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Follicular Transplantation:
Commentary by Richard C. Shiell, MB, BS
Melbourne, Australia
This is a very important paper on hair transplantation, well written, and covering every important aspect of the subject. A recent advance like stereoscopic microscopy is simply an aid to obtain more accurately cut pilosebaceous units. Cloning, if it ever becomes a practical reality, will simply provide us with more materials. Whatever happens, we will still be using something close to the Bernstein-Rassman technique in decades to come, as it provides convincing results with nature's own building blocks, the compound pilosebaceous units.
The authors Bernstein and Rassman are well known for their contributions to this field in the past 5 years and this paper is virtually a mini-textbook on hair restotation pratice. There is no doubt that their techniques are revolutionizing hair restoration surgery and almost every practitioner in this field has already been influenced by their past writings and very convincing case presentations at meetings.
In this paper there is much sound advice for the beginner about case selection and donor hair availability. Experienced surgeons have learned much of this in the past by trial and error but the authors provide abjective measurements of donor site size and hair density, which makes the "learning curve" far less arduous for the newcomer to this field. Four pages are devoted to the vitally important task of assessing the degree of present and future hair loss. The authors emphasize the importance of measuring the degree of hair shaft miniaturization in both the donor and recipient areas. This is an advace indicator of future trends and is often ignored by those looking only for gross hair loss.
The authors make many very valuable points throughout this paper. Some concepts are difficult for the beginner but make excellent revision reading for the experienced sugeon. These are not necessarily new concepts but on the other hand they are points that are rarely discussed and have been seldom, if ever, written in the past.
The authors point out the importance of counseling the patient and educating him about his condition so that his expectations can be realistic. The patient who is complaining of a recent acceleration of his hair loss is probably very anxious and keen to proceed with surgery. This is the very patient who is at the geatest risk of being unhappy with the outcome of the surgery, due to difficulty in keeping up with the continuing hair loss or because of accelerated hair loss as a result of surgical intervention.
Richard C. Shiell, MB, BS
Melbourne, Australia
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