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Current Methods of Surgical Hair Restoration-BHT

I said there were two main types of surgical hair restoration in use today and this is true but I feel that body hair transplantation is worth mentioning in a separate page but it is an extension of the FUE procedure in that the same tools are used. BHT stands for "body hair transplant", an abbreviation that I first used when body hair was being discussed in 2002/2003. It is literally the transplantation of hair from other parts of the body to the bald or balding scalp. For the purpose of this discussion however I am not including beard hair as I feel it should be set apart from regular body hair for reasons to be discussed.

BHT Body hair transplant by Dr. Ray Woods. Body hair shown to grow much longer on the scalp.
Body hair transplant by Dr. Ray Woods. Body hair shown to grow much longer on the scalp.

BHT was first carried out in Japan in the 1920's and 1930's by Sasagawa and Okuda and then was not seen again till Dr. Ray Woods performed body hair transplantation in 1989, nearly sixty years after the Japanese. It has been noted by both Okuda and Woods that when body hair is transplanted to the scalp or other areas of the body where the hair grows differently than the hair to be transplanted, that the transplanted hair eventually takes on the characteristics of the hair in the recipient zone. This is completely contradictory to Orentreich's Theory of Donor Dominance as it would indicate that the recipient zone dictates final hair growth and is not dictated by genetics. As it turns out there is a combination between the two that influence hair growth. I posit that the Orentreich's theory is correct and true with regards to the genetic predisposition that determines DHT sensitivity but the recipient site dictates the growth characteristics of any hair transplanted. This is why Woods noted that chest and back hair transplanted to the scalp had much longer anagen phases which translated to longer growth than before surgery. Okuda noted that hair transplanted into eyebrows eventually acquired the shorter anagen phase of the native neighboring eyebrow hair and no longer needed to be trimmed weekly. In other words, hairs that normally have different growth characteristics of the native hair in the target recipient zone would eventually take on the same characteristics of said native hair in the recipient zone.

BHT Body hair repair by Dr. Arvind Poswal in India
Body hair repair by Dr. Arvind Poswal in India

Body hair is a surgical option but should only be used for "last resort" situations. Examples in which body hair can be used are:

  1. Cases in which the donor zone is "tapped out" with little to no viable donor hair left in the traditional safe zone. This can be due to too many FUSS procedures making the scalp too tight for additional FUSS procedures. It can also include cases of FUE where the limitations of extractions have been met thus any further FUE would make a cosmetic detriment to the visible density.
  2. BHT is very helpful in extreme repair cases where the recipient zone is unnatural in appearance due to poor aesthetics by a previous surgeon and/or excessive scarring and too little or no traditional scalp donor hair remains to make an acceptable repair possible.
  3. Excessive scarring in the donor zone can benefit from repair by placing body hair into the scars for a camouflage effect.
  4. Adding density to otherwise natural looking hair transplant results when no further traditional donor hair is available.

All of the above scenarios can benefit greatly from body hair but the patient MUST understand that body hair is not nearly as reliable as scalp hair when it comes to final growth. On average, body hair has a final yield that varies wildly between 30% and 70%. The typical areas of the body that are considered to be "the best" sources of donor hair include the chest, the back and the legs, in that order. The challenge with using body hair is that the extraction process causes much more damage to the graft as opposed to those grafts removed in the same manner (FUE) from the scalp. The reason for this is the pliability of the skin tissue. When one is working on the scalp with FUE there is very little "give" or compression movement. The tissue of the scalp is fairly thin so the angles of the grafts are not distorted much when pressure is applied. The tissue of the body however has much more give and is more prone to graft distortion due to the greater movement of the tissue. It's like comparing the springs of a solid mattress to a very soft mattress. The springs of the soft mattress will move more than the springs of a solid mattress. When applying this analogy to hair shafts, they will tend to bow outward thus making transection a more likely occurrence.

What About Beard Hair For BHT?

bht-beard-hair-transplant-scalp
Beard hair to scalp transplant result by Dr. Christian Bisanga in Belgium.

 

Beard hair is different. Beard hair has the benefit of being more coarse and hardy and they are less susceptible to damage during extraction. Because they are more coarse they also give better coverage, graft for graft, than hair from other parts of the body. Beard hairs are ideal for placement into scar tissue from previous FUSS procedures and they tend to have higher yield in scar tissue as well. The only real concern with beard hair is that because it is usually considered coarse it may not blend well with native hair if the native hair is considered to be fine and soft. There are no stated observations that I am aware of, much less studies, that have shown beard hair to take on the characteristics of the recipient sites they are placed into.

 

 

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