Single Hair Transplantation Using the Choi Hair Transplanter YUNG CHUL CHOI, MD, PhD JUNG CHUL KIM, MD, PhD
A new procedure for single hair transplantation using
the Choi hair transplanter is presented. This operation provides obvious cosmetic advantages in hairline refinement and the reconstruction of eyebrows, eyelashes, beards, and pubic escutcheon. The surgical technique is described in detail. J Dennatol Surg Oncol 1992;18:945 -948.
any hair transplant surgeons'-' have advocated the use of single hair grafts for softening the hairline, filling gaps between grafts, and replacing eyebrows. A number of different techniques for obtaining single hair grafts have previously been described. In 1980, Marritt' reported a simple method of harvesting single hairs from the periphery of standard grafts. These small grafts are removed from a standard size graft by carefully incising on both sides of a hair located at the periphery of the standard graft using a very sharp scalpel. Tenotomy scissors are then used to cut the small piece of tissue containing the single hairs from the larger graft. ShielP uses a #11 blade to cut single hairs from a standard 4-mm graft. Norwood6 has employed the use of razor blades with a Castroviejo blade holder instead of surgical scalpels. Recently, Unger' described a process where individual hairs are stripped from the periphery of standard grafts by using forceps, thus not cutting or removing any of the skin or subcutaneoustissue. We use a number 20 blade to separate individual hairs from the strip of hair bearing scalp. Recipient sites for single hair grafts are made with large bore needles (number 16 or number 18), surgical blades (number 11 or number 15), and Mamtt micrograft
dilators.8We devised the Choi hair transplanter to facilitate the insertion of grafts into the recipient sites.
Surgical Technique The patient is photographedbefore preoperative sedation is administered. A marking pen is used to draw the proposed incision, as well as the anticipated area to be grafted. The hair on the donor area is cut to 1 cm long. Local anesthetic in the form of 1% lidocaine with 1: 100,000 epinephrine is then instilled into the donor scalp. After the epinephrine has caused the tissue to blanche, an elliptical incision is made in the occipitalscalp and the donor scalp is removed (Figure 1).A two-layered closure is carried out in the usual fashion (Figure 2). A standard type of gauze and stockinettedressing is applied and the removed donor scalp is washed with cooled normal saline. An elliptical graft is placed on a block of wood and cut into segments with a number 20 scalpel blade, carefully positioning the blade between the visible hair follicles (Figure 3). Using the same blade, each segment is then cut again into a single hair graft (Figures 4 and 5). Single hair grafts are kept in cooled saline until required. Normally, magnification is not used. The local anesthetic is instilled into the recipient area. The single hair grafts are placed into recipient sites using the hair transplanter (Figures 6 to 14). These single hair grafts are very firmly held in place within 24 hours, thus requiring neither dressing nor bandage.
Discussion The advantages of this method are as follows: 1. The procedure can be performed under local anesthe-
From the Togo Clinics (YCQ, Seoul, Korea, and the Department of Immunology uC@, School of Medicine, Kyungpook National University, Taegu, Korea. Address correspondence and reprint requests to: lung Chul Kim, MD, Department of Immunology, School of Medicine, Kyungpook National Unioersity 202, Dong-ln Dong Taegu (700-423, South Korea.
0 1992 by Elsevier Science Publishing Co., Inc. 0148-0812/92/$5.00
sia with little discomfort to the patient. 2. The yield is excellent, probably because the circulation in the recipient area is barely disrupted. 3. Hair direction can be made more natural (Figures 12 and 13). 4. The needle of the hair transplanter is fashioned in the dimensions of a 21-gauge needle, inflicting the abso-
lute minimal degree of tissue injury to the most cosmetically critical area. 5. The surgeon is offered greater versatility when doing repair work because of the added ability to get into very small spaces (Figure 11). 6 . This method has excellent yield in areas of scarring, making it very amenable to scar camouflage (Figure 9). 7. Single hair grafts are excellent for reconstruction of eyebrows (Figure 12), eyelashes (Figure 13), beards
J Dermatol Surg Oncol
Figure 6. The Choi hair transplanter with single hairgrafts.
CHOI AND KIM CHOI HAIR TRANSPL.ANTER
J Dermatol Surg Oncol 1992;18:945-948
Figure 8. The Choi hair transplanter in place.
B Figure 11. Hairline refinement. A) Preoperative punch grafts. B) Postoperative.
(Figure 14), and pubic hair (Figure 10).Because of their small size, minimal bleeding, and absence of scarring and tufting, the grafts are easily inserted and create a very natural appearance in these areas.
Figure 9. Burn scar camouflage: single hair grafts in situ and one being inserted.
Two disadvantages of this method are that the preparation of single hair grafts is tedious and time consuming. With practice, 250 single hair grafts can be prepared within an hour. We averaged 3 hours for eyebrows or
1 D e n a t o l Surg Oncol
A Figure 12. Eyebrow reconstruction.
C B) Postoperative. 0 A close up of the r8econstructed eyebrow, 2 years postoperative.
Figure 13. Eyelash and eyebrow reconstruction. A) Preoperative. B) Postoperative. 0 Three years postoperative.
A Figure 14. Beard reconstruction.
Preoperative. B) Postoperative. 0 Two months postopei*ative.
pubic hair reconstruction. However, it is necessary to have a minimum of two nurses to achieve this time efficiency, which could also be considered a disadvantage.
Acknowledgment. The authors wish to thank Akio Kakinuma for the manufacture of the Choi hair transplanter.
References 1. Mamtt E. Transplantation of single hairs from the scalp as eyelashes. J Dermatol Surg Oncol 1980;6:271-3. 2. Fujita K. Reconstruction of eyebrows. La Lepro 1953;22:364.
3. Tamura H. Pubic hair transplantation. Jpn J Dermatol 1943; 53:76. 4. Nordstrom REA. 'Miaografts' for improvement of the frontal hairline after hair transplant. Aesthet Plast Surg 1981;5:97. 5. Shiell RC, Norwood OT. Micrografts and minigrafts. In: Norwood OT, Shiell RC, eds. Hair Transplant Surgery. Springfield: Charles C Thomas, 1984. 6. Norwood OT, Shiell RC. Hair Transplant Surgery. Springfield: Charles C Thomas, 1984. 7. Unger WP, Nordstrom REA. Hair Transplantation. New York: Marcel1 Dekker, 1988. 8. Marritt E. Micrograft dilators: in pursuit of the undetectable hairline. J Dermatol Surg Oncol 1988;14:268-75.