posted by ISHRS on December 1, 2004

The goal of hair transplantation is to give you, the patient, completely natural-appearing hair growth that expresses your unique individuality. Advances in hair transplantation techniques, procedures and technology make this goal achievable for most patients today.
When hair transplantation was first developed in mid-Twentieth Century, the goal was “coverage” using plug-graft technology and techniques of the day. Patients were pleased with the restoration of hair to balding areas of the scalp; most understood that a “pluggy” look was an unavoidable side effect of transplanting large, multi-hair plug grafts from donor site to recipient site. Sometimes a skilled and experienced transplant surgeon was able to mask the plugginess.
Fast-forward to the Twenty-first Century and you find the physician hair restoration specialist able to approach hair transplantation with a choice of elegant techniques and refined technology developed especially to allow the physician to create “naturalness” in restored hair. “Coverage” of hair-loss areas is still a basic principle of hair transplantation, but “naturalness” is the guiding philosophy.
You, the patient, should have an understanding of what “naturalness” means. A good place to start is to understand what it does not mean:
“Naturalness” does not mean hair-for-hair replacement of every hair lost in the balding process. The changing ratio between hair remaining at the donor site and hair lost at the recipient site would make it impossible to replace every lost hair, and keep replacing lost hair as hair loss progresses over the years. Hair-for-hair replacement is not likely to be possible until-at some date still in the future-hair cloning and genetic engineering enable the growth of hair on demand in the laboratory. Hair-for-hair replacement is not, in fact, really necessary; the human eye cannot easily detect a difference between 50% and 100% hair density at any part of the scalp other than the hairline.
What naturalness does mean is that the physician hair restoration specialist works with you to restore a “look” that provides the aesthetic balance that expresses your individuality. Even though this “look” is not a hair-for-hair replacement of lost hair, it restores the natural pattern of your hair growth, frames your face, and makes your hair once again a part of your overall appearance rather than a distraction the makes your hair loss your most noticeable feature.
Naturalness also means that the physician hair restoration specialist will plan your hair restoration around your pattern of natural hair growth and your natural hair-loss patterns. (See About hair loss for information about hair-loss patterns.) There is no “one size fits all” approach to aesthetically successful hair restoration-every person is an individual whose hair restoration must be individualized to that person’s needs and wishes. The goal of naturalness must be achieved with uniquely individualized use of technique and technology. Creative use of technology can, in properly selected patients, include combining oral finasteride (Propecia®) and topical minoxidil (Rogaine®) hair restoration drugs with hair transplantation. (See Nonsurgical Hair Loss Treatment for more information on hair restoration drugs). In selected patients, hair restoration drugs can (1) delay the need for hair transplantation in younger patients, and (2) in older patients, stimulate hair growth to fill in areas between hair grafts.
Naturalness can also mean incorporating a natural hair-loss pattern into an overall hair restoration that is pleasing to you, the patient. Not only is hair-for-hair replacement not a viable goal of hair transplantation, sometimes the hair restoration goal must be modified to accept some degree of hair thinning. This might be a successful solution, for example, to the problem created by a limited supply of donor hair, moderate to extensive hair loss, and progressive balding.
Not all baldness patterns could be incorporated into a natural pattern of hair restoration because only some baldness patterns have any degree of aesthetic attractiveness. However, if the face is properly framed, a middle-aged man with a limited supply of donor hair and progressive hair loss may be very pleased with hair restoration that provides selective coverage of hair loss areas with limited hair density. Newer techniques of mini-, micro-, and follicular-unit grafting can be used to make “less” look like “more”.
If naturalness is to be a successfully achieved goal it must be one that remains successful over time. If your hair restoration has the appearance of natural hair growth when you are 20, 30 or 40 years old, it should still have that appearance when you are 50, 60 or 70 years old. The skilled and experienced physician hair restoration specialist takes into account how well hair restoration will hold up with the passage of time. Included in the physician’s assessment is the likelihood of need for future transplantation sessions to keep pace with progressive hair loss. Good planning of the initial round of hair restoration should create the desired natural appearance; any future transplantation sessions should be needed only to maintain the natural appearance.