Hair transplantation recipient sites: where the science and art of hair transplantation are applied

In the terminology of hair transplantation, the recipient site is where hair is transplanted. It is the area of the scalp where hair follicles are transplanted to correct hair loss. The hair follicles used for transplantation are harvested from the donor site, scalp areas at the side and back of the head where follicles are not influenced by the gene(s) responsible for male pattern hair loss. In certain circumstances, other parts of the body such as the beard and the chest can be sourced for donor hair. For more information, see The Donor Site: Savings & Loan of Hair for Transplantation. With minor exceptions, the donor site is the same for both male and female hair transplantation.

The purpose of hair transplantation is to restore aesthetic balance to a person’s appearance-a balance that is lost with balding of the scalp. Whether hair loss is confined to one area (for example, recession of the hairline or balding on top of the head) or over most of the scalp, the aesthetic balance of a person’s face is compromised. The hair loss area can become the feature that draws attention away from the face and dominates overall facial appearance.

Restoration of facial balance-restoration of appearance that pleases the patient-is a process that calls upon the surgical science of hair transplantation and the aesthetic artistry of the physician hair restoration specialist.

Aesthetics of the Recipient Site

The person with hair loss consults a physician hair restoration specialist because he/she is not pleased with the change in appearance created by hair loss. The physician hair restoration specialist listens to the patient’s wishes and concerns and interprets them in the context of:

• The patient’s age, location of hair loss, degree of hair loss, progression of hair loss, the patient’s family history of hair loss and availability of donor hair
• Surgical techniques and procedures that could be used to address the patient’s wishes and how these techniques and procedures can be used to achieve the best aesthetic result given the patient’s age, characteristics of hair loss, and wishes of the patient including time and cost of hair transplantation.

The end result of transplantation should always be optimum aesthetic outcome for the patient as agreed upon between patient and physician. The patient should not be “sold” an approach to hair restoration. Rather, the patient and physician should agree on an approach and an anticipated outcome after full and honest discussion of (1) the patient’s wishes, (2) the physician’s recommendations, and (3) the patient’s concerns about the number of transplant sessions required, cost and potential complications.

Primary aesthetic concerns that must be addressed include:

The hairline: A recreated hairline should be placed at an aesthetically correct position on the frontal scalp, be natural in appearance, be appropriate to the patient’s age, and be congruent with the appearance of other original or restored hair on the scalp. The skilled and experienced physician hair restoration specialist also takes into account how a recreated hairline will “age” as the patient ages. The hairline should remain appropriate to the patient’s age over a period of time; a hairline that looks natural when the patient is 28 should continue to appear natural when the patient is 48.

Natural appearance and ease of styling: “Natural appearance” is the key phrase describing hair transplantation today. The type of donor hair selected, graft placement, size of grafts and overall transplant technique are selected to assure that transplanted hair is as “natural” in appearance as original hair and is amenable to styling as appropriate to the patient’s wishes. (For information on donor hair characteristics, see The Donor Site: Savings & Loan of Hair for Transplantation.

Science and Surgical Technique at the Recipient Site

Preoperative planning is directed toward achieving an optimum aesthetic result at the recipient site-a result that meets the expectations of the patient as agreed upon after full and frank discussion between patient and physician hair restoration specialist. Optimum aesthetic result is achieved by the physician hair restoration specialist’s skillful and experienced use of:

• knowledge of hair follicle biology and its application in the processes of hair transplantation, the physical characteristics of hair (caliber, color, texture, curl) and how to use these characteristics to maximum aesthetic effect at the recipient site
• transplant follicular unit grafts ranging in size from single-hair to multiple hairs, and which types of graft are appropriate for use in the patient to achieve the optimum aesthetic result
• surgical techniques of donor hair removal, preservation of donor grafts between removal from donor site to implantation in the recipient site, preparation of scalp skin for graft implantation, and implantation of grafts at the correct depth and angle to assure survival and subsequent hair growth at the angle appropriate for natural appearance and ease of styling.

Three (or more) haired-grafts are most suited where density is a primary objective, 2-haired grafts behind the hairline and in the frontal forelock and single-haired grafts for the very front and a feathery hairline.

The number and size of transplant sessions needed to accomplish the anticipated aesthetic outcome varies from patient to patient and from physician to physician. One procedure may be enough if the area is limited in size and not completely bald and the patient has a conservative view of how much hair is enough. On the other hand, 2-3 procedures may be advised if the area in question is large and almost completely bald. Obviously there are variations in between and the outcome is dependent on the quality and availability of enough donor hair from the back and sides of the scalp. In suitable candidates, hair may be supplemented from other parts of the body e.g. beard or chest.

One must understand that hair loss is an on-going condition-i.e., the patient may lose hair in the future. In such an event, more surgery may be required than is recommended at present.