Transplanting hair from the body to the balding scalp, typically referred to as Body Hair Transplantation or BHT for short, has become a subject of intense interest to many patients (especially those who are endowed with the body hair of hairy back gorilla).

Some hair transplant physicians have been experimenting with and studying the viability of such body to scalp hair transplants, including Coalition member Dr. Bob True in New York City.

Dr. True made an excellent presentation on this subject at the recent annual ISHRS (International Society of Hair Restoration Surgery) meeting in San Diego this October. He was kind enough to provide me with his presentation so that I could share highlights of his findings on this forum.

According to Dr. True, there are up to 5 million hair follicles on the body. The follicles vary widely in hair character and behavior with the hairs on the torso generally most similar to scalp hair. Some races have very little torso hair. It is rare for a woman of any race to have much torso hair.

He finds that there is a wide variance among men who do have torso hair and that for men torso hair increases to the sixth decade of life.

Another fascinating phenomenon is that frequently the transplanted torso hair does not shed. Dr. True has observed this in several cases and believes that the determining factor is that the grafts have been placed in small batches immediately upon harvesting. However, he finds that the hairs do shed if the grafts are placed at the end of a several hour harvesting session.

He also finds it fascinating that torso hair transplanted to the scalp typically changes character. It tends to lose its wave, grows longer and becomes more similar to the native scalp hair.

However, unresolved questions remain and include:

what is the best and most reliable technique?
the survival rates of torso grafts?
the effect of the scalp host on torso follicle cycle?

For selected patients the torso represents a resource of many thousands of grafts. This expanded resource can be used to achieve higher density than their scalp donor allows, cover more of the bald scalp, and or accomplish repairs not otherwise possible.

However, patient selection based on their body hair donor characteristics is critical since only a minority of hair loss sufferers are ideal or viable candidates for a body hair transplant (BHT).

Dr. True uses a methodology for determining and scoring a patient’s viability using a “Torso Donor Index” (TDI) which evaluates five key patient characteristics:

(1) Density which may be more than 40FU/cm2
(2) Similarity between scalp and torso hair
(3) Proportion of 2- 3 hair FUs (Follicular Units)
(4) Size of the hair bearing area
(5) Length of the torso hair

Patients with Torso Donor Index (TDI) scores of 4 or less are not candidates. Patients with TDI scores of 5, 6, and 7 have limited supplementary resource that may allow for focused touch up work. Patients with TDI scores of 8 and above may have a donor resource that exceeds their scalp donor resource.

This methodology for evaluating patients is shown in the accompanying photos as well as a patient with a high score of 9 who garnered 3,000 grafts from his chest and stomach areas.

This is really really good.

This is the FIRST comprehensive SCIENTIFIC study I've seen on body hair transplants. Dr. True is to be commended for taking the time and energy to do it.

There is no quantitative information on "yields", but Dr True's observation that hairs immediately planted after extraction seems to be a very useful bit of information. For the first time since coming to my own conclusion that bht has very little value, Dr. True's observations may offer a way toward cosmetically significant success.

In my own experiments with bht, the grafts were out of the body between 1/2 hour and 2 hours. Perhaps these bh grafts can't tolerate being out of the body that long compared to scalp hair as Dr. True suggested.

I will experiment with bht again, but this time I will arrange to implant them immedietly after excision. Should be interesting to see if the yields improve.

Thank you Dr. True,
Dr. Feller

Dr. Feller,

Apparently it takes a great FUE physician to notice one. Your humble response is in refreshing contrast to much of the FUE chest pounding discussions online.

I suspect you and Dr. True will both end up being very popular with all hairy backed gorrillas and then go blind. Be careful with what procedures you choose to offer!

Pat

Dr. True's treatment protocol is also the most sane I've seen and I agree with each line of it. Especially the part where he only accepts easily removed grafts that don't have to undergo significant traction forces and then double checking them under the scope to make sure they are really intact. This has rekindled my interest in this area of HT. Even better knowing someone nearby is also working in this arena.

Pat, losing a bit of vision might be worth it IF the yields improve into the 85% or better range. Actaully, it is easier on the eyes to remove bht because they are spaced so far appart when compared to scalp FUE.

This is what I love about these forums. I didn't go to the last ISHRS meeting and would never have known about that presentation. Thanks for posting it here Pat.

Dr. Feller

Great post!

Props to Dr True. I had a consultation with him just over a year ago and he was showing me some BHT cases then.

One question though, why is chest hair the main BHT site? I know Dr A has used Leg and arm hair but most others seems to use chest hair by default. My chest hair is of the same texture and length as that of my arm and leg hair. The only difference being that I have more hair in my legs and arms . I personally would rather lose my leg/arm hair than my chest hair.

I hope BHT yields improve and I look forward to hearing more results from various surgeons. I would especialy like to see more BH into scar tissue cases.

Dr. Feller - since you said you would do further experimentation regarding this method of bht, have you done so yet? if so what are the results like?

Excellent thread!

Gentlemen, I'd like to add there are plenty of doctors who have had successful BHT sessions for the past few years. (Some of them are persona non grata on this forum) I dont even want to mention their names but I do want to add they have an impressive array of photographs that I've viewed of patients who look pretty good. I've seen some pictures of almost entire BHT on their noggin's (say an NW7) to adequate coverage over their entire head. Many had great body hair to work with. Thats one advantage they had in such a successful result. There is one photo of a gentleman with strcitly chest donor who's hair is about 6 inches in length throughout (held beside tape measure) and he had no remaining scalp donor before his session.

It provides a genuine alternative for those who thought they had run out of alternatives.

I've heard beard hair donor is one of the best donors available. I dont know if its because it grows better or because it is such a thicker caliber. It usually works best when blended with scalp hair. Some scalp hair or even leg hair is necessary for hairlines/temples. But I've also seen all beard donor BHT's that looked promising.

I agree that beard hair is very promising, IMO.

I however disagree that BHT is even a consideration--- In fact, I do not believe that Docs should be charging for it, unless they are taking a small deposit and then charging the patient for ACTUAL GROWTH.

We are yet to see any real success and unfortunately almost every BHT patient has scalp hair mixed in which dilutes results.

Additionally, many of the BHT results we have "seen" that are being touted as a success are of Indian/Middle Eastern descent who have 3-5K of scalp donor mixed with BHT and promoted as a success.

They are not a success.

Back to beard hair--- this is the one body hair source that has me very excited--- the growing/resting phases are more consistent and each hair is more robust, so if mixed in with scalp hair may provide excellent density. Even if a patient got 1000-1500 1 hair beard grafts, say in the crown or mid-scalp region it would provide a huge boost if they grow.

I am not taking a shot at you wylie, just disagreeing with you that BHT is a genuine alternative.

There are several docs who have been touting BHT for several years-- in fact..one of my good friends has had bht--sat in the chair for 2 weeks and got nothing.
The results just are not there.

Of course, I hope that is does work out-- don't think it will, but I am really hoping that beard hair works out.

Jason

quote:

Originally posted by the B spot:
We are yet to see any real success and unfortunately almost every BHT patient has scalp hair mixed in which dilutes results.


Jason

This is a typical "glass half empty" reply.

There is a reason the results are "diluted", it's called "design".

Thats exactly the intended result, a blend of both scalp and body hair for the "diluted" look.



P.S. I'm not taking a shot at you either, but the results you will see featured by almost every doctor doing this are usually a blend of both scalp and body hair. Exclusive BHT are probably a low success rate.

Wylie,

If you paid 100K for a glass of milk and got only half a glass you'd have a different outlook on BHT. Now, imagine that glass being only 10% then you'd be really pissed.

I agree 100% with Jason on this (except for the beard hair).

Think of it this way. Dr. Wong did a small bit of BHT on me a few years ago. Granted, it was one of the first trials he did but having what I would call "ideal" body hair for a procedure like this don't you think that I would have had more done by now? If body hair was a solid resource Dr. Wong would have given me a true full head of hair by now. Fact is, it isn't and I still have a thin crown.

You can use body hair to transplant on your scalp? It sounds like there is a mixed read here. Some are quite thrilled with the concept while others are not. I happen to have a lot of body hair and it would really be nice if I could use it

~Baldie3000

Well, it seems the critics of BHT are coming out of the woodwork, but strangely, none of them work for doctors who are experienced in performing BHT.

So...............that kind of lessens the impact of their criticism.

I'm not saying that BHT is going to replace strip surgery. We seem to be taking sides as though its either this or that, and nothing in between. Like you cant add the two together for best results, and if you do its somehow cheating.

I would like critics to back their own doubts with some more evidence of why it does not work. I dont think there are any real long term results to speak of, but in the short term, it looks quite viable for those with limited options.

Unfortunately, those who have spent little time researching the matter disregard it, or point to the addition of scalp hair as somehow negating its results.

Some folks will never buy into the concept of this, regardless. So they will remain uninformed and critical at the same time.

quote:

Dr. True uses a methodology for determining and scoring a patient’s viability using a “Torso Donor Index” (TDI) which evaluates five key patient characteristics:

(1) Density which may be more than 40FU/cm2
(2) Similarity between scalp and torso hair
(3) Proportion of 2- 3 hair FUs (Follicular Units)
(4) Size of the hair bearing area
(5) Length of the torso hair

I like the methodology and that indeed is an excellent addition to any serious discussion but Dr. True has not included beard donor in this index. I wonder if this has changed. I may have to contact him.

if you contact true, post here what he says are his results with bht with placing grafts within that half an hour time period. also, dr feller (or spex since you would know what feller has to say) have you done this further experimentation??

Wylie,

I'm not a naysayer because we don't do it. I'm a naysayer because I'm tired of seeing people get ripped off. Period. In addition, the onus is not upon me to disprove anything, it is on you to back up your claims as it is for the doctors performing this procedure to do the same. One or two "successes" (which I fail to agree are successes) do not justify the use of this procedure.

As a filler? Sure, once scalp hair is depleted but even at this last point in possibilities the procedure should be performed after the appropriate disclaimers are made. Those disclaimers should read...

"The results from this procedure will not resemble the results gained from the use of scalp hair."

"Body hair does not necessarily take on the characteristics of head hair. There have been cases where it has in the past but these patients had body hair that already resembled their head hair to a degree and those documented cases are few (as in two or three)."

"Body hair has a much lower survival rate than scalp hair thus it will take far more grafts to get an acceptable result."

"Body hair may not necessarily behave like scalp hair once (if) it grows in so do not expect to be able to have normal hair styles like those that have had procedures performed using scalp hair."

There are doctors out there saying that it is JUST AS GOOD to use body hair as it is scalp hair. There are doctors out there telling perfectly good candidates for more PROVEN techniques with PROVEN donor sources that body hair is the way to go. This, simply put, pisses me off, because it means more patients calling ME to say that I was right and they were wrong to believe in the "doctor" that talked them into spending three weeks of pain, tens or even hundreds of thousands of dollars, for results that look like some tumbleweeds were glued to their heads. THESE are the guys that wind up having to spend even MORE money just to correct or camouflage the body hair that was transplanted.

The whole point of getting a hair transplant is not to simply put more hair on one's head. It is to reduce the appearance of balding as much as possible and to allow for some hair styles that are actually flattering to the patient and not make them look like they have the mange. It is support from people like you that help to push the sale of this procedure and it ultimately leads to the further perpetuation of the great myth that BHT is a reliable procedure.

So, no Wylie, I am not a critic because we don't perform BHT. I'm not a critic because I'm "scared" it's going to replace strip. I'm a critic because the promotion of BHT being a reliable donor source is a scam established by those looking to differentiate themselves in a very competitive field. Instead of relying on consistent results that actually compete with other clinics you have BHT being presented under a veil of blurry photos, three month "progress photos" and past BHT patients being "happy but have moved on" even though there is no actual evidence by the patients themselves. In fact, we now have one high profile BHT patient being presented as a successful result on his doctor's website when the patient himself has just come forward and said that all of his BHT has fallen out thus making the procedure a complete failure. Oh, and the doctor KNOWS it's a failure as well. Knowing this one would think that if BHT were so successful this doctor would be able to pull out another result that is just as "successfule" to put in his gallery, however, he has not.

I've said it many times before and I'll say it many times again. BHT is a LAST resort. When I say "last" I mean that patients should only consider this procedure if they have had unacceptable work in the past that looks unnatural and MUST be addressed so that the patient can move on and have a relatively normal existence. For those patients that simply "want more" and have depleted their scalp hair reserves, they should only move forward with BHT if they truly understand the shortcomings and high probability of failure.

Btw, I feel I must add that my rant does not reflect on the information presented above by Dr. True. In fact, I applaud his breakdown of the subject as it appears he is the only one to have actually done so.

Joe and I have the same views on BHT (other than beard hair and I am cautiously optimistic, not a legitimate source)

If BHT was offered to patients in the pursuit of scientific knowledge for free---then great.

If it is offered as a "last resort" for an EDUCATED patient, who understands his or her situation, then great.

There just isn't any credible proof that BHT is an alternative.

It MAY work on a few patients, but almost EVERY patient has scalp donor/re-distributed plugs AND bht---- I mean 10000 bht with 4-5K of scalp donor should produce a result equivalent to 8-9K of scalp donor, ESPECIALLY if they are mixed together.

There are so many more patients who have had nothing to show for BHT---and if you search this site there are a couple of BHT patients who posted in 06/early 2007, PROMISING to document their results--- they haven't--because there is no result.


Anyway, just because I work for a clinic that doesn't offer bht doesn't mean anything---Dr. Shapiro is widely known for his appetite for knowledge, willingness to share his techniques and on occasion learn from others. The same for Dr. Wong.

Good topic, good discourse

Jason

I agree with Joe and B Spot about BHT.

Unfortunately, I just haven't seen any high level of consistency yet with body hair transplantation. Is it possible? Maybe. But until I can see evidence of consistently high growth yields with it, I cannot personally recommend it. But as a hairy man myself, I do hope that doctors can perfect this

In my opinion, I would not even attempt to have my beard hair used for a hair transplant. The question of whether or not it effective in my opinion is irrelevant since to me, scarring is the primary issue. FUE leaves scarring, minor or not, it's scarring - and hair taken from the face will leave scarring on the face. Too risky in my opinion.

I do however, like Dr. True's scientific breakdown on this thread. Perhaps I will call him in the near future and interview him on this subject to see what he says in addition to the above presentation.

Falc

I agree with Joe ,Bspot , and Falceros but I think beard hair in the scar is a viable option for a select few.
I appreciate Dr True presentation but without any final result pics its all just blah blah blah!!!
Maybe things will change but right now its a HUGE chance your taking. Jotronics right , Ive seen guys pay $50.000 and up for super thin wirey results
There is one hellboy that had good resultts ,but for every good bht result there are 10 failures.