‘There is no excuse for poor hair restoration surgery.’

This was the resolute message of Martinick Hair Restoration’s Dr Jennifer Martinick when she addressed an international symposium in San Francisco in October.

In a presentation entitled, ‘Cosmesis Does it Matter’, Dr Martinick said hair restoration physicians had a responsibility to draw on all the skills, tools and research at their disposal to create a natural looking aesthetic hair transplant for their patients.

Dr Martinick told the conference of international delegates that while performing a natural looking hair transplant looked deceptively easy, there were still too many examples around the world of inferior work.

She said sub par transplants continued to be a problem and this was often due to inexperience of the surgeon, poor technique, poor quality control in surgery and failing to properly plan surgery.

Posing the question of whether throwing paint on a wall made someone an artist, Dr Martinick said simply transplanting hairs did not make someone a hair restoration physician.

The difference between an obvious and natural looking transplant was created by the additional minor steps a surgeon took to improve the aesthetic appearance of the work.

Additional steps had to be taken to create a realistic natural looking hairline and mathematical planning was needed to ensure the appropriate density of replanted hairs – which included planning for a graduated central density – to avoid a ‘see through’ look.

In demonstrating the importance of direction to create a full looking head of hair, Dr Martinick said one should bear in mind that light was blocked more effectively when objects all faced the same direction.

Equally important for creating a natural looking transplant was the orientation and curl of the replanted donor follicles.

Dr Martinick emphasised that the upmost care and quality control in surgery was needed to avoid iatrogenic long term complications, ensure the correct depth of placement of the transplanted follicles, optimum blood supply and healthy growth of the transplanted follicles.

To ensure the health and growth of the transplanted follicle, extreme care was needed for graft handling and when creating a recipient site for the donor follicles.

Pits that were placed too deep or poorly trimmed could result in bent or retained hair fragments, possibly leading to folliculitis

Dr Martinick said an examination of cases where poor growth had been achieved from a transplant for 4,500 follicular units pointed to a range of contributing factors.

Some of these factors were poor graft preparation, poor graft handling and a lack of quality control.

Patient selection was extremely important with factors such as exhausted blood supply, sun damage, diabetes, being a smoker or having a medical condition all posing a potential impact on the success of hair transplant surgery.

Dr Martinick said maintaining high standards in surgical hair restoration depended on a doctor taking full responsibility for training staff and strict and constant quality control.

In reiterating the importance of providing patients with a natural looking hair transplant, Dr Martinick said there were no excuses for inferior surgical work when one considered the ISHRS held so many regular courses, workshops and lectures.

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