Beard to Scalp FUE Hair Transplant – Pros and Cons

Despite rapid progress in the quality and efficiency of hair restoration, lack of sufficient hair to be transplanted has always presented a challenge for hair transplant surgeons. I like to describe this condition as hair supply and demand mismatch. This mismatch of supply and demand is seen in some patients:

• Patients with a large area of baldness that requires coverage such as advance classes of VI and VII
• Patients with low quality donor hair like the ones with very fine hair of lower density in donor areas
• Some patients possess both these limitations

We have more options available to us thanks to the modern techniques of FUE hair restoration. Many patients who may have not been considered for a hair transplant can receive one today. Utilization of hair from other areas of the body can increase the hair reserve that could be used to restore the balding areas. Beard hair in many male patients is considered the next best thing after scalp hair. Beard hair possesses many similarities to scalp hair that makes it a great source for scalp hair restoration in many patients.

Pros of Beard to Scalp Hair Transplant

Selection of the patients who have supply and demand mismatch is very important in obtaining a good result and eventually having happy patients. Here are a few advantages of beard to scalp hair transplant that help the surgeon decide whether or not the beard could be a viable option:

• Scalp supply and demand mismatch – Almost anyone with this mismatch who has average or better than average beard hair could benefit from some extra hair that the scalp donor area cannot offer.
• Using the beard as donor hair helps the surgeon preserve donor hair on the traditional scalp safe zone for more critical areas such as frontal hairline, temporal points and eyebrows.
• Thicker hair shaft – Beard hair is usually much thicker than scalp hair which helps with creating more volume in transplanted areas. This thickness difference is very obvious in patients who have very fine scalp hair in which beard hair could be used as the main source to restore the balding areas of scalp.
• Facial hair is considered unwanted in many men who always shave their faces and removing it is considered a relief for them. Even men who grow a beard would like to remove the hair from under the chin or neck area. Many of our patients report that they spend less time shaving every day.

Cons

Although beard hair can bring more options for many men who did not consider this option in the past, beard to scalp hair transplant has its own limitation and problems:

• Some men with sparse beard hair do not have sufficient beard hair that could be used as a donor source.
• The average number of hair follicles per follicular units or grafts is usually less than scalp donor grafts. Less hair per grafts equals less overall coverage. Beard hair per graft is usually closer to 1. This number is usually around 2 and more in scalp hair grafts.
• Although coarse thickness of beard hair is beneficial to some patients who need more bulk, the coarse hair can be problematic in some areas where hair is naturally finer like temporal points, eyebrows and frontal hairline. It is better to reserve beard hair as filler in the top and crown area for that reason.
• Beard hair has lower Anagen/Telogen ratio. This means beard hair follicles spend less time in growth phase while staying in the Telogen or resting phase for a longer period of time. That limits the number of hairs that present themselves at a given time on transplanted areas while minimizing the advantage of keeping transplanted hair to cover other areas.
• Changing harvesting – Hair transplantation using facial follicular extraction can be more challenging.  The skin in certain areas of the face is much more mobile and that makes stabilization of the skin for extraction of grafts more difficult. A change in the angles of the facial hair bearing areas and difficulty accessing those areas can add to this complexity.

How it is Done?

We have been trying several extraction tools for beard hair extraction. Manual extraction usually gives the surgeon the highest flexibility and this is a more suitable technique for managing the angle changes and skin mobility of the face.

Some motorized tools that utilize blunt punches could be helpful with lowering the transection rate of beard hair. Robotic hair extraction cannot be used for facial hair extraction due to its current design.

What to Expect?

As mentioned before, there is a difference in terms of anagen/Telogen between facial and scalp donor hair. Facial hair has a longer growth phase (anagen) and stays in the resting phase (telogen) for a shorter period of time. This Anagen/Telogen ration is even lower in hair from other parts of body like the chest and extremities. Patients should be aware that beard hair behaves differently and their expectations should be modified accordingly.

Thicker beard hair shaft is an advantage for patients who need more bulk on top and crown areas. This advantage sometimes can overcome the shorter anagen/Telogen ratio of beard hair especially when the scalp donor hair is extremely fine.

Complications of beard to scalp hair transplant is very minimal and include folliculitis, redness for a few days, pitting in certain areas and abscess formation in donor area.

Beard area in a person with average or more than average facial hair density provides about 3000 grafts only from the areas under the chin and neck.  If a patient is willing to remove all of his facial hair, this number can be doubled.

Conclusions

Most patients who come to us with different stages of baldness have enough scalp donor hair that can support a full head of hair throughout their lives. Some who are destined to go to advanced stages of baldness, or the ones with poor scalp donor hair quality, may need further help. Beard hair is the best source of hair after scalp in most male patients.

Minimal complications of beard to scalp hair transplant and potential advantages of it have encouraged us to use it more often in the last few years in our practice.