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Hair Transplantation and Ethnic Differences

In hair transplantation which is a personal procedure, the person’s hair loss pattern, hair structure and the quality of hair in the donor area are important factors affecting the success of operation. It is not always possible to achieve natural results in hair transplantation with a standard design. For this reason, a personal hair design should necessarily be created and the right hair transplantation technique should be determined along with the design. Another factor that has a significant effect on the diagnosis of hair loss, at all stages of hair transplantation, potential complications and hair transplantation results is ethnic differences. In a scientific study on individuals who received hair transplantation across the world, it was observed that some types of hair loss were more common in certain ethnic groups.

Hair Habits Determine Hair Type

Traction alopecia, which is a condition of hair loss arising on the scalp, especially in the front and side parts due to very tightly tied or braided hair, is more commonly seen in African American women. Braiding hair too tightly and thinly comes to the fore as a traditional hair style in African American women. This tightly braided hairstyle, which started to be used in Egypt in 3500 BC and then came to the African continent, has been adopted as a communication tool for the African culture. Likewise, braid hairstyles commonly used in Africa were an important identity qualification that determined the person’s tribe, age, marital status, and social status.

Hair loss is very common in the African community, and it can be a sensitive subject for people losing hair in their early 20s. Hair loss can occur through the heavy use of hair creams, tight braiding, and hair extensions over time.

Each Race Has Its Own Hair Transplantation

Ethnic differences have a great effect on patients’ preferences for hair or beard transplantation. For example, beard and mustache transplantation is the most commonly preferred procedure by patients who come to Turkey from Arab countries. The main reason for this is that having a bushy beard symbolizes power and masculinity for Middle Eastern men. Europeans prefer naturalness in both hair and beard, unlike Arabs who demand sharper lines in beard transplantation. 

Although there are numerous hair types in various sources, human hair is generally examined under three different ethnic groups in the medical literature Yellow (Asian), White (Caucasian), and Black (African) race. Although the chemical and protein structure of hair is the same in 3 ethnic groups, they differ from each other in terms of hair growth pattern, hair density, and hair shaft diameter.

If we list these differences in a table;

  Hair growth pattern Hair density
Asians Fastest Medium
Africans Slowest Lowest
Caucasians Medium Highest

As can be seen in this table, each race has its advantages and disadvantages.

Asians have the fastest hair growth pattern and moderate hair density with a hair growth of about 15.3 cm in a year, Africans have the slowest hair growth pattern and the lowest hair density, while Caucasians have a moderate hair growth pattern and the highest hair density. The most important criterion determining a person’s eligibility for hair transplantation is the hair density in the donor area.

The hair density has 2 components;

  • The number of follicular units per square meter on the scalp and the diameter of the hair shaft.  Each of the follicular units contains an average of 1 to 4 hair follicles.

If we look at the cross-sectional view of the hair of people of different races;

  • The hair shafts of Asians are round and smooth, while Africans’ hair shafts are smooth and Caucasians’ hair shafts are oval.
  • Asians have the largest hair shaft diameter, Africans have the smallest, and people of the white race have a medium-sized hair shaft diameter.

Abundancy and Thinness of Hair Follicles are Again an Ethnic Characteristic

The hair follicles of Asians are found in single, double hair follicle groups on the scalp, while Africans have grafts with triple hair follicles and Caucasians have grafts with triple and quadruple hair follicles. Although African people have a thin hair shaft, the reason for their voluminous appearance is that their hair is curly. 

This characteristic allows us to obtain a more voluminous appearance with fewer grafts in hair transplantation. Although it is advantageous to have curly hair in this respect, it may cause complications, especially in the graft-harvesting phase of the hair transplantation procedure. 

In Africans, the epidermis layer (upper skin) that surrounds the hair follicle externally is thicker and tighter compared to other ethnic groups. This may cause damage to the hair follicles, rupture, and a high transection rate (graft damage during extraction) in the graft-taking phase.

Another possible complication is the risk of “keloid” development on scars in the healing process after hair transplantation. This abnormal wound formation, which occurs as a result of ongoing tissue repair due to the production of excess cells by the body after the wounds are healed, is more common in Africans than in other ethnic groups. 

It is possible to obtain successful results from hair transplantation of patients with African hair if it is performed by an experienced hair transplantation specialist and a professional team with modern equipment, proper technique, and care.

Dr. Serkan Aygın Clinic has been performing hair transplant operations on African people and the curly-haired Arabian race for many years. Such hair transplantation is a hair transplantation procedure that is much more technical and requires much care than hair transplantation procedures of those with normal-smooth hair. 

In Asian people, the number of hair per square centimeter is smaller compared to Caucasians and Africans, but their hair appears thick and voluminous since the diameter of the hair shaft is larger. Thanks to this characteristic of their hair, they have the advantage of getting a voluminous hair look with fewer grafts in hair transplantation like Africans. Asians experiencing hair loss may have a narrower/smaller donor area than that of Caucasians. In such a case, hair transplantation can be performed by harvesting follicles from beard or chest hair (BHT/body hair transplantation) to increase the donor hair reserve.

DHI (Direct Hair Transplantation) Method in Hair Transplantation

The hair follicles of Asians have a more active metabolism. Therefore, they are more prone to dehydration (water loss) and are not suitable for long-term storage. In the first phase of the hair transplantation operation, the hair follicles harvested for transplantation are kept outside until the transplantation procedure starts. In this period, the grafts must be kept under proper storage conditions and transplanted as soon as possible to remain alive.

Considering this, we can say that the most suitable hair transplantation technique to be used on Asian people is the DHI technique which allows the hair follicles to be transplanted more healthily by minimizing the time of hair follicles to remain outside of the tissue.

The Caucasian race with the highest hair density has a smooth, wavy, or curly hair structure and a color scale ranging from black, and brown tones to yellow and red.

Hair Color of People Is A Sign of Hair Density

The highest hair density is seen in blondes with an average of 146.000 hair and the least hair density is seen in reds with 86.000 hair. Caucasians come to the forefront as the most common ethnic group of hair loss compared to Africans and Asians. Androgenic alopecia, also known as male-pattern hair loss, is most commonly seen in Caucasians.

If we analyze the head shape;

The portion from the tip of the nose to the back of the head is longer compared to the horizontal plane (the portion extending from the top of the head, from one ear to another). This anatomical characteristic may cause both hairless areas to be larger and more prominent, symmetrical, and deep receding in the frontotemporal region.

Most Advantageous Race in Hair Transplantation

Although Caucasian people may need more grafts than Africans and Asians to get a voluminous look in hair transplantation, their scalp is more flexible than that of Africans and Asians. The length of hair follicles is also shorter compared to Asians with very long hair follicles. This structural characteristic allows the grafts to be collected more easily in Caucasian people, helping reduce the likelihood of damage to hair follicles and the risk of transection to a minimum, as well as enables the use of different techniques such as Sapphire FUE, DHI, and hair transplantation without shaving.