Hair transplant best in turkey
Although the following calculations apply with a graft of any size, a 4-mm graft and the associated pattern is used (Figure 2) to demonstrate the placement of grafts in the recipient site.
The area of x, equivalent to the space between the grafts under ideal conditions, is the sum total of four areas of y (y X 4 = x) and is calculated as the difference between a circular graft, z, and the area of a square encompassing the circle.
Since the area of a round graft, defined here as z, measures 12.5 mm2 and the area of the square encompassing z equals 16 mm2, the area between the grafts represents 3.5 mm2 (the sum total of y X 4), or 28% of the size of the graft itself.
Thus, this area becomes significant, allowing an individual to visualize the separation between the grafts. Scar contraction, which decreases graft size, enlarges the spaces between the grafts.
As the surgeon makes the transplanted grafts smaller, the size of the area x approaches the distance between the growing hair groups within a graft.
This means that the visibility of the space between the grafts becomes less noticeable as the graft size decreases.
To illustrate this point, assume that a person has an average hair density of two hairs/mm2 and a graft size of 1.25 mm with an average of four hairs per graft in a recipient area.
To accomplish this, some of the bare area between the growing hair groups may have to be excised (microscopically) when preparing the grafts.
Using a regular pattern, the area of z equals 1.23 mm2, y is now 0.33 mm2, and x closely approximates the 1.23- mm2 area.
The distance between the groups of hairs
within the four-haired grafts will not exceed 1 mm
The lack of uniformity in placement and smaller graft size in larger quantities maximizes undetectability. Natural hair growth is simulated as the spaces between the grafts approach the spaces between growing hair groups.
Doughnutting,2,3,13 the decrease in density within the center of the graft, increases proportionally to graft size.
It often results from lack of sufficient oxygen transport to the center of the graft when grafts exceed 2 mm in size. As the graft size increases, the amount of ischemia increases.
The physical laws governing oxygen diffusion in hair grafts are the same laws that physicians observe in pulmonary alveolar edema.
From a practical point of view, a person with Norwood Class 7 hair loss pattern1 has lost 75% of his hair population in the front, top, and crown.
Traditional hair transplantation attempts to restore hair by moving half of the donor hair (12.5% of the original hair population) to replace the 75% of the lost hair (illogical at best).
If dense clustering attempts to produce a 1.2: 1 surface area between the recipient and donor area under the conditions shown in Figure 2 (ie, larger traditional transplants), then there cannot be enough donor hair to cover the bald area under any reasonable argument.
This same logic applies to scalp reductions, hair flaps, and all other forms of surgical hair restoration.
The ratios of bald skin and movable donor hair (using any available method of hair restoration) are critically dependent upon the geometry of the process, modified by the aesthetic skills of the surgeon an the attributes of the patient’s hair.
Therefore, physicians must establish realistic goals with each patient and communicate them in a manner consistent with the “informed consent” required of all physicians.
Megatransplant sessions (more than 1000 grafts per session) more readily create the illusion of a fuller head of hair by redistributing the hair in smaller skin units placed in random patterns.
The more densely these units are placed to each other, the better the illusion of fullness.
One- or two-haired graft transplants, recommended in individuals with coarse black hair and light skin, to be effective, must be placed in massive quantities to make the impact financially and clinically practical, and aesthetically pleasing.
It often takes twice the number of hairs per session to achieve the same bulk in individuals with fine hair when compared with individuals with normal hair bulk.
As the hair becomes finer (and lighter in color in light skinned individuals) the number of hairs per graft can increase without producing a “picket fence” appearance.
Three-hair graft transplantation is best performed in an “average” person with light brown, medium weight, wavy, soft character hair.
In individuals with higher hair bulk, the number of hairs per graft should be reduced (this becomes even more important when the color between hair and skin has a high contrast).
Contrary to present belief,
the number of grafts transplanted in any one session is limited by the size of the donor strip and the recipient are, not by the blood supply in the recipient area.
In individuals with very high density, it is possible to transplant as many as 3000+ grafts per session. Patient satisfaction, in such individuals, is extremely high.
Figure 4 reflects the actual placement of grafts with a dense packing technique used routinely in my surgical practice.
The graft quantities (and the very close packing of those grafts) used in the patient portrayed in Figure 3 should not routinely be used in advanced hair loss patients who will most likely not lose significant amounts of hair.
This patient demonstrated that dense packing of grafts in large numbers and with small intermittent spaces is not only possible, but also does not produce a blood supply problem (as commonly thought).
If dense packing of the grafts is used in the most advanced hair loss patients, one must consider that an imbalance may result as the hair loss pattern progresses.