Facial hair looks like pubes Facial hair looks like pubic hair Beard hair like pubes My facial hair looks like pubic hair Beard hair looks like pubes Facial hair looks like pubic My facial hair looks like pubes. Body to Scalp: Evolving Trends in Body Hair Transplantation


Woods was the first to successfully harvest FUE grafts using 1-mm circular punches in 1995. A similar technique was described by Inaba in his textbook in 1996.[ 4 ] In 2002, the term 'Follicular Unit Extraction' (FUE) method was coined by Rassman and Bernstein to describe this procedure.[ 5 ] Beard hair looks like pubes.

While body hair transplant with FUE is being utilized in hair restoration only recently, Okuda in 1939 first described in principle body hair transplants where he used hairs from scalp, brow, axillary, and pubic areas to restore hairs in cicatricial and congenital alopecia of scalp and pubic areas.[ 6 ] Hirai et al. in 2001 recorded first successful body hair transplant with the use of modified 18-gauge hypodermic needles to harvest small amounts of beard hair by cutting around single follicles to the level of the sub dermis.[ 7 ]

Procedure and instruments

Motorized or manual FUE punches, either sharp or dull, in sizes 0.75 to 0.9 mm in diameter are suitable for body hair transplant; hypodermic large bore 18-G needles for needle FUE, forceps, petri dishes, tensioner's (KD's spreader), magnification (loops and visors) with cold light sources for adequate visualization and height with tilt adjustable operation table are primary requirements for the procedure.

FUE method with either motorized or manual punches is suitable for harvesting of body hairs. Most body hair follicular units with exception of beard hairs have single follicles and are thinner than scalp hair; punches sized 0.75 to 0.9 mm diameter are adequate for body hair harvesting.[ 9 ] Smaller the punch diameter, smaller will be resultant scars, which are less visible and cosmetically more acceptable. Body hairs emerge at more acute angle to the surface of skin, lie shallower in the dermis, and change directions or patterns within a small area as compared to scalp hair. Accordingly, the operating physician should match the angle, direction, and depth to reduce graft transection. Both sharp and dull punches can be used for harvesting of grafts, as per operators' preference. Author personally prefers sharp punches as appears faster and more useful for body hair transplant.

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For beard hair harvesting, the patient is kept in supine position with neck extended to adequately expose the face and submandibular region. In the beard area; hair follicles from cheeks, sub mandibular area, and along the mandibular region are harvested first. The beard in moustache and chin areas defines the secondary sexual characteristics of males, hence should be harvested last along with the side locks.[ 26 ] Such an approach gives a more defined look to the patient, that is if the patient wishes to maintain a beard after transplant. However, harvesting can be done from the moustache, chin, and side lock region, if there is additional requirements of grafts as these areas are excellent source of beard grafts. The patient should be counseled that maintaining a beard may not be possible and instead a permanent clean shaven look will be more suitable after transplant. After matching the angle and direction of the beard hair, punches 0.75 to 0.9 mm in diameter are inserted to approximate 2 mm deep to the skin surface to score the grafts. To reduce transection during extraction hypodermic needle can be used for scoring of grafts. The needle tip is used to cut circumferently around the follicular unit. Then exposed dermal tissue is grasped with the holding forceps and the tip of the needle is used to cut the adhesions of the follicular unit from surrounding dermal tissues under direct magnified vision; following the angle and direction of hair.[ 27 ] Compared to scalp, at places the body tissue is softer or more fluid and manual stretching may not provide the necessary traction before scoring of grafts. To remedy this, the author has developed a unique instrument the KD's spreader that provides adequate stretch with minimal fatigue.[ 28 ]

Other sources of body hair harvesting are the chest, back, legs, thighs, arms, and even axilla and pubic region. Supine, lateral recumbent, and prone positions are suitable for harvesting from chest and back, with change of patients position according to direction of emerging hair follicles and surgeons' preferences. Arm board can be utilized for harvesting from arms [Figures ​ [Figures2 2 – 6 ].


Body hair transplant can serve as viable option for hair restoration in select hirsute individuals in advanced cases of androgenetic alopecia who have a limited supply of scalp donor hair.

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Harvesting of body hair grafts is slower due to their placement and rapidly changing orientation in different body areas as compared to scalp hair and higher transection rates are observed while harvesting for the same reasons. Body hair transplant requires higher degree of skill to achieve satisfactory results. Lower density of body hair follicles, slower harvesting times, operators' fatigue due to demanding nature of the procedure, anesthesia requirements, and patient discomfort limits the total number of body hair grafts that can be harvested per session. Compared to scalp hair, body hair with the exception of beard is thinner and mostly occurring as singular hair follicles in individual follicular units; consequently more body hair follicular units are required to give a similar density, volume, and coverage in the balding scalp versus scalp hairs. Increased surgeon fatigue due to longer duration and higher skill requirement may also contribute to poor graft yield. In body hair transplant, final yields are lower as compared to scalp hairs.[ 8, 10 ] Umar S found that the graft uptake in case of body hairs is between 75–80%, while others mention the yield between 60 to 80%.[ 10, 29 ] In author's experience, while harvesting from beard areas the transection rate is between 10 to 20%, while from chest, pubic region, and legs the transection rates increase to about 20–30%. The author prefers strip dissection with FUT technique in axillary area to improve graft yield, as the resultant scar can be easily camouflaged in the axillary folds. Being a surgical procedure there is always an individual difference in efficacy; however, with more practice the yields are likely to improve. Well counseled patients generally are satisfied with the outcome of this surgical procedure. Umar S in an extensive study of more than 122 patients, found all patients completing the study (63.1%) reported a good assessment of healing, hair growth and high overall satisfaction with the surgical outcome.[ 8 ] The highest scores were given by the patients who in addition to body hairs also utilized head and nape of neck and periauricular hair as donor sources. When beard hair was utilized the patients reported similar degree of satisfaction with result and hair growth when compared to patients in whom scalp hair and hairs from nape and periauricualr area were combined. Whereas in the patients where body hairs from areas other than scalp and beard were used (trunk, limbs, axilla, and pubic hair) reported marginally lower scores in terms of donor area healing and growth rates.[ 29 ] There is a requirement of more controlled studies to understand the long-term efficacy and side effects of body hair transplant; with respect to yields, effects of recipient influence on anagen duration, growth rates, and characteristics like length, density, and long-term survival of these transplanted body hairs. There is a need for a scoring system for patient selection based on total graft requirements, availability of quality as well as quantity of donor hair from different body sources to predict a successful outcome. Robert True has presented a scoring system termed Torso Donor Index (TDI) [ Table 2 ].[ 30 ] This evaluates five key patient characteristics of chest hairs: Density, which may be more than 40FU/cm

, similarity between scalp and torso hair, proportion of 2–3 hair follicular units, size of the hair bearing area, and length of the torso hair. Where the Torso Donor Index is less than 4, the patient is deemed unsuitable for a body hair transplant, whereas patients with a TDI score of 5–7 may be suitable under certain circumstances. Patients with a score of 8 or more have more body hair than scalp hair suitable as donor material and are therefore suitable candidates for a body hair transplant.


Harvesting of body hairs is more time consuming and requires a higher level of skill in comparison with conventional FUE done for scalp hairs. While yields from body hair transplant are lower compared to conventional scalp transplants, body hair offers a viable source of donor hair follicles in hirsute individuals for hair restoration. Beard hair is easiest to harvest and provides high optical density in the transplanted area. Body hair transplant tends to produce a inferior result as compared to the conventional scalp FUE, and this should be counseled to the patient along with the need for shorter hairstyles or grooming for better results. If used judiciously, either alone or in combination with scalp hair, it can produce aesthetically acceptable results especially in advanced grades of alopecia with lack of adequate scalp grafts. Body hair can also be utilized for softening the hairlines and camouflage scars from previous surgeries or disease process. As recipient influence on body hairs is minimal and they retain most of their native characteristics, implant body hairs in planned manner mixing with scalp hairs in the implanted area to produce a more cosmetically acceptable result. FUE using body hair can be an effective hair transplantation method for select hirsute individuals who suffer from severe baldness or have inadequate scalp donor reserve.[ 29 ]

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