Follicular Unit Excision to Harvest Body Hair

69 Follicular Unit Excision to Harvest Body Hair

Arvind Poswal

Summary

With the advent of follicular unit excision (FUE), accessing alternate sources of donor hair apart from the scalp became possible. Body hair transplants (BHTs) have evoked widespread interest and fascination in the minds of hair loss sufferers as well as hair transplant doctors. Results, however, vary widely (patient to patient as well as doctor to doctor). The scalp donor area is a limited resource and cannot be expected to repopulate the entire remaining bald scalp. BHT has allowed physicians to expand the possibilities for patients without adequate scalp donor to finish their hair restoration. BHT has also opened up additional indications such as softening hairlines and eyebrows with the use of finer body hair. FUE makes it possible to excise individual follicular units from the body and beard donor areas without strip excision and suturing. This enables the use of robust body and beard hair as additional donor sources in suitable (hirsute) patients. Obviously, patients without adequate body hair usually cannot benefit fully from BHT. Keeping the hair growth cycles and other limitations of body and beard donor hairs in mind, these hairs can be used to augment the scalp donor hair. This treatment option is very helpful for patients with advanced degrees of hair loss and those who may have lost scalp donor supply due to various reasons. Body donor hair differs in characteristics from the scalp donor hair in terms of length, caliber, color, growth cycles, speed of growth, predisposition to graying, and texture (wave, curl, etc.), and when transplanted to the scalp, they will maintain their original characteristics after transplantation.

Keywords: BHT body hair scalp hair depleted scalp donor extensive hair loss androgenic alopecia follicular unit excision body donor hair FUE/FUSE growth cycles

Key Points

•Body hair transplantation (BHT) expands the amount of donor available to patients.

•BHT can be uniquely helpful in improving scars, restoring facial hair with more homogenous hair, or creating softer hairlines or eyebrows when using fine body hair.

•Body hair has very different growth cycles and characteristics that need to be taken into account.

•The best candidates are those with robust and high-quality body hair.

•BHT is an advanced technique and requires much patience and skill by the surgeon.

69.1 Introduction

69.1.1 Why Use Body Hair?

The idea is to use the hair growing on the body as an additional donor supply. The hope is to reduce the “donor limitation” that exists with scalp donor. For many patients with severe hair loss, scalp donor hair is not sufficient to provide enough coverage. The typical hair loss patient’s major goals are density and coverage, and this is only possible with a relatively high number of grafts. The scalp donor area provides a good but limited resource. Patients with advanced hair loss must tap additional donor resources to achieve satisfying results. By opening up body hair supply, some patients have access to significant resources of previously unavailable donor hair.

Body hair transplantation (BHT) includes all nonscalp hair-bearing areas. The most common areas include beard, chest, abdomen, back, and extremities. The beard will be discussed alongside the others here, but is covered as both a donor source and a recipient area more comprehensively in Chapters 68 and 81. Body hair can be transplanted to the scalp or other facial areas such as the beard, eyebrow, etc. Body hair characteristics, patient selection, donor preparation, procedural detail, as well as postoperative care will be discussed in detail.

69.2 Body Hair Characteristics

Body donor hair differs in characteristics from the scalp donor hair in terms of the following:

•Length, caliber, color, and texture (Fig. 69.1).

•Growth cycles.

•Speed and duration of growth.

•Predisposition to graying, etc.

Fig. 69.1 Follicular unit grafts pictures from different parts of the body. (a) Scalp. (b) Beard. (c) Chest. (d) Abdomen.

Orentreich discussed donor dominance and the tendency of the hair to maintain its original features wherever it was harvested.1 Although recipient site influence on the character of transplanted body hair has been reported elsewhere,² the author’s experience is that transplanted body hair will retain its original characteristics after transplant³ (Fig. 69.2). Depending on the type of body hair, the caliber, length, and color vary greatly. Beard hair can be two to three times the caliber of scalp hair, while chest and extremity hair is usually much finer. Fine body hair can sometimes pose more challenges during extraction as the grafts are much more fragile and can be more prone to trauma during both extraction and implantation.

Fig. 69.2 Beard hairs transplanted to the scalp retain their original characteristics.

The growth cycle, as mentioned earlier, is different for hair in various areas of the body. Typically, 85 to 90% of scalp hair is in the anagen phase at any one time. Conversely, anywhere from 40 to 85% of body hair can be in the telogen phase at the same time. Just as importantly, the anagen phase of these body hairs lasts only a few months and allows the hair to grow relatively short, compared to that of scalp hair that can continue to grow for many years between cycles (Table 69.1).

Table 69.1 Hair growth cycles for different body regions

Body hair cycles
Body region	Telogen %	Anagen %	Growth duration
Scalp	15	85	2–6 y
Eyebrows	90	10	4–8 wk
Cheeks	40	60	50–60 d
Beard/chin	40	60	1 y
Moustache	45	55	16 wk
Axillary	70	30	16 wk
Pubic	70	30	13–16 wk
Arms	80	20	13 wk
Legs/thighs	80	20	16 wk

The percentage of hairs in telogen gains increasing importance with each passing hair cycle. When body hairs (from one area only) are transplanted after being preshaved 3 to 5 days in advance, the hairs are likely to be closely synchronized in their anagen phase. Most of these hairs will be in the growth phase at the time of excision. Thus, for the first couple of cycles, their growth phase may be closely synchronized. However, that synchronicity will not continue. Because of this, at various points in time, there will be a large percentage of body hair in the telogen phase, and they will not be making any marked impact on overall density.

69.3 Indications

Body hair to scalp transplantation is ideal for patients with extensive hair loss (Norwood 5 and above) and when scalp donor hair is not sufficient to cover all areas of baldness. When coupled with existing donor supplies, body hair gives an overall increased donor reserve for patient desiring more density (Fig. 69.3, Fig. 69.4, and Fig. 69.5).

Fig. 69.3 Example scalp + body follicular unit excision (FUE). Total 1035 grafts (3,729 scalp, 2,480 beard, and the rest from the chest, abdomen, and armpit). (a) Before. (b) After.

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