Use of Body Hair and Beard Hair in Hair Restoration

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Key points

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    Body hair (beard, leg, chest, and other areas below the neck) can be used by itself or in combination with scalp hair to provide coverage in cases of severe baldness, to aesthetically improve hairlines and eyebrows, restore facial or other body hair, and camouflage scarring.

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    Body hair retains some of its characteristics but the recipient site can also modify them minimally; thus, matching likely final hair characteristics is important.

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    Leg and chest hair does not typically grow to the same length

Definition of Process, and Distinction from FUE Using Head Hair Donor Sources

FUE traditionally involves restoring balding areas of the head by extracting grafts in vivo from the SDA one follicular unit at a time. It is a minimally invasive process involving little pain and is performed with patients receiving local anesthesia and a mild sedative. Depending on the number of grafts to be transplanted, most procedures can be scheduled over the course of several back-to-back work days with additional work for extensive cases scheduled months later. Microsurgical techniques

Preoperative planning

Planning should include identification of the donor hair sources, approximately how many grafts are needed from each source, and mapping where the donor source hair will be transplanted. It is generally preferable to use a hybrid of hairs from different donor sources in the recipient to create a blended look, which is aesthetically more pleasing than a mosaic look that could result from grafting islands of nonmixed body hairs. By estimating the number of grafts needed and where the grafts will

Donor Preparation

Anagen hair selection is performed by two maneuvers. In the case of body hair extractions, donor areas are pretreated with 5% minoxidil once or twice daily for a variable period of 6 weeks to 6 months before surgery. This is done because minoxidil shortens the telogen phase by inducing follicles resting in the telogen phase to begin the anagen phase,18 although no study has reported how effective this is in human body hair. In human scalp hair it has also been reported that minoxidil increases

Procedural approach

Surgery proceeds more smoothly when the patient, surgeon, and assistants are coordinated in the process. Because sessions can take up to 8 or 9 hours, patient and surgeon ergonomic comfort is of paramount importance. The correct operating table is vital; a table that does most of the postural changes rather than the patient or surgeon is most ideal. An operating table should ideally be capable of tilting sideways in addition to the usual Trendelenberg and reverse Trendelenberg positions. A

Deciding for Each Day’s Session Which Hairs Should be Transplanted

Because of limitations of how many hairs can be transplanted for a given patient during a session for each day (typically a 1500- to 1800-hair maximum), it is worth developing a strategy to determine which hairs should be transplanted (donor and recipient areas) each days when multiple sessions are contemplated for a patient in a given week. This strategy can be modified according to day-to-day experience and is not necessary for a one-time session.

Anesthetic Technique

This is primarily for the patient’s comfort

Potential complications and their management

When beard hair is the donor source, local anesthesia commonly causes transient, mild paresis of oral mimetic muscles that last 1 to 2 hours. In addition, hypopigmentation at the extraction site of beard hair may occur, especially in darker skin. However, this is usually tolerable for appearance.2 Uncommon wound complications, such as hypertrophic and keloidal scarring, can occur in susceptible individuals, and good preoperative clerkship is necessary.

Immediate postprocedural care

Nonhead hair donor sites are left open and coated with bacitracin or Neosporin ointment for the first 7 days after surgery twice a day, and triamcinolone lotion 0.1% is used daily for the first 3 days after surgery. Oral antibiotics, although not necessary, may be given for 5 to 7 days postsurgery. Cephalexin, or a substitute in the event of drug allergies, is used to cover gram-positive bacteria. In the absence of minoxidil allergies, the author has recommended that recipient areas are treated

Rehabilitation and recovery

It can take several months or even a year for the full effect of body hair transplants to be seen. During this time, the patient should be instructed on general hair care, especially with hair treatments. When the patient has had severe baldness or problems that require extensive repair (or both), and before surgery the client used wigs or other methods to disguise these issues, it is often difficult for the patient to make the psychological adjustment from using to not using a wig. There is a

Summary

When used appropriately, body hair by itself or in combination with hair from the SDA can improve the overall aesthetic appearance of a bald scalp, and especially hairlines and eyebrows. Body hair can also be used to camouflage existing defects from prior hair transplantation surgeries or in situations of relative or absolute lack of head hair donor supply. General limitations in the use of body hair and beard hair in hair restoration include the longer procedure required (often over several

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Disclosures: S.U. is the founder of DermHair Clinic.

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