Hair Transplantation in East and Southeast Asian Patients

89A Hair Transplantation in East and Southeast Asian Patients

Damkerng Pathomvanich

Summary

East and Southeast Asian (ESEA) males typically have a brachycephalic or a relatively broad, short skull with less frontal projection. There is a marked hair to skin color contrast in ESEA patients, and straight black hair in light skin color makes it challenging to achieve natural-looking hair transplant results. ESEA hairs are found at lower density compared to Caucasian hairs. The best way to correct and soften the hairline is to find single hair follicular units during graft preparation and place these in the front rows.

Keywords: ESEA hair characteristic head shape hair transplantation hairline design donor harvesting

Key Points

•East and Southeast Asian (ESEA) skull is generally brachycephalic, with a relatively broad, short skull and less frontal projection. This results in a flatter hairline contour.

•Hair characteristics in ESEA are coarse, black, and straight in the majority of patients, and this makes it even more challenging for hair surgeons to achieve natural-looking results.

•Follicle length is greater and thus there is a somewhat increased potential to have higher transection rates during harvest with both follicular unit transplantation (FUT) and follicular unit extraction (FUE). Premade incision should be deeper to accommodate the longer graft.

89A.1 Introduction

East and Southeast Asian (ESEA) hair characteristics are unique. Hair surgeons should know or be aware of ESEA hair characteristics, facial features, head shapes, and culture before proceeding with hair transplantation in order to ensure a successful patient outcome.

All the characteristics described earlier play a significant role in hair restoration surgery, influencing the surgeon’s hairline design, method of harvesting, and choice of site creation and graft placement.

ESEA males typically are brachycephalic with relatively broad, short skulls and less frontal projection compared to Caucasians who tend to be dolichocephalic with relatively long skulls and more frontal and occipital projection (Fig. 89A.1).

Fig. 89A.1 (a) Asian head. (b)Caucasian head.

The hair-to-skin color contrast in ESEA is very significant. The hair is usually straight and black, while the skin color tends to be very light. These characteristics make it more difficult to achieve natural-looking results in this population. The skin-to-hair color contrast tends to be even greater in East Asians as compared to Southeast Asians.

89A.2 Hair and Skin Characteristics

Avram and Rogers reported that hair in Caucasian males has average follicular unit (FU) density in the donor area ranging from 70 to 100 FU/cm² with the average hair density count of 260 ± 30 hairs/cm².¹ Ortega-Castillejos and Pathomvanich recently performed a retrospective assessment of the FU density of Asian men using video microscopy and embedded software for FU counts. In male Asian patients with androgenetic alopecia (AGA) who underwent hair transplantation, they found the average density at the mid-occiput to be 125 hairs/cm² and at the parietotemporal it was 108 hairs/cm² with 7% miniaturized hairs.² Yoo reported that Korean men have an average of 137 hairs/cm² at the occiput and 118 hairs/cm² in the temple.³ According to Tsai et al, the normal Chinese scalp has an average hair density of 137.08 hairs/cm², with a predominance of two-hair FUs at 50.29%. This similar study also concluded that Chinese men with AGA have an average of 68.07 FU/cm².⁴ There are somewhat different hair characteristics even among ESEA and it is unclear whether the differences in counts may be due to different devices or observer differences. Nevertheless, all the studies revealed that the hair density in ESEA was lower than that seen in Caucasians, but the impact produced by the coarser hairs might make the ESEA hairs appear thicker. Hair caliber in an average Caucasian man is 70 μm compared to 100 μm in ESEA. The difference in hair diameter is significant (Fig. 89A.2).⁵