The ultimate hair transplant technique has to respect the only remaining limitation to the surgical treatment for hair loss, each patient has a fixed amount of good genetic hair from the sides and back of their scalp that can be used to transplant in the balding area.

It is of paramount importance that the hair transplant surgeon is entirely focused on ensuring every transplanted graft survives and grows.  Any technique or procedure that ultimately increases the percentage of survival of the transplanted hair should be used. Conversely, any technique or procedure that decreases survival must not be used.

The techniques that maximize survival of the grafts during the hair transplant are as follows:

1. Having a doctor (not a technician), who is highly trained, perform the hair transplant.

   Any physician can legally perform hair transplants, even if they have little or no training. It is of utmost importance that any doctor performing hair transplants should have formal training under the strict guidance of a residency or fellowship program. Taking a weekend course on hair transplants or "on the job" hair transplant training at one of the big hair transplant clinics is inadequate.

   Over the past ten years there are many doctors that have tried to automate the hair transplant process (in order to perform two or three hair transplants a day); in doing so, they have effectively taken the physician out of midst of the hair transplant procedure and replaced him with a technician (who performs the hair transplant unsupervised). I fail to see the quality in performing the hair transplant in this style and believe the doctor should be doing the hair transplant surgery.

2. Being meticulous and not rushing the hair transplant procedure.

   Typically a hair transplant lasts four to seven hours, therefore, if the hair transplant physician is going to be involved in every step of the hair transplant process he can perform only one hair transplant procedure a day.

3. Natural Hair Grouping Transplants.

   Hair does not just come out of the scalp individually, one by one, but actually grows naturally in groups of one to four hairs with a fibrous sheath surrounding them.

   Since that is how God designed everyone’s scalp, that is how we do a hair transplant. We perform hair transplants with the single hair groups on the hairline and the natural groups of three and four hairs farther behind for density.  The benefit of performing the hair transplant with the individual "natural hair groupings" is the completely natural look we achieve and a higher survival rate of the transplanted grafts.

   To try to obtain a natural look, many doctors now perform transplants with what is called "single hair micro grafts." They separate the "natural hair groupings" into single-unit hair grafts and transplant the hairs individually. By separating the natural groupings of hair, the transplant surgeon is going against nature. A study published in the Journal of Dermatologic Surgery showed that the survival and quality of these grafts markedly decreases. (Follow this link for photos and results of this study) The best alternative is to mimic pattern as God designed it, instead of trying to change it.

   The photos below shows patient immediately post-op who had "Single Hair Micrografts" transplanted on the left side of the patients Vertex and the "Natural Hair Groupings" Grafts transplanted on the right side of the patients Vertex.

   

4. Using the Stereoscopic Microscope in order to dissect out the grafts.

   The stereoscopic microscope is probably the most important innovation in hair transplants. The "natural hair groups" must be preserved intact during dissection to insure increased survival and growth. Many doctors dissect with the naked eye or with minimal magnification. That leads to increase transection and destruction of the hair. When dissecting the donor hair without the stereoscopic microscope it is nearly impossible to ensure that the "natural hair groupings" will remain intact.

   For a balding man seeking a transplant, his most precious commodity is his “hair bank," hair that is available as a source for transplants  The use of the "stereoscopic microscope" to dissect the grafts enables me to visualize each and every individual "natural hair grouping."  By using the "stereoscopic microscope" the trauma to the surrounding hair is greatly reduced and our patients receive superior quality grafts with a much higher incidence of survival.  I can now achieve survival rates of 95 to 100 percent, as compared to other techniques where the survival rate is much less.  The "stereoscopic microscope" also enables us to trim excess tissue away from the hair follicle, therefore, smaller incisions can be made, which enables us to pack the grafts closer together to give a denser look.

5. Hairline design and graft placement techniques.

   The design of the hairline is crucial to the overall look of naturalness.  A physician could use all the latest techniques and technology but still create unnatural looking hair transplant because they do not understand the aesthetics of a natural human hairline.  There are five important area of concern when creating an aesthetically natural hairline and frontal forelock.

   The anterior (or central) starting point of the frontal hairline:

   

   Many hair transplant surgeons (or their technicians) place the hairline too low on the forehead, which will never look natural as the patient ages.  Particularly with younger hair transplant patients who have more extensive baldness, the hair transplant surgeon needs to create a more conservative pattern that will look natural now and twenty years from now.

   The lateral frontal hairline:

   

   Many hair transplant surgeons (or their technicians) design too wide of a frontal hairline can create the look of an unnatural comb-over or hairpiece.

   The angle of the hair exiting the scalp:

   

   The angle of the hair gets more acute at the more anterior (frontal) part of the hairline. Many hair transplant surgeons (or their technicians) create the incision so the hair comes out perpendicular to the scalp, which is not aesthetically pleasing and does not cover the scalp as well.  This also looks unnatural since your hair would not normally grow in this direction.

   The irregularity of the frontal hairline:

   The human hairline is naturally very irregular. It is a common mistake of hair transplant surgeons to make the hairline too symmetrical and too linear. The human eye is naturally drawn to lines, which will draw unnecessary attention to the hairline and make the patient self-conscious. An irregular hairline is natural and does not draw attention to it.

   Direction of the incision

   Follicular Units	Coronal Incision	Sagittal Incision

   The hairs in a follicular unit typically sit side by side when looking at hair from front to back. This is a cosmetic benefit because the hairs are in a row instead of lined up behind one another, which gives a thicker cosmetic result. Therefore, the incision with the needle should be placed with the long axis going from ear to ear (coronal incision) versus from front to back (sagittal incision).

   Since hairline design is so important to the overall result, it is vitally important that your hair transplant surgeon has been properly and formally trained in the art of hair restorations. Never let a technician design your hairline.

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