Men's legs may be new source for hair transplants

In the February issue of the Archives of Dermatology, Dr. Sanusi Umar explained that the finer, softer hair found on the leg is an ideal candidate for hair grafts that aim to recreate the hairline.

"The whole idea is to take hair transplantation to the next level," said Umar, a private practitioner in Redondo Beach, Calif., and clinical instructor in dermatology at the University of California, Los Angeles.

There are "several problems" with traditional methods for hairline transplant, he believes.

"First, the traditional transplant takes hair from the middle of the back of the head, and that hair happens to be the thickest hair on the head," he said. That means that, "if you take it from there and put it in the hairline, despite your best efforts, it will end up slightly harsh[-looking] and unnatural in the hairline. It's problematic to say the least," Umar explained.

"The other issue is that people bald or thin to varying degrees," he noted. "You can have mild baldness or it can be very severe." This means that the standard method of hair transplant is of little use to a man who has lost most of his head hair and therefore has no source for the transplant.

"You're fighting a losing battle because there's just not enough to work with. Most ethical practices will therefore tell a very bald person that they cannot do it because it will not look natural," Umar said.

"In addition to that, over the years there are a lot of patients that have had hair transplantation that is antiquated," he added. "They have a 'pluggy' look. They have scars. And they no longer have any donor supply left on the back of the head to deal with that issue, because it's already been used up."

Looking for a solution, about seven years ago Umar began exploring "advanced body hair transplantation" or the "U-graft method."

Essentially, the technique involves scouting for hair from all over the body, keeping in mind that not all patients are equally hirsute.

"With this approach I can combine beard hair, chest hair and leg hair, depending on the person's hair distribution," Umar noted. "Mixing that with some thicker head hair as well, I can come up with about 20,000 to 30,000 hairs, which means I'm then able to tackle some very severely bald individuals."

However, recreating a natural hairline at the forehead requires especially fine hair. Umar believes that leg hair "works the best in terms of simulating nature [in this spot]. Sometimes we can also take hair from the nape of the neck, which is also very fine. And then for behind the hairlines we can use some of the thicker head hair."

In his case report, Umar published the results of two such transplant efforts. One involved the exclusive use of leg hair follicles to recreate the front of the patient's original hairline/temple area, while the other involved mixing transplanted leg and head hair to soften and bring forward a custom-designed "widow's peak" hairline for a patient.

In both cases, the transplant procedure gave rise to what Umar described as a "fully grown and soft-looking hairline" within nine months. Between 75 to 80 percent of the fine transplanted leg hair flourished in its new home on the head, and three to four years later both patients had experienced minimal hair loss in the transplant area.

However, Umar noted that men seeking such procedures should be both patient and prepared for a hefty bill. The procedures are typically spaced over two sessions (each involving three to five days) that are spread over the course of a year. And at $7 to $10 per hair follicle graft (with each follicle containing anywhere from one to four strands of hair), the bill will ultimately total in the thousands, Umar said, with so-called "slick bald" patients facing the highest expense.

Opinions from other experts in hair transplantation were mixed.

Dr. Malcolm Roth is president of the American Society of Plastic Surgeons and chief of the division of plastic surgery at Albany Medical Center in Albany, N.Y. He hailed the innovation as "yet another example of how new techniques continue to refine and improve outcomes in cosmetic procedures to give patients more natural results."

However, Dr. Barry DiBernardo, who has a private practice in Montclair, N.J., said the procedure does raise a few questions and concerns.

"Finding hair from other parts of the body is not new at all," he noted. "We've long considered that option, because clearly when you're designing a hairline . . . the more we can make it look like what was there in the first place, the better," DiBernardo explained.

"But when you use body hair it can be a different thickness," DiBernardo said. "It can have more curl to it than the original hair. So these reports sound fine. But the approach does raise the issue of a hair mismatch, which of course will depend on the person. Everybody varies," he said.

"The other thing is the question of the potential for scarring, or leaving pinpoint scars, following harvesting of hair," DiBernardo pointed out. "Because while you're not going to see the back of the head and it's a very good area for healing to begin with, you will see the leg. And the leg certainly doesn't heal as well as the scalp."

More information: Find out more about hair transplants at the U.S. National Library of Medicine.

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