How does it vary from scalp hair transplant? It is important to first review the anatomy of beard and the difference between the characteristics of scalp and beard hair.

Beard and moustache hairs consist mainly of single-hair follicular units. Under the influence of androgen hormones, beard growth starts during puberty, and increases in density until the mid thirties. This contrasts with scalp hair where the increased action of androgen hormones cause miniaturization of hair follicles and eventual loss of hair.

We divide the face into a side view and frontal view for the purpose of beard transplantation. The side view includes the side-burns, the cheek beard, the jaw line beard and the beard below the jaw line. Out of these four areas, the cheek beard is cosmetically the most important. In the frontal view, the fore beard, comprised of the moustache and goatee is the most prominent feature and higher densities of hair are present in this area. The hair below the chin and jaw line that extends onto the neck is also considered to be part of the beard.

The density of beard hair is less compared to the scalp. The maximum density is over the chin and mid portion of the moustache. The caliber (thickness of the hair shaft) of beard hair is larger compared to the scalp. Beard hair shafts are also more elliptical (flatter) in cross section compared to scalp hair which is more oval or circular in cross section views. This is why beard hair tends to be more curly than scalp hair.

For beard transplants, grafts are removed from the Donor Area in the same way as in a routine FUE (follicle unit extraction). The main difference is in the distribution of the grafts and the recipient site creation. We can use both FUT strip harvesting and / or FUE harvesting methods for getting grafts to transplant into the beard area. One advantage of FUT strip harvesting is that the harvested hair shafts can be left longer in length which allows us to pre-determine the curvature of the hair and ensures that placement in the recipient sites allows for the hair shaft to curve towards the skin, giving a more natural appearance. This is even more important when transplanting eyebrows compared to beard transplants, but the basic principle for both recipient areas are very shallow recipient sites and implanting grafts with hair shafts curving towards the skin.

With beard transplants the frontal view is cosmetically more important than the side views and requires more density compared to the sides views.

During implantation, 1-hair grafts are placed over the superior outline, similar to transplanting a scalp hairline. Then combinations of 1-hair and 2-hair grafts are used in the other areas. Implantation compared to scalp hair takes longer because the beard area provides less stability (loose tissue relative to the scalp) and great care is taken to avoid injury to the Facial Nerve distribution below the skin.

We make use of nerve blocks to provide complete anaesthesia of the recipient area. After the nerve blocks, field anaesthesia is given.

During the post-operative phase, some drooling may occur on the first day after surgery as a consequence of the local anaesthesia. Superficial ecchymosis (blood stains or blotches in the superficial skin layers) secondary to tumescence (fluid injected into and just below the skin in order to lift the skin from the vascular plane and nerves in order to minimize injury prior to making incisions, however these blotches disappear over 3 to 5 days post surgery.

Sources:
– ISHRS 2013 Practice Census Results
– Vogt, A., K.J. McElwee, and U. Blume-Peytavi. Biology of the hair follicle.
– Kapil Dua; Aman Dua; Renu Kothottil – Article on Facial Hair Transplantation in Hair Transplant Forum International, Volume 25, number 4, July/August 2015
– Dr. A Nel hair restoration practice experience

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