hair restoration in chinese ethnic groups
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Hair restoration in Chinese ethnic groups

Ethnicity has a strong influence on the distribution of hair follicles in individuals. Ever since Dr. Bernstein popularized follicular unit transplants as a state of the art technique, most patients who have undergone the hair transplants have been Caucasians, Hispanics and South East Asians. Hence most of the techniques are modified to suit their needs. To broaden this field of study, Dr. Tsai and his group have conducted systematic studies on normal and balding patients of Chinese origin to give a better view to surgeons treating patients of this ethnic group in the future.

One hundred patients were studied for hair characteristics with the main emphasis on hair density and the number of follicular units available for a hair transplant procedure. Half the number of patients who were normal and with an average age of 27 years had 1 sq cm area of their hairs shaved from three different regions in the scalp, while the other half with the average age of 34 years who were in different stages of baldness were shaved in the donor site area. The number of follicular units and the number of hairs were counted in all these areas. In normal men and women with no hair loss, the average number of follicular units was 71.78/sq cm, the average number of hairs/sq cm was 137.08 and the number of hairs per follicular unit was 1.91. The results from bald patients revealed 69.09 follicular units/sq cm, 127.39 hairs/sq cm and 1.84 hairs per follicular unit. The surgeons carried out hair transplants in a hundred patients based on these results for frontal hair reconstruction, and used about 700-1000 follicular units to achieve an average hair density of 30 follicular units/sq cm.

Follicular units vary according to the ethnicity of the individual. The number of follicular units/ sq mm is 1 in Caucasians and Asians with the hair grouping in two and average hair density/ sq mm also being 2. In Africans only 0.6 follicular units/sq mm with an average hair density of 1.6 and hair grouping of three is recorded. Although oriental ethnic groups have hairs grouped in two, the number of follicular units/sq mm is 0.7 and average hair density is 1.4.

Why the authors chose follicular unit transplants is for the usability of follicular units that results in retaining a natural look. Since follicular units are always found in natural groups of 2, 3 or 4 and single in areas where there is a finer transition of the hairline with the rest of the skin, the use of follicular units is very aesthetically pleasing to look at and looks natural. In the Chinese patients, the number of hairs in a follicular unit is mostly two, relatively fewer numbers of 1 and 3 and very rarely 4 or 5 follicle units were found. Hence Chinese have only 70% of the hair density of Caucasians. Apart from a broad frontal scalp, hair characteristics also differ in that Chinese typicaly have straight and dark hair. Hence reconstruction of a natural hairline is possible without compromise on aesthetic appeal only using follicular unit transplants.

This study is useful since surgeons all over the world can understand the differences of hair characteristics between races especially when there is lot of cross cultural interaction and as doctors need to cater to patients from across the globe.

Hair restoration in Chinese ethnic groups references

  • Tsai RY, Lee SH, Chan HL. The distribution of follicular units in the Chinese scalp: implications for reconstruction of natural-appearing hairlines in Orientals. Dermatol Surg. 2002 Jun;28(6):500-3. PMID: 12081679
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