HAIR RESTORATION IN AFRICAN-AMERICANS

African American Hair transplantation is similar in the basic mechanics to other ethnicities in hair transplantations.  However, there are many unique factors which must be considered in the pre-op, operative and post-operative stages to ensure the most beneficial results.

The pre-op factors to consider

1. history of keloid or hypertrophic scarring
2. scarring scalp disorders and scarring alopecias – Most commonly CCCA (Central Centrifugal Cicatricial Alopecia), Traction Alopecia, Dissecting Cellulites in African American men
3. adequate donor density – donor density can be disguised due to the thick curl of the hair, making the donor appear denser than it is

Operative factors

1. Hairline design – AA male patients are more demanding and will usually desire less temporal recession in the design
2. When performing strip surgery, patients can have an adverse reaction to dissolvable sutures making the healing process more challenging.  Some authors recommend non-dissolvable sutures to decrease this inflammatory response.  I agree with this method of closure for AA hair.
3. When performing FUE procedures, I usually trim the hair shorter than usual – almost flush with the skin so that the exit angle does not confuse the actual direction of the hair and possibly create a transection of the follicle while punching the graft.
4. With FUE, we extract as we harvest to assure the angle is correct.
5. The ARTAS robotic system is presently being studied for AA hair transplantation applications.

Post-operative factors

1. Hyperpigmentation – darkening of the skin can occur at the donor and recipient sites
2. Ingrown hairs/folliculitis- These can occur 2-3 months after surgery when the hair begins to grow due to the curliness of the hair,  but can easily be treated with antibiotics
3.  Hair growth with the scarring alopecias that appear to be quiescent can be less robust than in virgin scalps
4. Keloid or hypertrophic eruptions can be treated medically in the office to help resolve

In summary, hair transplantation in African American patients, both male and females after proper patient selection is very rewarding to both the patient and the physician.  With present hairstyles and hair being worn very short, FUE in AA males is becoming increasingly more popular.

The characteristic curl of hair in people of black ancestry usually gives an impression of good hair density. This can be an advantage in black hair transplant. In a white-skinned person with substantial hair loss and very low hair density, hair transplants or other surgical procedure may not be possible if enough donor hairs cannot be obtained from a donor site. Under the same hair loss conditions, a black patient may be an acceptable candidate because fewer donor hairs are needed to create a satisfactory impression of hair density.

Harvesting of black, curly hair from a donor site for hair transplants requires a slightly modified technique. In whites, the scalp hair generally grows straight. In people of African ancestry, both the follicles and hairs have a degree of curvature in relation to the scalp that must be accommodated in the harvest of donor hair.

In summary, surgical hair restoration is as available to African-Americans and others of black African ancestry as it is to whites, and is equally successful. Some unique characteristics of black hair and skin require preoperative evaluation.