Surgical Retoration

Body Hair Transplant (BHT) is so called because the donor follicles come from the body instead of the scalp. BHT is best used when there is lack of good scalp donor hair and the body hair can be placed as a fill-in to traditional transplanted areas. Simply put it is not the first recourse to hair transplantation and one would only look for non-scalp hair only when the scalp cannot provide the same.

There are many different sources for body hair. Starting from the nape of neck, back, chest, etc. to legs. These also represent many different types of hair. The morphology of these hairs is characteristic of the native areas and may include finer hair, straighter hair, curlier hair, coarser hair, shorter hairs, and potentially longer hairs. The wide variety alone makes them different than scalp hair.

Differences between scalp hair and body hair

There are 5 million follicles on the body of which only one hundred thousand are on the scalp. There is a significant difference in the character of the follicles on the scalp and the rest of the body. Though the donor follicles from the rest of the body are not very similar to the scalp follicles, the one best for use on scalp are the ones that come close in length, texture and behavior to scalp hair. Generally it has been found that hair from the beard and the torso are closest in comparison to scalp hairs and hence the most commonly used non scalp donor areas are beard and chest.

However, when using body and beard areas as the additional donor source, it is important to observe the differences in the characteristics of this hair compared to the scalp hair. While the genetics of the donor follicles dominate there are some recipient site influences which impact the growth and behavior of the hair after implantation. It must also be impressed on the patient that the body and beard donor hair may or may not change their characteristic curl, color, caliber after transplant to the scalp.

Hair cycles and density in different areas

Body Site Anagen % Telogen % Anagen Duration Telogen Duration Density (Hairs/cm2) Follicle Depth
Scalp 85 15 2-6 years 3-4 months 350/cm2 5-7 mm
Beard 70 30 1 year 10 weeks 300-500/cm2 2-4 mm
Chest/Back 30 70 1-2 years 3-6 months 70/cm2 2-5 mm

The duration of anagen or the growth phase of chest hair is much less than that of scalp hair and hence it can never grow as long as the scalp hair. The growth phase of the beard hair is better but still less than that of scalp hair and this is a better option as compared to chest or any other body hair.More importantly the ratio of growing to resting hairs (anagen- telogen ratio) is not great in the chest as almost 40-70 percent are in telogen/resting phase as compared to 10-15% hair in resting phase on the scalp. This means that one needs to harvest only hair those are in the growing phase. (This is the reason that the chest or the back needs to be shaved at least 5 days before the planned surgery and the beard area needs to be shaved 2 days before surgery). Also there is significant difference between the thickness of the skin of the scalp and body. For all the above reasons it is important to for the patient to understand the realistic outcomes. The outcome may be no growth, fine hair growth which is not cosmetically acceptable or very sparse growth. For these reasons, at HAIRREVIVE we perform a test procedure using chest or back hair, prior to undergoing a larger body hair procedure. Six months after the test procedure we evaluate the yield and appearance of the transplanted hair. If the growth appears optimal and the patient and surgeon are satisfied with the outcome, further procedures are planned. If sub-optimal results are seen we avoid further procedures. Generally speaking the beard hair transplants have a success rate of 80-85%. Hairs on the torso also survive well but results are slightly less predictable as compared to beard grafts. Hence it is best to perform a full-fledged body hair transplant only after evaluating results from a test procedure.

Body hair donor areas

Due to the reasons mentioned above non scalp donor hair can be separated into two categories: beard hair and the rest of the body (usually the chest and the back). Beard hair follicles are androgen dependent and usually grow as single hair but some people with thick coarse beards may have two three hair units. As the beard hairs have a very favorable anagen-telogen ratio they are more successful as compared to using hair from other body areas.

This is because the chest, back and other hairs have very short growth cycles and do not grow much longer than 3 to 6 cm in length. The body hairs also differ from the scalp hair in curliness -they are usually curly, and beard hairs are curlier than the other body hair.Hence these hairs cannot be used to restore the hair line and usually need to be mixed with scalp hair to look more natural.

It is important to keep in mind that sometimes even when the source of body hair is coarse, the hair will not grow as coarse on top of the head. The hair may produce a cosmetically insignificant result as compared to head hair and beard hair.

Indications for body hair transplant

  • Individuals with advanced grade of hair loss having limited scalp donor follicles and having good beard or torso hair
  • Depletion of scalp donor areas due to previous hair restoration surgeries with inadequate coverage of recipient areas.
  • Combining with a regular scalp hair transplant to augment the coverage.
  • For camouflaging donor scars
  • Extensive scarring alopecia of the scalp where the scalp donor area is inadequate

Some patients prefer to use body hair over scalp hair. In these circumstances, a trial of body hair might be performed to evaluate the growth and appearance of the grafts.

Requisites for performing body hair transplants

We are best able to locate the anagen hair by first performing a wet shave of the recipient area. The hair must be shaved against the grain so that the donor area hair is smooth like hairless skin. The purpose is to help us identify actively growing hairs that will grow longer over the following days. With beard hair, the anagen hairs may be noted within a day and can be harvested at that time. With torso hair, it is best to evaluate the donor area 4-5 days after shaving because torsohairs take longer to grow.

Considerations

  • Density in the donor area of the body site should be at least 40 or more FUs/cm2
  • Total dimension of the hair bearing area with the above mentioned density
  • Proportion of more than one hair (2-3 hair) Follicular units
  • Length of torso hair
  • Similarity between torso hair and scalp hair

Based on these parameters one can assess the eligibility for performing torso hair transplantation.

Procedure

Patients have to wet shave the chest/back/abdomen, 5 days before the surgery, to identify the hair in growing phase.

Anesthesia

The anesthetics used are the same as that for strip harvest or FUE.

Usually a ring infiltration is performed. As the surface area for chest is much larger the anesthesia requirements are also more. Hence it is better to perform torso hair transplants over two or three days if a large number of grafts is planned.

Implantation is similar to that for FUT or FUE. Care is taken to not allow the grafts to desiccate and to implant them as soon as possible. It is important to note that these grafts are even more delicate and need to be handled carefully.

Post-operative care of the donor area is similar to that of FUE. A light gauze dressing is applied to cover the donor area. Patient is asked to remove the dressing next day and to gently wash the area with soap and water. The recipient area is wet after 48 hours.

Body hair transplants are performed just as often as scalp hair transplants. Growth is fairly predictable at 4-6 months so patients and their physician will know if desired results are attainable. On a rare instance, a poor yield at 12 months can change to an excellent result between the 12 and 24 month time period.

Some body hair transplants are not equally as successful as scalp or beard hair transplants. Coverage in general is easier to achieve with scalp hair so this should be the first line of treatment for hair loss.