Hair Restoration Blog

Where can we take hair for hair transplant other than the back and sides of the scalp?  This is a common question that I am asked on a regular basis.  The answer is “hair can be harvested from almost any part of scalp or body that grows hair and it can be transplanted to any part of the skin.  We have performed hair transplant from many different areas of the body on patients who do not have sufficient donor hair on their scalp for transplantation or in people who had old hair transplant procedures that violated the donor area with multiple punch biopsies and through scarring.

Pubic area is prepped before harvesting hair for hair transplantation into the balding spot of patient

It is important to understand that scalp donor hair is always the best option when it comes to hair quality for the best result in hair transplant surgery.  The scalp hair has a longer growth phase (anagen) that is about 1-6 years and a shorter resting phase (telogen) that lasts around 4-6 weeks.  This makes scalp hair a more economic choice for hair restoration surgery.  When using scalp hair for donor, almost every transplanted hair stays in growth its phase and only a small portion goes into the dormant phase in which hair falls and another hair grows in a few weeks.

Body hair, in general, has a shorter growth phase which could last only about a few months and a longer resting phase.  That is why body hair never grows more than a certain length.  There are some limited studies that show that transplanted body hair can change their innate characteristics and increase its growth phase when transplanted to the scalp, but we still need more research to provide information on the details of the process.

At US Hair Restoration, we have used pubic hair successfully in a patient with great demand due to his fine scalp hair and violated donor hair that could not provide sufficient hair for transplantation into the scalp.  The patient’s hairline has been restored using scalp hair from the occipital area (back) of the head and the balding spot on the crown was reinforced using pubic hair.

So if you are lacking adequate hair on your donor area of the scalp or need a large number of grafts, you may be able to consider other options including pubic hair transplant.  Obviously, the donor quality should be evaluated closely by a good hair transplant doctor to determine the candidacy of the patient for body hair transplant to scalp.  The details and methodology of this process is being published in medical journals.

Trichotillomania (TTM) [Greek: tricho (hair), till (to pull), and mania], also called trich, is hair loss due to an impulse control disorder distinguished by the repeated urge to pull out hair of scalp, body, eyelashes, eyebrows, facial hair, nose hair or pubic hair.  Trichotillomania may result in noticeable bald spots or hairless patches.

Trichotillomania is more common during the first two decades of life with female predominance; however it could be seen in both sexes and all ages. Trichotillomania may resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual’s teenage years, but may happen at any age. Depression or stress can trigger the trich. Due to social implications, the disorder is often unreported and it is difficult to predict accurately prevalence of Trichotillomania.  It is stated that 2.5 million people in the U.S. may have TTM, with a 1% prevalence rate.

Patients with trichotillomania may live relatively normal lives.  TTM may not be known by the patients and in fact most patients deny any manipulation of the hair.  An additional psychological effect can be low self-esteem, often associated with being rejected by peers and the fear of socializing due to appearance and negative attention they may receive.  Trichotillomania can be effectively treated by habit reversal training along with a variety of psychiatric medications based on the underlying disorder.

I have recently seen a male patient with male patterned baldness in our Los Angeles hair transplant clinic who has previously undergone a hair transplant surgery in another hair transplant clinic about a year before with over 500 grafts on his crown area.  The result of the surgery that should have been completed at the time of our consult was very disappointing both to the patient and to us.  I performed a microscopic evaluation of the scalp in both the frontal and crown area.  I noticed broken hair at both frontal native hair area and crown area, which was evidence of manipulation of the hair.

Patient denied any hair pulling, but had disclosed having experienced a nervous breakdown recently.  However, he did not deny that he had been too conscious about newly implanted hair follicles after his hair transplant that might have forced him pulling most of his transplanted hair grafts.

I recommended a psychological evaluation and treatment of any underlying disorder and we decided to re-evaluate him in a few months after his psychological treatment.  I won’t recommend a hair transplant until he shows no evidence of trichotillomania for a considerable period of time.  I have previously treated a patient who has had hair loss due to trichotillomania at childhood with hair transplant, but was treated completely with no evidence of pulling hair for a long period of time.

Different types of body hair and the indication for the procedure is a question that I have been asked many times in last week. So that is why I thought I should write a post to answer it for everyone. Body hair transplant has been discussed in Hair Restoration Blog in the past in several posts. Patients ask which one is a better source for body hair transplant to the scalp: chest hair, abdominal hair, pubic hair or armpit hair.

Hairs of the body have different characteristics, than hair from the scalp Pubic hair is generally thicker and curlier than other areas of the body. Chest hair may be thick in some patients, but may be finer than scalp hair. Armpit (Axillary) hair is also generally curlier than scalp hair, but may not be as thick as the other types of body hair.

Before deciding to use body hair, a hair transplant surgeon has to examine the scalp donor hair carefully and then only consider body hair if the scalp hair is severely depleted. Depending on the area that you want to use body hair, you may choose different types of body hair. If you want to choose body hair only to fill in the crown area in patients who already have good coverage on top and front, pubic hair could be a good option.

Research has shown that body hair characteristics may change and become longer when transplanted to the scalp. It also shows the anagen phase of body hair may become longer after transplanting it to the scalp. Which is why this is one more advantage for body hair transplant, but still body hair transplantation needs to be done selectively.

Q:

I am 65 with 2 hair transplant surgery in the past. I ran out of donor hair and I was told I don’t have much more hair for my crown area. Is it possible to use armpit hair and pubic hair for hair transplant on to my crown? Is it going to be a high rate of transection for hair from those areas because of the curly hair there?

A:

The best option is always transplanting hair from scalp to scalp. Scalp hair is the most economical in terms of the number of hair that can stay and grow at any given time. Because of efficiency of hair on the back of the scalp (donor hair), we hardly ever use body hair transplant including armpit (axillary) or pubic hair, but hair from those areas could be used in some conditions such as violated donor areas from old technique surgeries leaving not much donor hair to work with, in presence of large balding area. Body hair transplant, as we discussed before is not a good substitute for scalp hair transplant, because of of the difference in hair growth cycle in those areas as long sleep phase (telogen) and short growth phase (anagen). There are some new studies indicating that body hair may change its trait in favor of recipient area (grow for a longer period of time thus become longer), but it cannot completely become scalp hair.

Body hair transplant with pubic and armpit hair in particular has its own problems. Body hairs have different characteristics from scalp hair. They are limited in numbers and should be reserved for the cases that no other alternatives are available. As we mentioned before, in cases of severely diminished donor hair, body hair could be an alternative to scalp hair. Body hair could be conveniently obtained with FUE techniques. Patient needs to be tested before the procedures with FOX test. If patient is FOX positive, it means that the hair could be harvested for the actual procedure with no trouble.