Beware of Laser hair restoration surgery; it has no hope as a hair restoration procedure

Hair restoration procedure Laser hair transplant

Laser Hair Restoration

In the 1990's Micro Grafts and Mini Grafts were widely used for hair transplant surgery in mega sessions to achieve acceptable hair density in first session of the hair replacement surgery.

Micro and mini grafts are still used as exclusive hair restoration procedures and involve extensive graft preparation and handling along with tremendous assistant support. Teams of 8-10 surgical assistants work with a hair restoration surgeon for 8-10 hours together to isolate the grafts. Though these mega-sessions result in aesthetically superior results, it is considered to be a highly demanding hair restoration procedure on the part of a hair transplant surgeon because of the long time taken for isolating hair transplant grafts.

Problems with Micro Grafts and Mini Grafts

Laser hair restoration was initially thought of as a hair restoration procedure which could remove the graft compression problem associated with micro and mini-grafts.

Graft compression is the result of the hair transplant procedure where follicular hair transplants with 1-2 and 3-4 haired follicular grafts are inserted instead of single follicular transplants in order to achieve a high density. And when thousands of such grafts are closely placed together in mega sessions, the scalp skin pushes or squeezes the hairs through the slits, making them appear as if they are growing from a single hole. This tufted hair effect is called graft compression. Sometimes overcrowding or graft compression also led to the exclusion of the grafts.

Initial Experiments for Laser hair restoration

As laser surgery was becoming popular with most of surgeries performed, Laser hair restoration was seen to have much potential in solving the graft compression problem associated with mini-grafts and micro-grafts by the use of highly focused laser beam.

It was thought that when a laser beam would be used for preparing a narrow slot in the scalp for the implanting hair graft it would offer a better hair transplant procedure. By actually removing tissue, it was thought that laser hair transplant would reduce the risk of graft compression, and produce more natural results.

The first laser hair transplant procedure was performed by Dr. Unger and David in 1992 using the carbon dioxide laser. The subsequent laser hair restoration studies were undertaken with the hope to achieve a reduction in bleeding due to photocoagulation effect of laser. It was thought that laser hair restoration would lead to more natural hair restoration results due to consistent recipient channel depths produced by uniformly vaporized tissue. The proponents of laser hair transplantation thought that by using a laser hair transplant technique they would be able to transplant hundreds of grafts together which could reduce the time of a hair transplant surgery many fold.

Flaws of Laser Hair Transplants

But the histological and histo-chemical analysis in laser hair transplant experiments had a different story to tell. In all laser treated specimens, the damage to the tissue was more evident than seen with the standard punch technique. Thermal damage caused by the high energy of lasers in all laser hair restoration studies was found to be statistically significant for both the connective tissue and the adnexal structures (hair follicle, sebaceous glands and eccrine).

Even with modifications and advances in laser hair transplant technology, there was not seen to be much possibility for laser hair transplant surgery to replace the conventional methods of hair transplant surgery, however tedious and time consuming they had been.

Why did laser hair restoration fail

Most of the reports and experiments confirmed that not only is laser hair transplant inappropriate for follicular unit transplantation, it is actually detrimental regardless of whatever different modifications and variations of laser hair restoration procedure it is tried.

The reason for failure of laser hair restoration lies in the procedure itself and has nothing do with a hair transplant surgeon not being efficient in the procedure. The laser beams have the properties of "selective photo-thermolysis" (this is the ability to destroy a specific target without injuring the surrounding tissue). Hair transplant surgery is different in this regard from other surgeries because of the lack of a target tissue. And when one is using laser hair transplant surgery for channel creation, it is actually making use of the destructive properties of the laser. The laser literally burns a recipient hole in the skin and actually damages the surrounding skin in the process. And all the claims made by laser companies for a new class of laser causing no thermal damage, is anything but true. Regardless of the source and the type, a laser is something which causes thermal damage by burning the tissue by its high energy. The laser hair restoration technique always leaves surface change and scarring. Not only this, high energy laser beams used for laser hair transplants may damage hairs existing near the implant site because of burning of the surrounding tissue.

There is another drawback of laser hair transplant surgery which is more critical than the one discussed above. The high energy of the laser beam leads to the closing of the blood vessels. This characteristic feature of the laser beam is useful in other types of surgery where it helps to close wounds and provides quick healing. But in the case of hair replacement surgery, blood supply is very crucial for nourishing the grafts after they are transplanted. This is the main concern about a laser hair transplant surgery. Laser assisted transplants either are not able to grow or heal more slowly and have unpredictable growth due to impaired blood flow.

The thermal damage caused by the laser hair restoration to the surrounding tissue destroys the collagen and weakens the elastic support around the newly transplanted grafts. It also increases the coagulum (clot) around the graft which, in turn, decreases oxygen perfusion and retards healing. The uniformly created channels created by laser hair transplant surgery lose all its promise when the laser "loosens" the "snug fit" between the transplanted graft and recipient site. And this is the reason why laser hair restoration results in unpredicted and slow growth of the hair follicle.

The advantage of laser towards decreasing bleeding at the recipient site is also of not much use. A hair transplantation surgeon can decrease bleeding more effectively by the use of precision instruments and better hair transplant procedures than using laser.

Regardless the hair restoration procedure a hair transplant doctor uses, maximizing the growth of a transplant is the primary aim of any hair transplant surgery. And whatever the type of implanted graft, whether it is a single follicular unit or a group of follicular units, restoring the blood supply to the graft is of utmost importance. Since the laser hair transplant surgery fails to accomplish the vital function of restoring the blood flow, laser hair restoration is to be simply ignored as a hair restoration procedure.

References:

1. Chu et al: 'Laser Assisted Hair Transplantation', Dermatol Surg, 27, 4 April, 2001, 335-342
2. Sadik et al: 'Comparative hair transplant surgery', Dermatol Surg, 27, 9 Septamber, 2001, 807-812