From a paper by: Dr Mike Beehner New York USA
There are occasions when insufficient suitable donor scalp hair is available, and other sources of hair suply are sought. It is the author’s contention that beard hair is the best source of such hair, if the density is sufficient, the angle of the jaw is protuberant enough, and the patient is willing to accept a thin scar in this region.
In transplanting men with very poor donor areas or those with depleted donor areas from past surgeries, there sometimes is the need to obtain hair from another site. During the past three years, we have performed donor harvesting from the beard on four occasions. A number of criteria should be present before performing such a procedure, and these will be reviewed.
Materials and Methods
In each of the four sessions in which we harvested beard hair, some scalp hair was also harvested. The shape of the beard donor area is a rounded “V” shape with each end tapered. Care is taken that the excised tissue is located well under the edge of the jaw margin, so that the visibility of the scar will be minimised as much as possible. Each of the four donor specimens averaged around 10 cm in length and 1.7 cm in width. The tissue was dissected under stereoscopic microscopic vision (10x) and all the follicular units were comprised of one hair apiece. They were notably coarser than their counterpart scalp hairs harvested from the sane patient.
It is very important that the patient should not shave for two days prior to the surgery, so that the angle of the hair’s exit from the skin can be seen clearly. For the one patient who had a beard we shaved the hairs at the donor area to 2-3 mm. in height. A “ring block” local anaesthetic is administered along a line drawn approximately 1-2 cm. outside the proposed donor tissue to be excised. The dermis and subcutaneous layers are then tumesced with saline 1:100,000 epinephrine solution until the tissues are firm. This maximises transection of hairs during excision of the donor tissue. Both edges of the wound are then undermined 1-2 cm from the wound edge. This undermining allows the skin levels to ‘slide’ towards one another and facilitates the closure. The dermis is first brought together with several interrupted, inverted 3-0 Vicryl sutures, and then the skin is closed with a running 4-0 Prolene suture.
Scalp hair is always the preferred source for donor hair in androgenetic alopecia transplantation. However, if more hair is needed, and there is no more available scalp donor hair, it is the author’s opinion that, for most such patients, beard hair represents the next best alternative. The only exception may be in the instance of moustache restoration, such as after burns, in which the coarseness of beard hair may be preferable to scalp hair in more exactly duplicating the calibre and texture of moustache hair.
The advantages for using beard hair over other alternative sites (chest, axilla, pubic area etc.) are as follows:
a) In many men there is reasonably good density of hair in the beard area under the chin.
b) Beard hair can grow to a length of several centimetres.
c) In most cases if the surgery is performed skilfully, the resultant scar can be hidden fairly well.
d) There are no apocrine glands associated with these hairs, as there may be in the axilla and groin, which could possibly give off undesirable secretions or odour.
The disadvantages for using beard hair in scalp hair restoration are as follows:
a) Beard hair is much coarser than scalp hair and can therefore only be placed within the central regions of the scalp being transplanted.
b) There is a resultant scar under the chin, which can only be completely hidden if the man is committed to wearing a beard for life.
c) Adding beard harvesting to scalp donor harvesting in the same session is time consuming and adds at least 1-2 hours to the session.
There are certain men for whom harvesting donor hair from the bears can help the hair transplant surgeon. The following criteria should probably be met before doing this on an individual patient:
1) Sufficient scalp donor hair does not exist to meet the goals of the patient and surgeon.
2) The patient accepts the fact that he will have a scar under his chin after the surgery.
3) The density of the hair on the underside the chin/jaw is sufficient to warrant harvesting hair there.
4) The shape and contour of the patient’s jaw is such that the resultant scar will be reasonably blocked out from most visual angles.
5) The difference between the patient’s scalp hair and the beard hair is not so disparate that the beard hair will “stick out like a sore thumb” after it is placed on the scalp.
© 2002 ESHRS