to be harvested.

Generally, body hair follicles are single hair follicles so the number of grafts that are required may be more.

One should keep in mind that body hair generally exits at more acute angle and they are at less depth in the dermis as compared to the scalp follicle. So, the doctor should try to match this basic anatomy while extracting in order to avoid transection of the grafts.

Implantation
The method of implantation is essentially the same as that of scalp to scalp hair transplant. It is always better to mix the scalp hair with the body hair to cover the behind area of the scalp and the crown area. This provides good density, coverage, and over all results.

Once the procedure is complete the donor site of the body hair is covered with antibiotic ointment. No bandage is required on the body hair donor area.

• Complications

The general complications of scalp to scalp hair transplant and the complications that can happen in the recipient area can also happen in the body hair transplant. Although these are rare but the common side effects that are encountered are:


1. Hypopigmentation or light spots may occur at the site from where the follicles are extracted in the beard. This is generally more noticeable in the persons with darker skin. It is always advisable to harvest the grafts from under the chin so that it is less noticeable.

2. Keloid: keloid can form in the donor sites especially if the harvesting is done in the sternal area. One should always inquire about the keloid formation during history taking and clinical examination. It is also good to avoid harvesting from the mid chest or sternal area.

3. Other complications that are likely to occur are folliculitis and ingrowing hair due to burying of the graft.

• Key points to remember :
• Difference in growth cycle of body hairs from scalp hairs
• Body hair often has a lower diameter than the hair on scalp
• Follicular unit from scalp may consist of 1,2,3 or 4 hairs but follicular unit from other body parts may generally have single hair
• Extraction of hair follicles

Consult to Dr. Sangay Bhutia from Hair & Senses if you have any questions about hair transplant. Fix up your free consultation with experts to know more here