Follicular Unit Extraction in East Asians

Abstract

Hair transplantation in East Asians has special concerns due to unique facial shape, hair, and scalp characteristics. East Asians often have a broad, flat face with a prominent zygoma. Therefore, a flat and low hairline is commonly preferred over an oval design, which demands a larger number of grafts. East Asians have thicker, deeper hair follicles than Caucasians, and their hair is black. Of all Asians, East Asians have the lightest skin color, creating the highest scalp–hair color contrast. Moreover, their hair density is very low. While the average hair density in Caucasians is about 190–200 hairs/cm², East Asians with androgenetic alopecia have a hair density of approximately 120–130 hairs/cm², accounting for only 60–70% of Caucasians’ hair density. Idiopathic occipital fibrosis also occurs more often in Asians than Caucasians.

In conclusion, Asians have less available hair follicles for harvest while requiring relatively large amounts of grafts. Therefore, it is crucial to minimize follicle damage during harvest at the same time maximizing engraftment. In general, deeper punch insertion with a punch of larger diameter is necessary when performing FUE in East Asians, in comparison with Caucasians. Possibility of follicle damage is heightened during the process as a result. Thus, delicate manipulation with a full grasp of follicle anatomy, dynamics, and techniques of FUE has much importance.