Since the introduction of FUE in the early part of the century, there have been many refinements to the technique. Though patients of African descent are believed to be among the best candidates for hair restoration surgery, because of the low colour contrast between their skin and hair, and the excellent coverage provided by its curl or kink, the results with FUE have been very poor.

The main reason normally being that the grafts extracted have been of a poor quality due to the unpredictable nature of the curl of the hair. Understanding the unique hair qualities of African hair enables the surgeon to help the African/African American patient achieve the best possible results.

We at Cosmetic Medical Plus strive to treat each patient as an individual and as such we feel patients should be viewed and treated in their own unique way.

The hair shaft of African hair is oval on its cross section (in contrast to the round shafts of Caucasians and Asians). This configuration allows the hair shaft to twist on itself and form the characteristic kinky or curly hair. This hair type provides excellent local coverage since each hair covers a large area around it.

However, a limitation of this hair type is that the tight curl doesn't allow the hair to be easily combed back to cover thin or bald areas that are some distance behind it. To compensate for this, the surgeon should place at least a small amount of hair in all of the areas that need coverage.

African hair can be divided into two distinct, but overlapping types:

1. wiry and tightly kinked
2. a loose, wavier kink with a softer feel

The surgery in each case must observe the slight differences outlined.

African patient with density of 1.6 hairs/mm2 and tightly kinky hair	African patient with density of 1.6 hairs/mm2 and curly-kinky hair

African hair is also unique in that the density of naturally occurring follicular units is relatively low (they are spaced farther apart). Africans have an average density of about 0.65 follicular units/mm2, in contrast to Caucasians with an average density of 1.0 follicular unit/mm2.

During the transplant, the surgeon must account for this by spacing the grafts in African/African American patients slightly further apart to insure that there will be adequate coverage of the areas to be treated. Technically this works well, since the slightly larger grafts cannot be placed quite so close together.

The following table compares some easily measurable aspects of the follicular units in Africans/African Americans and Caucasians.

Another important consideration when transplanting those of African descent is the characteristics of the donor scalp. Their scalps tend to be thicker, more fibrotic and less distensible.

A final issue in transplanting Africans/African Americans is their increased risk of hypertrophic scarring and keloids. Although the incidence of keloid formation is rare in the back of the scalp, the formation of hypertrophic scarring is quite common.

It is of paramount importance to identify a condition called Acne Keloidalis that commonly occurs among African community. This presents itself as small bumps on the back of the scalp, and if present needs to be addressed by the surgeon.

We at Cosmetic Medical Group understand the unique nature of African hair and have had consistently good results with the H+ Technique. Due to the complex nature of this procedure and the unique way in which we tackle it, we are confident of achieving highly natural and satisfying results and hence back it up with a written guarantee.