Hair Transplant Surgery and Leg Hair

Can Leg Hair Be Used for Scalp Hair Transplant Surgery?



Some hair transplant surgeons report success using body hair for scalp transplants, but other doctors aren't so sure. 

The techniques used in hair transplantation have undergone improvements since the method was first introduced in Japan in 1939. Now, a reportedly new technique is getting attention for transplanting body hair to the scalp -- but not all hair transplant surgeons expect it to be effective.

Hair transplant surgeon Robert Jones, M.D., of Oakville, Ontario, performed innovative chest-to-scalp hair transplantation in 2008, using techniques that reportedly improve on previously poor results. Dr. Jones' breakthrough -- published in the June 2008 issue of Dermatologic Surgery (34 [6]: 857; Epub 2008 Mar 24; PubMed PMID: 18363725) -- was that he was able to implant the hair into scar tissue on the scalp. The scar tissue was the result of a previous hair transplant (the scar is typically a line across the back of the head where hair, now in front, was "harvested").

Another doctor, Sanusi Umar, M.D., who is associate instructor of dermatology at the University of California, Los Angeles, was interested in replicating the technique. Dr. Umar maintains a clinic in Redondo Beach, Calif., where two patients were looking to improve on their previous hair transplant surgery. Both were specifically dissatisfied with the appearance of their hairlines (the place where hair meets the forehead), which Umar reportedly fixed by transplanting between 1,500 and 1,800 leg hair follicles. While body hair may be different from what grows from the scalp, the two patients were pleased with the end result.

"The hairline was fully grown and soft-looking by nine months," Dr. Umar told a writer for The New York Times, explaining that one of the patients "started combing his hair backward and sporting a ponytail, exposing his hairline comfortably." In eight subsequent cases (one of whom is a woman), the technique reportedly has worked equally well. In each, says Umar, traditional hair transplants were ineffective or unworkable because of scar tissue or lack of donor hair.

Doctors who are skeptical about leg hair or body hair transplants
 
Matters of appearance are largely subjective, of course. And what works on one head may not work on another.

Several hair transplant surgeons shared their thoughts with us on the technique. The first was Robert Bernstein, M.D., of Bernstein Medical in New York City. Dr. Bernstein, a hair transplant surgeon, says he tried the technique a number of years ago but was dissatisfied with the results. "I don't think it's a good idea," Bernstein says. "With leg hair, you have one hair per hole, not follicular units." Scalp hair, unlike the rest of the body, has multiple hairs rising out of each follicle. "Leg hair is very fine. It might thicken up a little bit but not enough. In men you want full thickness, but this can make it look like it is miniaturizing, as it does when you're losing it."

Bernstein also notes that because leg hair emerges from the skin on an angle, more wounding of the donor site occurs as each hair is individually extracted. He does consider body hair, from the chest or back, to hold better potential for success. "But it's still extracted one hair at a time," he concludes.

Robert Leonard, M.D., of Leonard Hair Transplant Associates in New England (Boston, Cape Cod, New Hampshire and Rhode Island), concurs with Dr. Bernstein. "It is very undesirable to harvest donor hair from anywhere except the scalp to restore scalp hairlines," he says. "The reason for this is that the hair growth cycle on the leg, for example, is very different from that of scalp hair. These hairs do not grow as long, and the characteristics of the hair itself are different."

Dr. Leonard has harvested hair from the beard and pubic areas, but he is adamant in his disagreement that the procedure described by the California doctors would be effective for most patients. "It should be more expensive to perform this rarer unorthodox procedure," he says. "There would have to be a very good reason even to consider it, such as no further scalp donor hair to use.

A nuanced view of why body hair can be donor transplant hair
 
Responding to The New York Times story, Dr. Alan J. Bauman, medical director of Bauman Medical Group in Boca Raton, Fla., writes, "Body hair transplantation remains controversial to some degree because the cycling and growth rate of non-scalp follicles may be much slower than those on the head. Results can therefore be somewhat unpredictable; however, Dr. Umar seems to have had some good success with the leg hair in these particular cases, which is encouraging." Bauman indicates he has used beard hair in the past, "which seems to grow quite robustly on the scalp."

So rather than look at this as a long-awaited breakthrough for all hair transplant patients, it might instead be considered an industry niche, an option when the standard approach --harvesting donor hair from the back of the head -- simply does not work.