African American

Dear Elvonna - I 
The big challenge in your situation is the quality of your donor hairs - if you have a good density in the back of your scalp, I could anticipate a more impressive result. The other consideration is that, in women of color, there can be a lower percentage of hair growth, resulting in less coverage. The only way to assess the exact amount of hair growth you are likely to experience is to perform a test procedure of say 40 grafts, then waiting 6 months to see how things grow.
The alternative is to proceed with a procedure of 1300 to 1400 or so grafts, filling in both temple areas (500 grafts per side) and placing the remaining 400 or so grafts along the hairline to provide increased density and  perhaps bring it down/forward a bit.  In addition, a second procedure may be desired in the future to provide more density.

I welcome your thoughts.

Posted by Jeffrey S. Epstein, MD, FACS

The big challenge in your situation is the quality of your donor hairs-  if you have a good density in the back of your scalp, I could anticipate a more impressive result.  The other consideration is that, in women of color, there can be a lower percentage of hair growth, resulting in less coverage.  The only way to assess the exact amount of hair growth you are likely to experience is to perform a test procedure of say 40 grafts, then waiting 6 months to see how things grow.
The alternative is to proceed with a procedure of 1300 to 1400 or so grafts, filling in both temple areas (500 grafts per side) and placing the remaining 400 or so grafts along the hairline to provide increased density and  perhaps bring it down/forward a bit.  In addition, a second procedure may be desired in the future to provide more density.

Posted by Jeffrey S. Epstein, MD, FACS

Like in all other ethnic groups, hair transplantation in individuals of African-American or other African ethnicity is a procedure designed to restore permanently growing hair to areas of hair loss.  The donor hairs come from the back and sometimes sides of the scalp, where a single donor strip is removed then the incision sutured closed.  Once transplanted, the hairs first fall out at 2 to 3 weeks, then for the next 3 months, the scalp looks essentially like it did prior to the procedure.  Three to four months later, the hairs will begin to grow, and over the next year the density will gradually increase as more and more of the hairs grow to their normal density and length.

There are however unique differences when working with the typically more curly hair- some advantageous, some disadvantageous, while others are just what they are.  For advantages:  because the hairs are curly, larger grafts can be used, many containing 2 to as many as 5 hairs, without compromising naturalness- this means more hair coverage per graft.  Naturalness in general is the easiest to achieve with these curly hairs.  The disadvantages:  because the grafts are inherently larger due to their curl, they cannot be placed as closely together and fewer grafts are able to be transplanted in a single procedure.  This often means that patients will desire a second procedure 8-plus months later to achieve greater density by placing the second round of grafts between the prior placed original grafts.  The other disadvantage is a greater risk of donor site detectability- the scar itself typically heals as a fine line, but for some reason the curliness of the hairs results in some patients in a slight parting of the hairs from both sides of the incision, something that can be detectable when the hair is cut short.  Once the procedure is performed, patients are unable to shave the hair short, otherwise the donor site will be visible.

There are few risks with the procedure, and most are those associated with standard hair transplants.  The donor site incision typically heals as a 2 mm wide incision, easily concealable with hair that is cut with anything longer than a razor with a #2 or #3 guard.  Hair growth seems to be not as reliable in certain cases, especially in women who have a combination of traction alopecia (from tight hair pulling due to certain hair styles or from the application of hair extensions and weaves) and genetic hair loss, with often another etiology of the hair loss which can sometimes be difficult to diagnose.  It is for this reason that Dr. Epstein will sometimes suggest a test procedure of 30 or so grafts to assess after 4 to 6 months the rate of hair growth before the undertaking of a larger definitive procedure.

Finally, despite the curliness of the hairs, transplantation of the beard and eyebrows is possible amongst individuals of this ethnic group.  Similarly to transplantation of the scalp, a smaller number of grafts are utilized than that used in other ethnic groups.

Most of our patients travel from out of town to have it performed on a fly in/fly out basis.  The entire procedure can be scheduled by phone and email, with Dr. Epstein, or one of the other Foundation for Hair Restoration doctors, able to evaluate photos sent by the patient.

Posted by Jeffrey S. Epstein, MD, FACS