We have special interest in dealing with afro-hair patients. Afro-hair has unique surgical characteristics and technical challenges due to its curly/kinky nature. Only surgical teams that operate at very high standards are able to deal with these challenges.
- Hairs pierce through the skin in a curved fashion, which means that if an incision is made cutting through the skin surface straight down, there is a high probability that the roots of these hairs are transected. This will result in a significant amount of scarring and wastage of hairs. Experience and surgical skills in both FUT Hair Transplant and FUE Hair Transplant are necessary to get a feel for the curved nature of the skin and make an incision in a curved fashion so that the follicles are protected.
- The curved nature of the hair necessitates that more tissue must be left around the follicles while preparing the grafts in order to prevent graft damage. Chubbier grafts necessitate bigger recipient incisions which means that a smaller number of incisions can be done per area. This also means that the transplanted density must be less than in patients with non-afro-hair.
- Curved grafts are more difficult to place which means experience and skills of the surgical team is needed to place these grafts without damaging them.
- Kinky hair makes FUE very difficult. FUE is the blind insertion of a straight surgical punch in order to extract grafts and works best when the hair is straight. A bigger surgical FUE punch must be used in patients with afro-hair in order to harvest intact grafts. Bigger punch means more scarring. Extra talent and experience is needed in getting a feel for the curved nature of the hair and making curved insertions.
- Hair loss in afro-hair men is more diffuse than in whites. The donor area is frequently affected by the thinning and donor density is also lower which means the donor capacity is less. For the same reason, an FUT scar or even FUE scars at the donor area may be more visible.
Female Afro-Hair Transplants
The most common hair loss problem in female afro-hair patients is traction alopecia, which is hair loss due to using too tight braids. It is usually presented as the loss of hair at the edges and premature receding of the hairline. In advanced cases, a type of scarring alopecia may occur, causing extensive loss including the mid-scalp and crown areas.
The good news for traction alopecia patients is that there usually is a healthy donor area at the back of the head where donor hair can be harvested for a transplant.
In non-afro-hair females, hair loss is usually a sophisticated problem. It is usually related to metabolic or dermatologic diseases that firstly need to be diagnosed by an experienced dermatologist and medically treated. All possible metabolic and dermatologic diseases must be overruled before surgical restoration can be considered, as attempts at doing surgery while an underlying disease is present are doomed to failure. Female afro hair patients are no exception and all possible underlying diseases should be ruled out first before an attempt at surgical restoration is made. Once the diagnosis of traction alopecia is made plans for surgery can be done.
Due to the challenges related to afro-hair explained above, FUT is a better option than FUE for afro-hair patients in the majority of cases:
- FUT allows for microscopic dissection under direct vision versus blind punch excision in FUE. FUT causes much less risk of damage to the hair follicle.
- FUE in afro-hair requires larger surgical punches than usual which causes larger scars. FUT does not have this problem.
- FUT can be done without shaving the donor area whereas FUE requires complete shaving.
- Linear scar caused by FUT is not a concern in females due to a longer hair style.
Male Afro-Hair Transplants
Male pattern baldness (androgenic alopecia), is the most common cause of hair loss in men. This is the thinning of hair all across the top of the head, while leaving a more permanent area at the back of the head. However, hair loss in afro-hair men is associated with some difficulties;
- Hair loss in afro-men seem to progress in a more diffuse pattern, reducing more the donor potential at the back of the head.
- Thinning at the back of the head not only limits the donor capacity, but also makes surgical scarring caused by FUT or FUE more visible.
- Due to the kinky nature of hair and due to diffuse thinning, afro-hair men tend to keep their hair very short. This makes donor scarring more of a concern.
- The kinky hair type makes FUE more difficult and limits the amount of donor hairs transplanted.
- Body Hair Transplant (BHT) is rarely possible due to the unfavorable architecture of hairs.
Due to the above-mentioned limitations, hair transplants in Afro-men should be done cautiously. FUT should be the method of choice if the donor area is estimated to provide enough coverage for the linear scar. If FUE is preferred then graft harvesting must be done conservatively in order not to cause significant donor damage and to preserve donor area esthetics. Hairline designs should also be done more conservatively especially in young afro-hair men, considering the limited donor availability.
