Hair replacement techniques. An overview

From Orentreich's initial studies of the donor and recipient dominance of disease and of dermatologic conditions and his translation of those observations into punch-graft hair transplantation, a number of innovations in hair replacement have occurred. Many of these have been modifications and improvements of punch-graft techniques. Others have had major impacts on the treatment of baldness, such as flaps, scalp reduction, and tissue expansion. It is the combination of techniques, especially tissue expansion and punch-graft transplantation, that seems to hold the greatest promise for surgical treatment of baldness. Whether the hair replacement surgeon performs all of these procedures or not, he or she must be aware of the benefits of all of them and take them into consideration in developing a total plan for the individual patient. The hair transplant surgeon must also be aware that procedures desirable during the earlier stages of baldness may need to be modified with other types of surgery later in life as the alopecia becomes more developed, especially in the face of imprecise genetics in male-pattern baldness. The hair replacement surgeon not only must be aware that such modification may be necessary, but also must be knowledgeable about what those options entail. For example, tissue expansion may be a desirable adjunctive treatment with progression of baldness and would be possible if the parietal area has not been extensively harvested for punch grafts.(ABSTRACT TRUNCATED AT 250 WORDS)