A Hair Breakthrough May Not Be The Breakthrough That it Seems To Be
Use of Nape and Peri-Auricular Hair by Follicular Unit Extraction to Create Soft Hairlines and Temples: My Experience With 128 PatientsBackground Hairlines and temples can look unnatural due to coarseness of the safe donor area of transplanted scalp hair. Although the thinner caliber of nape and peri-auricular (NPA) hair would be ideal to create softer hairlines, they have not been used mainly because of concerns that they are nonpermanent.
Objective We assessed the outcome of NPA hair transplanted to hairlines and temples in selected patients.
Methods During November 2006 to November 2011, follicular unit extraction (FUE) transplantation using NPA hair was conducted in 128 patients following a shave test involving the visual evaluation of hair density and caliber of shaved head donor areas. The test was used to determine permanent versus nonpermanent donor areas. A questionnaire was sent to patients to assess satisfaction with their restored hairlines, with a follow-up questionnaire sent to those who initially responded.
Results Three-quarters of patients are good candidates for use of NPA hair to the hairlines and temples based on the shave test. Of 128 patients transplanted, 71% responded and reported a mean overall satisfaction of 8.3 (scale, 1-10). Patients saw full hair coverage at the recipient area at a mean of 9.6 months after surgery. Nineteen patients reported lost grafts. Thirty-three patients responded to a second survey and reported a mean overall satisfaction of 8.5 at an average of 4.6 years after surgery; only 5 (15%) new instances of graft loss were reported.
Conclusions Soft, natural-looking hairlines can be created in select patients using NPA hair as a donor source by FUE hair transplantation.
These are just my (Dr. Rassmans’s) opinions (regarding the Press release which may be more exaggerated than he original publication as one reader rightfully points out):
Taking neck hair, which is often finer than scalp hair, has problems with it. These problems include:
(1) more prominent scarring occurs in the neck and the neck area is very visible so such scars will be detectable as punctate scars
(2) neck hair is often not permanent hair as scalp hair is, so if one transplants the frontal hairline with these finer hairs, they may disappear with age.
This is a warning to those who see this press release. They must know the risks associated with a neck hair donor area.
Actual article is posted here: https://asj.oxfordjournals.org/content/early/2015/09/22/asj.sjv137.full?ijkey=X8GZ55Qz4zRGY4J&keytype=ref
I am a big fan of your blog but do not think that your evaluation of the article by another Los Angeles-based hair transplant surgeon, whose press release you cite above, was as complete as it could have been. I wonder if you were responding more to the press release (usually exaggerated) rather than the original publication it was based upon. As a disclaimer, I’m not employed by the hair transplant surgeon.
1) I think it is more helpful to the reader to cite the open access article per se than a press release (although a link to the article is embedded in the release):
https://asj.oxfordjournals.org/content/early/2015/09/22/asj.sjv137.full?ijkey=X8GZ55Qz4zRGY4J&keytype=ref
2) The paper of the author’s experience with 128 patients appeared in a peer-reviewed journal that should add some small weight to its validity
3) The crux of your concern, which seems legitimate, is that if one transplants the frontal hairline with these finer nape and peri-auricular (NPA) hairs, they may disappear with age. Yet, the author (Dr Umar) conducted a “shave test” (see article for description) as a major feature of his report, which presumably lessens or removes this possibility. Whether one believes that this shave test is predictive or not of future loss, your blog comment gives the impression that these finer hairs were just transplanted de novo without this methodology.
4) Another concern you note is that “ more prominent scarring occurs in the neck and the neck area is very visible so such scars will be detectable as punctate scars.” Yet, this is a report of a series of many patients followed for a lengthy (average) period of time. Although 71% responded to a questionnaire after the procedure (and it is always possible but unlikely that the 29% who did not responder had the “problem”), this did not seem to be a major issue for responders.
5) Finally, the author’s paper describes how to stagger in conventional safe donor area hair into the hairline with the transplanted NPA hair, thus covering the possibility that those who might still go on to lose their NPA hair despite passing the shave test will have “back up” hair.