Guidance For Prospective Asian Hair Transplant Patients

Dear Alex:

Thank for your letter. You certainly have a grasp of the unique traits and “Asian hair” and you bring up some interesting questions about the implications of hair restoration in the Asian population.
You are correct that in Asians the follicular units tend to have one or two hairs on the average rather than two, three, and four hairs, but I don’t necessarily believe that that is the reason that Asians have straight hair. Having straight hair is more of a function of the biochemical structure than numbers of hairs in the average follicular unit. The factors that you have mentioned, lower number of hairs per follicular unit, lower numbers of donor follicular units overall, and a high degree of contrast between skin color and hair color make it more difficult to create the illusion of density after transplantation. However, on average the hair shaft diameter of Asian hair is wider than non-Asian hair thereby compensating to some degree for the lower hair density.

The unique challenges involve the need to create a natural appearance and provide reasonable density given the characteristics of Asian hair. Some of these are competing needs and must be balanced by the surgeon and the patient in consultation. Since Asian hair is more coarse it is imperative to use only single hair grafts, and finer ones if possible, in the frontal hair line to avoid  a “pluggy” look.  The shape of the Asian skull and forehead tends to be larger and wider, therefore the requirement for grafts is potentially larger. The combination of low hair density, high skin/hair contrast, and the need for high numbers conspire to create a challenge in creating density. “Dense packing” is certainly a way to create density however the danger is that you can use up a great amount of donor reserves by creating density in a small area and ignoring the potential future need. These factors should be discussed with the physician and a plan based on the long term objectives should be implemented with the thought that a compromise in either density or coverage area may be required.

I would suggest that you be seen by a physician who can evaluate your donor capacity and provide an assessment of your hair loss situation. Ideally the physician should demonstrate that he or she is aware of the unique challenges of hair restoration in the Asian population and acknowledge some of the factors that you have brought up. It would also be helpful to see some patient results so that you can get an idea of the density and appearance of similar reconstructions.