89C West Asian Hair Characteristics

Ali Abbasi, Ramin Rabbani, and Sheida Abbasi

Summary

There are three major ethnic hair characteristics: African, Caucasian, and Asian. Asians are known to have fewer hairs than Caucasians.36 Asians can be divided into two main subtypes: West and East Asians. West Asian hair characteristics include three large ethnic subgroups: Persian, Turkish, and Arabic. In West Asians, there are more differences in hair characteristics (color, caliber, shape, density, terminal hair-to-vellus hair ratio, and anagen-to-telogen ratio), but there are no differences in the intimate structures of fibers that were evident among these three types (African, Caucasian, and Asian) of hairs.³⁷ Through the research in medical literature, the author could not find more about Arabic and Turkish ethnic subgroups’ hair characteristic. These data are restricted to Persian (Iranian) ethnic subgroup in comparison with Eastern Asians and Caucasians. According to the study, the total hair density, follicular units, and hair shaft diameter of Iranians are significantly higher than those of East Asians. And finally, in comparison with other Asians and Caucasians, Iranian hair count is the same or close to that of Caucasians and is significantly higher than that of other Asians.

Keywords: West Asian and Persian (Iranian) hair characteristics FUE and FUT in Iranians

89C.1 Background

Differences in hair characteristics have been described according to the ethnic background, namely, African, Caucasian, and Asian. Asians are known to have fewer hairs than Caucasians.³⁵

Asians are generally divided into two groups: West Asians (the concept is in limited use, as it significantly overlaps with the Middle East) and East Asians. Hair parameters and characteristics have been studied mostly in East Asians, whereas very little data have been reported in the literature regarding West Asians. West Asia is a territory including three large ethnic subgroups, Persian, Turkish, and Arabic, and there are more differences in hair characteristics in this group (color, caliber, shape, density, and terminal hair-to-vellus hair ratio, and anagen-to-telogen ratio). Nevertheless, there are no differences in the intimate structures of fibers that were observed among these three types of hairs.³⁷

The author could not find more information through the research in medical literature about Arabic and Turkish ethnic subgroups’ hair characteristics, so much of the data presented restricted to the Persian (Iranian) ethnic subgroup and comparison with East Asians and Caucasians. Studies in Persian (Iranian) hair characteristics evaluated hair color, caliber, density, curl, anagen-to-telogen ratio, and terminal-to-vellus hair ratio in three regions of the scalp, vertex, temporal, and occipital areas. These studies demonstrated that there are significant differences between Persian and East Asian hair parameters.

89C.2 Evaluation of Persian Hair Characteristic

89C.2.1 Density

In a study evaluating 135 children, 70 males (51.9%) and 65 females (48.1%), aged 10 to 15 years, average 12.5 years, without any coexisting hair or systemic diseases (Table 89C.1), the highest density of hair was found on the frontal area.In this region, the average terminal hair was 288.78 ± 58.83/cm²,the average vellus hair was 34.74 ± 16.51/cm², and total number of hairs was 323.58 ± 66.34/cm². On the parietal area, terminal hair was 199.28 ± 61.46/cm², vellus hair was 27.11 ± 9.28/cm², and the total was 266.44 ± 65.55/cm². On the temporal area, terminal hair was 234.78/cm², vellus hair was 24.13/cm², and the total number of hairs was 258.78 ± 60.34/cm². On the occipital area, terminal hair was 259.15 ± 57.17/cm², vellus hair was 32.8 ± 15.76/cm², and the total number of hairs was 258.19 ± 60.34/cm² (Table 89C.1).³⁸

Table 89C.1 Comparing the mean density of terminal, vellus hair, and total hair per square centimeter on different areas of the scalp in 10- to 15-year-old children in the study

In another study specific to Iranian adults, the number of hairs in the average male and female with an average age of 30 to 33 years was found to be 37.7 hairs/4-mm punch for males and 33.1/4-mm punch for females. For males and females with androgenetic alopecia (AGA), the averages were 29.1 and 30.1 per 4 mm punch, respectively; there was no significant difference betweentwo groups in respect of terminal, vellus, total and terminal count,³⁹ and 1.92/hairs per follicular unit (FU).^4,40

In other study of 400 men of ages 29 to 47 years; the scalp hairs in the occipital area were made up of 36.3% one-hair, 40% two-hair, 19.3% three-hair, 4% four-hair, and 0.4% five-hair FUs The mean number of hairs per FU was 1.9240 and mean follicular density 97 FUs/cm^2,39 and 97 FUs/cm².³⁹

As shown inTable 89C.2, the total hair density in Iranians is significantly higher than that of other East Asian people. As can be seen inTable 89C.3 and Table 89C.4, the Iranian hair count is the same or close to that of Caucasians but is significantly higher than that of other Asians. This perhaps can account for the larger harvests of donor that can be achieved in the West Asian population.^{4,36,39,40,41,42,43,44}

Table 89C.2 Comparison of hair follicle count on the occipital region by 4-mm punch in Asian population

Table 89C.3 Comparison of normal hair counts between Koreans, white Americans, and Iranians

Table 89C.4 Comparison of follicular units (FUs) in Iranians and in other ethnicities

The average hair caliber in Persian men is 95 μm compared with 71 μm in East Asians and 70 μm in Caucasians.45 The hair is generally straight and dark or black in color. The length of hair follicle from the epidermis to the dermal papillae (in anagen phase of hair follicle) is very important. The average length of hair follicle among Persians is 4.5 mm, while it is 5.5 mm in East Asians and 4.5 mm in Caucasians. In In the FUE method of harvest, hair follicle length is very important to consider in order to transection. The chance of transection increases with the increase in length of the graft.

89C.3 Specific Aspects of Surgery

89C.3.1 Patient Selection

The incidence of keloid or hypertrophic scar especially in younger people at donor and recipient sites in Persians is the same as in East Asians. Keloid formation in people prone to keloid is more common following FUT than following FUE. In order to prevent keloid formation in FUT, the donor strip should be long and narrow, and trichophytic closure should be used to minimize the donor scar. The patients should be screened for these problems before the method of surgery is selected.

89C.3.2 Hairline in Persians

The most typical Persian hairline shape is wide and flat with a curve at the frontotemporal angle similar to that of East Asian people Fig. 89C.1).⁴⁶ In order to design a natural hairline for these patients, it is critical to consider these aspects, because they often affect facial contours. Reconstruction of the temple in young adults usually necessitates some degree of lateral flare of the frontal hairline, while this is not the case for older patients (Fig. 89C.2 and Fig. 89C.3).

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