[Donor supply of scalp and specificities of hair transplantation in Asians].

In 2005--2007 in a hair transplantation clinic 'Talizi' the flow of international patients increased dramatically, including those from Central and Eastern Asia. During this period 211 ethnic Asian patients underwent operations, including 146 patients from South Korea, 2--from China, 62-- from Kazakhstan and 1--from Philippines. Black and straight hair give impact of low density due to considerable contrast with characteristic for Asians light color scalp; therefore, from the very beginning we tried to transplant as many grafts (follicular units - FU) as possible. For the operation we chose strip version (FUSS) that enables to receive large number of grafts. The scale of transplantation varied in a range of 1200-3800 FU, on average--2500-3000 FU. Though, even from the very first cases we faced specificities of ethnic Asian scalp that significantly complicated our work: low density and low hair/graft ratio in donor zone in contrast to information from special literature, and low laxity (flexibility) of the scalp. We set an objective to specify indicators of donor density (number of FU on a sq.cm and hair/FU ratio), to study bio-mechanical specificities of ethnic Asian scalp and develop optimal surgical tactics for these patients after the evaluation of transplantation results. Observation group was composed of 211 patients from abovementioned countries and a sub-group--50 Korean patients for medium-scale hair transplantation (2000-3000 FU) by strip version. Study of donor characteristics of these patients revealed low density--74 FU/cm2; on 1 cm2 grow only 121 hairs, whereas hair/FU ration was 1,63. Strength required to close would edges (scalp tension power) varied from 1,4 kg-f to 2,6 kg-f depending on scalp flexibility and number of transplanted grafts (strip width), and amounted on average to 2,16 +/- 0,02 kg-f, p < 0,001%. This indicator is about 1,5 times exceeding the one of ethnic Caucasian patient group (1,47 +/- 0,02 kg-f, p < 0,001%). Low donor density of our Korean patients compelled us to increase width of the obtained skin strip (sometimes to 2,5 cm) in order to get required number of grafts (FU). In case of low flexibility of the scalps this resulted in high percentage (10-15%) of wide (4-10 mm) scar formation in donor area. In order to find the way out from this situation (restrict the width of the strip to 1,5 cm without affecting FU to be transplanted in one operation), we proposed the combination of the strip version (FUSS) with FU extraction (FUE). While this solution increased the duration and price of the operation, we believe that it is the most optimal version in case of large-scale hair transplantation for the ethnic Asian patients.