Hair from different sources have varying characteristics that need to be known before considering these sources as adjuncts along with scalp grafts for enhancing area coverage in extensive baldness in Grades 5-7 on the Norwood Scale.
We at Darling Buds, have been strong advocates of beard grafts for extensive baldness since 2009 and have been lauded since 2012 to have done the largest series of beard to scalp transplantation in the world. Please note that since I do all cases myself, claims of may other clinics have to be judged keeping in mind the doctor who does the procedure. There is a trend in most clinics now where the primary doctor has absolved himself of most if not all steps of the procedure!
There is seldom a case above Norwood Grade 5, where I have not advocated and offered beard grafts to increase graft counts. However, when this option is broached, patients get uneasy and often dismiss this as an option. Most such patients do however come back for BHT using beard grafts in the future as baldness progresses.
The unique characteristics of beard hair are-
(a) Beard hair have a long anagen phase which is akin to that of scalp hair- https://en.wikipedia.org/wiki/Human_hair_growth
(b) Beard hair are 3 times greater in caliber as compared to scalp hair. They add additional volume in patients with lesser levels of baldness but with fine hairs
(c) Beard grafts withstand the telogen phase after transplant much better than scalp hair grafts
(d) Beard hair color in blonde Caucasians may not match that of scalp hair
Racial skin characteristics dictate the areas of harvest from the beard.
Beard has 4 zones of possible harvest :
ZONE I :
The shadow area comprises the horizontal part under the jawline and above the neck. This is the submandibular region and most people are candidates for harvesting beard grafts from this region. The advantage is that even in darker skin types this area will not show even if by chance complications of hypertrophy or white spots occur.
Available grafts: 350-1000
The vertical area of the neck has in some individuals, a large reservoir of good quality grafts. However, the hair is acutely angulated to the skin surface. While harvesting the punch has to be aligned almost parallel to the kin and this leaves a linear trail scar that may be visible in some.
Available grafts: 500-1000
This zone is along the visible mandibular region below the cheeks. I would be comfortable to include this in the harvesting zone if the patient is light-skinned eg. in Caucasians.
Available grafts: 150-200
The cheeks have a large number of potential grafts and so this donor site, other than in dark the skinned population, can be indulged in.
Available grafts: 600-11500
Beard grafts are a valuable source of grafts for all grades of balding but mostly used for extensive grades of baldness.
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