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Naturally Occurring Hairlines in Orientals of Southeast and East Asian Origin and Their Application in Hair Restoration Surgery

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... At the temporal region, the average density is 69.6 FU/cm 2 and 97.6 hairs/cm 2 . This translates to 1.4 hairs/FU [11] (see Chap. 14). There are, however, several reports of superdense packing of more than 50 grafts/cm 2 with adequate growth [12]. ...
Chapter
The recipient area is much more important than the donor area with regard to the final result of hair restoration. Unfortunately, FUE advocates instead focus attention on this modality as the sole donor harvesting technique in hair transplantation and often neglect discussion of the recipient area. The recipient area will show the end result of hair transplantation that the patient is eager to see, hence is of paramount importance. It will show if the implanted hairs look natural with decent density, as was promised to the patient prior to the surgery. These factors are of ultimate concern to the patient as well as to the surgeon. Litigations frequently stem from the outcomes of hair transplantation if the result is not on par with patient’s expectations. This is the main concern regarding the recipient area that needs more attention.
Chapter
According to the ethnic, there are three major hair characteristics: African, Caucasian, and Asian. Asians are known to have fewer hairs than Whites. Asia can be divided into two parts: West and East Asia. West Asian hair characteristics included three big subgroup ethnic, Persian, Turkish, and Arabian, so in West Asia, there are more differences in hair characteristics (color, caliber, shape, density and terminal-to-vellus hair ratio, and anagen-to-telogen ratio.), but no differences in the intimate structures of fibers were observed among these three types (African, Caucasian, and Asian) of hairs. Through research in medical literature, the author could not find more about Arabian and Turkish subgroup ethnics’ hair characteristic, so this data is restricted to Persian (Iranian) subgroup ethnic and comparison with East Asia and Caucasian. According to study, the total hair density, follicular units, and hair shaft diameter of Iranian are significantly higher than of other East Asian people. And finally in comparison with Asian and American White people, the Iranian hair count is the same or close to White people and significantly higher than other Asian people.
Article
Background: Female hairline restoration has increasingly been in demand for the past decade. However, no reports address the correlation between characteristics of hair at the hairline and at the donor area. Objective: To assess follicular characteristics at the hairline and at the donor area including hair density, diameter, and their correlation. Materials and methods: One hundred one randomly selected Southeast Asian female volunteers were assessed for hairline and donor area characteristics. Data from the donor sites, including the temporal, parietal, occipital, and neck region were compared with that of the hairline. Results: Hairline density was 135.2 hair/cm with a diameter of 80.07 μm in midline, 112.95 hair/cm with 73.96 μm at the frontotemporal area, 69.82 hair/cm with 72.09 μm at temple peak, and 74.26 hair/cm with 72.35 μm at sideburns. The donor hair density was 98.89 to 152.19 hairs/cm and hair diameter was 76.80 to 81.11 μm. Aging was shown to affect hair density and diameter at the donor area. Conclusion: All donor sites are suitable for hairline restoration of the midfrontal region except in the neck region. The suitable donor area for the frontotemporal area, temple peak, and sideburns is the nape. Hair density and diameter declined with age at some donor sites.
Article
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Androgenetic alopecia (AGA), or pattern hair loss, is a common disorder in Asian men and women, with a reported incidence of up to 73% among general population. There are several descriptions regarding the characteristics of AGA in patients of European descent. Asian patients with AGA have different types of hair loss and family histories from Europeans, which may affect treatment response. Therefore, in this review, prevalence, hair loss patterns, familial factors, androgen receptor gene polymorphisms of Asian AGA patients, and management based on algorithmic guidelines for AGA are discussed. This review may be useful for dermatologists in clinical practice for diagnosing and designing management approaches for Asian patients with AGA.
Article
Full-text available
Androgenetic alopecia is the most common form of hair loss. It affects a large number of the local male population, with 1,812 men seeking treatment for hair loss at the sole dermatological tertiary referral centre in Singapore in 1994. The aim of this study was to assess the prevalence of male androgenetic alopecia in the community. A questionnaire-based cross-sectional survey with a one-stage sampling method was conducted. Each male was diagnosed clinically and the severity graded according to the Norwood Criteria. The survey area was in Bishan East, a housing estate with 8,004 households. A total of 335 households were selected for the survey. The household response rate was 84%. Within these households, 254 out of 378 men participated in the study (67% response rate). The prevalence of androgenetic alopecia was found to be 63%. The prevalence of the condition increased with age, from 32% among young adults aged 17 to 26 years to 100% among those in their 80s. Proportionately more Indians (87%) were affected compared to Chinese (61%). 81% of the respondents with androgenetic alopecia did not seek help as they did not view it as a problem. Of those seeking treatment, 74% used non-medical methods of unproven effectiveness. There is a high prevalence of androgenetic alopecia in the community in Singapore. Age specific prevalence and racial differences correlate well with both Western and local studies respectively.
Article
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Background and aim: Androgenetic alopecia (AGA) is undoubtedly the most common form of hair loss in males. It is a condition which may cause cosmetic and psychosocial problems in androgen-dependent cases. In this open, randomized and comparative study we evaluated the efficacy of oral finasteride and 5% topical minoxidil treatment for 12 months in 65 male patients with mild to severe AGA. Methods: We randomly assigned 40 (61.53%) patients to receive 1 mg/day oral finasteride for 12 months, and 25 (38.47%) patients applied 5% topical minoxidil solution twice daily for 12 months. Results: There were no significant differences between the 2 groups considering age, age of onset of hair loss, family history and type of hair loss (p > 0.05). In the clinical evaluation at the endpoint of treatment, the clinical cure rates (i.e. increased intensity of hair) were 80% (32/40) for the oral finasteride group and 52% (13/25) for the 5% topical minoxidil group. Encountered side effects were all mild, and there was no need to stop the treatment. In the group given oral finasteride, side effects were noted in 7 patients: 6 patients suffered from loss of libido, and 1 patient had an increase in other body hairs; irritation of the scalp was seen in 1 patient in the group administered 5% minoxidil. These adverse events disappeared as soon as the treatment was stopped. The laboratory data on both drug groups did not show any statistically or clinically significant intragroup changes from baseline values to the endpoint (p > 0.05), except the level of serum total testosterone which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were statistically decreased from baseline values to the endpoint (p < 0.05). Conclusion: In this comparative study of systemic finasteride and topical minoxidil, it was concluded that both drugs were effective and safe in the treatment of mild to severe AGA, although oral finasteride treatment was more effective (p < 0.05). Adverse events were not considered important either, and these side effects disappeared as soon as the treatment was stopped.
Book
Hair transplantation is in demand worldwide, but because Asian hair tends to be more sparse and coarse than Caucasian hair, transplantation procedures need to be adapted to Asian patients. This book, exclusively devoted to Asian hair, is a complete and comprehensive text written by a group of authors sharing their experience in their specialized fields of hair restoration. Included are many practical tips as well as chapters on regional transplantation such as eyebrows, eyelashes, sideburns, beards, and mustaches, in addition to the usual scalp hair restoration. With its many illustrations, the book gives readers a complete knowledge of hair restoration surgery and provides a quick, easy-to-use reference on Asian hair and the differences in patients' demands. With an influx of new physicians in this challenging field of medicine, further education and training are imperative and must be available to provide a high standard of medical practice. This compilation meets that objective and ultimately makes the valuable contribution of restoring patients' self-confidence.
Chapter
Hamilton (1951), in a frontier work, extensively studied the developing patterns of scalp hair in men and women from the prenatal period through the tenth decade. He divided the balding patterns into eight types with three sub-divisions, then compared the incidence of baldness between Caucasian and Chinese.
Article
Creating a natural hairline is one of the most important elements of a successful hair transplant. This article discusses the key skills needed to design a natural hairline. These are locating borders of the hairline as well as understanding and being able to mimic the visual characteristics of a hairline. Methods to locate the major borders and how to adjust them based on donor/recipient ratio are discussed. The visual characteristics of different hairline zones are described as well as techniques to recreate these characteristics using follicular unit grafting.
Article
Techniques in hair transplantation have evolved recently which make results look more natural. Hair restoration is one of the most exciting and innovative surgical fields in aesthetic surgery today. A precise appreciation of anatomy has allowed the use of follicular unit grafts. With better methods of harvesting and implantation, hair transplantation results represent a blend of art and science.
Article
This article attempts to guide the reader through all of the considerations that must be made before settling on the best hairline for a given individual patient. Five essential components to the hairline's design and construction are considered in detail: the height of the hairline, the general contour of the hairline, the intersection of the hairline's lateral arms with the side fringe, creating macrocontouring and microcontouring, and, finally, the direction and angulation of the hairs along the hairline. The pros and cons for using either the hemioval or the flared hairline contours are outlined. The author's strong preference in most patients is the flared design. A step-by-step method for drawing the hairline is given along with several "checks" to be done after the final drawing to confirm its proper orientation to the other landmarks of the head and scalp. The various choices for direction of hairs in the hairline are presented and discussed, with the author's preference stated for curving the hairline direction through the front-central aspect of the hairline. Six pitfalls are mentioned that should be avoided in hairline design. The option of adding anterior temple transplantation along with that of the hairline is explored. This area's contribution to framing the face and supporting the frontal hair is emphasized. A few comments on creating a female hairline are then made, particularly concerning the need to create a shallower and gently curved recession on each side.
Article
There are ethnic differences in the prevalence and types of androgenetic alopecia (AGA). Although there have been several reports on the prevalence and types of AGA in caucasian and Asian populations, there are very few data on a Chinese population that have been derived from a sufficient number of samples. To estimate the prevalence and types of AGA in a Chinese population, and to compare the results with those in caucasians and Koreans reported previously in the literature. A population-based cross-sectional study was carried out in 7056 subjects (3519 men and 3537 women) from May 2006 to December 2006 in a community of Shanghai. Questionnaires were completed during face-to-face interviews at the subjects' homes. The degree of AGA was classified according to the Norwood and Ludwig classifications. The prevalence of AGA in Chinese men was 19.9%, and the prevalence of female pattern AGA in men was 0.1%. The most common type in men was type III vertex (3.5%). The prevalence of AGA in women was 3.1%, while male pattern AGA was found in those aged over 50 years (0.4%), and the most common type was type I (Ludwig classification) (1.4%). A family history of AGA was present in 55.8% of men and 32.4% of women with AGA. The prevalence of AGA in Chinese men was lower than in caucasian men but was similar to that in Korean men; however, over the age of 60 years it was approaching that in caucasian men but was higher than that in Korean men. The most common type in Chinese men with AGA was type III vertex. Interestingly, the prevalence of AGA in Chinese women was lower than that in Korean women and caucasian women, and type I was the most common type (Ludwig classification).
Article
The need for a widely accepted, accurate, and reproducible standard of classification for male pattern baldness has increased with the advent and increasing popularity of hair transplant surgery. This report establishes such a classification, and reports its use in determining the incidence of male pattern baldness at various ages in 1,000 white adult male subjects. The action of testosterone as an incitant in male pattern baldness is well known, but this study points out the continued effect of time, even in later years. Since most hair transplant surgery is peformed on subjects with male pattern baldness, and because the success of hair transplant surgery is largely dependent on proper patient selection, a complete understanding of male pattern baldness is essential for consistently good results with hair transplantation.
Article
There are racial differences in the prevalence and types of androgenetic alopecia (AGA). There have been several reports on the prevalence and types of AGA in the general population of caucasians, but few studies on Koreans with samples of sufficient numbers have been reported. To obtain a more precise estimate of the prevalence and types of AGA in Korean men and women and to compare the results with those in caucasians. The prevalence and types of AGA were analysed in 10,132 Koreans (5531 men and 4601 women) who had visited the Health Examination Centre at Kyung Hee University Hospital for regular health examinations between December 1997 and July 1999. To classify the degree of hair loss for each subject, the Norwood classification was used in men and the Ludwig classification in women. For AGA in men, 'female pattern' was added to the Norwood classification. In Korean men, the prevalence of AGA (Norwood III or above) at all ages was 14.1%. It increased steadily with advancing age, but was lower than that of caucasians: 2.3% in the third decade, 4.0% in the fourth decade, 10.8% in the fifth decade, 24.5% in the sixth decade, 34.3% in the seventh decade and 46.9% over 70 years. Type III vertex involvement was the most common type in the third decade to the seventh decade; over 70 years, type VI was most common. A 'female pattern' was observed in 11.1% of cases. In Korean women, the prevalence of AGA (Ludwig I or above) at all ages was 5.6%. It also increased steadily with advancing age: 0.2% in the third decade, 2.3% in the fourth decade, 3.8% in the fifth decade, 7.4% in the sixth decade, 11.7% in the seventh decade and 24.7% over 70 years. Grade I was the most common type up to the sixth decade; over 60 years, grade I and II were similar in prevalence. Grade III (total baldness) was not observed. A family history of baldness was present in 48.5% of men and 45.2% of women with AGA. The prevalence of AGA in Korean men and women was lower than that in caucasians, as recorded in the literature. Korean men tend to have more frontal hairline preservation and show a more 'female pattern' of hair thinning than caucasians. Therefore, 'female pattern' should be added to the classification of AGA.
Article
Follicular transplantation using hair in its naturally occurring groups, called follicular units (FUs), has become the most popular technique in hair restoration surgery. Recently follicular transplantation was performed with a qualitative and quantitative concept to achieve the best clinical result. The characteristics and distribution of FUs are well studied in Caucasians and widely applied in hair transplantation surgery. In order to understand the normal distribution of FUs in the Chinese scalp, we counted the number of hairs and FUs in normal Chinese scalp to provide general information for surgical planning and design in bald Chinese patients. A total of 50 normal and 50 bald Chinese adults were enrolled to count the hairs on their scalp. One hundred bald patients receiving hairline reconstruction were also prospectively quantitatively evaluated. In normal Chinese scalp, an average 71.78 FUs/cm(2) and 137.08 hairs/cm(2) were calculated with a follicular density of 1.91 hairs/FU. Two-hair FUs are the predominate group (50.29%). In bald patients, an average of 68.07 FUs/cm(2) was found, which was less than that of the occipital scalp in normal nonbald patients. In reconstruction of the frontal hairline, a total of 700-1000 FUs were implanted with an average density of 30 FUs/cm(2). We found the average number of FUs (0.72 FU/mm(2)) was less than that in Caucasian patients (1 FU/mm(2)). The average density of 30 FUs/cm(2) implanted was suitable to reconstruct a natural frontal hairline in bald Chinese patients, which can achieve about 40% of normal hair density. Our results could provide the hair surgeon with general information about hair distribution on the Chinese scalp for surgical planning and design in their patients.
Article
Androgenetic alopecia remains the most common cause of male pattern baldness (MPB) in all races. The prevalence of MPB in Caucasians is well documented. The prevalence of MPB in Asians is believed to be very low, only one-fourth to one-third on average compared to Caucasians. However, according to my previous study, there is a clear trend indicating that it is approaching that of Caucasians. To assess the prevalence of MPB in the Asian population in Bangkok, Thailand; to compare this prevalence to previous studies conducted on Asians; and to compare the results to previous studies conducted on Caucasian. This study was conducted by two physicians and assisted by two registered nurses. The questionnaire included age, sex, Norwood classification, diet, family history of baldness, income, and education. The physicians examined the scalp of each interviewee upon completion of each questionnaire. The ethnic focus group in this study was Thai and Chinese who reside in Bangkok, Thailand. The interviews were conducted in hospitals, nursing homes, classroom, medical meetings, temples, parks, and villages. A total of 1124 men were randomized in this study. The prevalence of cosmetically significant MPB (Norwood III-VII) was 38.52% and steadily increasing with age, approaching that of Caucasians. Variant MPB was found to be 0.67% and other types of androgenetic alopecia was 0.6%. From an ethnic point of view, the majority of the groups were of mixed blood and mostly of Chinese origin, thus we were unable to distinguish between Chinese and Thai. This study shows that the prevalence of MPB in Asians is not as low as previously thought. The cause of this increasing prevalence is uncertain. There are no past studies in Thailand for comparison, however, it can be extrapolated that the socioeconomic environment and westernized diet may contribute to this prevalence.
Article
The principles and techniques outlined in this article will help the surgeon create hairlines that have the high degree of naturalness and substance expected by today's discerning patients. Surgeons can now establish a natural hairline during the first surgery that can stand on its own, independent of further sessions. It is not enough to "just use micrografts."Proper selection and use of FUs combined with artistry and skill provide surgeons with the tools to follow nature's lead in creating natural-appearing,soft hairlines while establishing the illusion of density. The author's approach is to create an initial framework based on the principles of hairline design,then use artistic ability and experience to fine-tune this framework.
Article
A variety of recommendations for creating "natural" hair directions and angles in hair transplanting have been described. Objective. A method of accomplishing that goal is outlined. Hair direction and angle are determined by multiple partings of the hair during the course of making recipient sites. Incisions are made to mimic such directions and angles. The direction is usually somewhat coronal and the use of grafts containing more than one follicular unit is particularly advantageous in producing a denser appearance. If the above technique is employed, one does not accelerate the rate at which existing hair in the recipient area is lost and the hair flows in a natural easy to manage fashion. Surgeons should nearly always mimic the scalp hair directions and angles seen in nature.
Article
To evaluate the association of androgenetic alopecia (AGA) with smoking and to estimate its prevalence among Asian men. Population-based cross-sectional survey. Tainan County, Taiwan. The eligible population consisted of all male residents 40 years or older in Tainan County. A total of 740 subjects aged 40 to 91 years participated in the survey between April 10, 2005, and June 12, 2005. Norwood and Ludwig classifications were used to assess the degree of hair loss. Information on smoking, together with other possible risk factors and age at onset of AGA, was collected using a questionnaire interview. After controlling for age and family history, statistically significant positive associations were noted between moderate or severe AGA (Norwood types > or =IV) and smoking status (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.14-2.76), current cigarette smoking of 20 cigarettes or more per day (OR, 2.34; 95% CI, 1.19-4.59), and smoking intensity (OR, 1.78; 95% CI, 1.03-3.07). The OR of early-onset history for AGA grades increased in a dose-response pattern. Risk for moderate or severe AGA increased for family history of first-degree and second-degree relatives, as well as for paternal relatives. The age-specific prevalence of AGA in Taiwan was compatible to that among Korean men but was lower than that among persons of white race/ethnicity. Smoking status, current amount of cigarette smoking, and smoking intensity were statistically significant factors responsible for AGA after controlling for age and family history. Patients with early-onset AGA should receive advice early to prevent more advanced progression.
Hairline Design in Asians. Presented at the 5th Annual Conference of the Pan Asia Academy of FPRS
  • D Pathomvanich
Pathomvanich, D. Hairline Design in Asians. Presented at the 5th Annual Conference of the Pan Asia Academy of FPRS. Bangkok, Thailand, 2015.
Laser assisted hairline placement. Hair Transplant Forum Int'l
  • D Pathomvanich
  • B Ng
Pathomvanich, D., and B. Ng. Laser assisted hairline placement. Hair Transplant Forum Int'l. 2008; 18(5):169.