Evaluation of past and present hair replacement techniques. Aesthetic improvement, effectiveness, postoperative pain, and complications.

OBJECTIVE: To evaluate and compare past and present hair replacement techniques of standard grafts, minigrafts, micrografts, scalp reduction, scalp flaps, strip harvesting, and punch harvesting procedures with regard to aesthetic improvement, effectiveness, postoperative pain, and complications.

DESIGN: Three hundred surveys were mailed randomly to patients who had undergone hair replacement over the last 3 decades. The questionnaire asked patients to rate the level of postoperative results and complications in several comparison groups with regard to the following factors: itching, pain, swelling, scarring, bleeding, altered sensation, poor growth, color and texture, infection, hairline, and natural appearance. Each factor was rated by the patients on a scale of 0 to 3 (0, none [best]; 1, minimal; 2, moderate; and 3, worst [severe]).

SETTING: Private facial plastic surgery practice.

METHODS: A hypothesis about each set of survey questions was formed based on general trends in patient responses, also known as the null hypothesis; chi 2 tests were conducted for each of the survey questions to determine the statistical trend with a certain level of confidence. The weighted arithmetic mean of the expected response was used for the varying number of patients responding to each question. Using the chi 2 test, the formulated hypotheses can be accepted or rejected based on the observed and expected responses.

RESULTS: Between 1981-1990 and 1991-1996, there was a reduction of 38 percentage points in the number of standard graft procedures performed, an increase of 31 percentage points in the number of minigraft procedures, and an increase of 48 percentage points in the number of micrograft procedures. The complication rate was 31% lower for minigraft procedures compared with standard graft procedures and 29% lower for micrograft procedures compared with minigraft procedures. The complication rate was 59% lower for strip harvesting procedures compared with punch harvesting procedures.

CONCLUSIONS: Newer hair replacement techniques have improved aesthetic results, with lower morbidity and complication rates. These improvements are responsible for the increase in the level of satisfaction of patients undergoing hair replacement surgery today.