Follicular transplantation. Patient evaluation and surgical planning

Follicular transplantation is a method of hair restoration surgery that uses hair in its naturally occurring groups called follicular units. By using the follicular unit exclusively in the transplant, the surgeon can move extensive quantities of implants in a single session to complete the hair restoration in as few sessions as possible. To briefly review the salient features of follicular transplantation, to discuss how the patient should be evaluated for the follicular transplant procedure, and to provide guidelines for the planning of the first and subsequent transplant sessions. This paper will examine: 1) ways to anticipate future hair loss, 2) how to assess donor reserves, 3) what can be accomplished in a single transplant session, 4) how to plan for subsequent sessions, and 5) how to manage the patient with diffuse androgenetic alopecia. Follicular transplantation is performed according to techniques detailed in a previous publication (Bernstein et al. Int J Aesthet Rest Surg 1995;3:119-32). Excellent cosmetic results can be achieved when there is meticulous attention to transplanting intact follicular units, when the extent of balding is accurately assessed, and when the finite nature of the donor supply is respected. Because of their small "physiologic" size, follicular implants enable the surgeon to transplant large numbers in a single session. Follicular transplantation will greatly increase the benefits of the hair restoration procedure when the patient is thoroughly evaluated and when the procedure is undertaken after careful short- and long-term planning.