Asian hair transplant does not simply mean a hair restoration procedure named after a geographic region. The procedure reflects the distinctive structural properties of Asian hair and special surgical considerations which these properties can cause during hair restoration. Asian type hair is characterized by relatively big hair shaft diameter, straight growth and special follicular structure which differs from that of European or Afro-textured hair. These properties affect almost every stage of transplantation from graft extraction and handling to implantation and postoperative hair growth.
One of the main characteristics of Asian hair is the thickness. Average thickness of European hair is in the range of 3-7 microns while for Asians, it is in the range of 4, 5-9, 5 microns. Hair shaft diameter is relatively large in many Asian populations including Chinese, Japanese, Korean and some South Asian population groups. Asian type hair is also thick and remarkably straight without or with minimal curvature of visible hair shaft [1]. It means that straight hair is able to grow outward, upward, or at relatively steep angles rather than naturally falling toward the scalp. Therefore, hair requires having sufficient length, density and weight to fall due to the gravity. This hair growth property plays important role when planning the direction and angle of implantation.
The differences are not limited to visible hair shaft. Follicular unit and subcutaneous part of hair follicle can also be relatively large. In some Asian patients, subcutaneous part of follicle may reach 3.5-4 mm below the skin while in some European hair types, it can be 2-2.5 mm.
The large size of follicular unit creates another special consideration which should be taken into account. Large graft has relatively large surface area and can have more contact with instruments during extraction, handling, transportation and implantation. The large size does not mean that follicle is relatively mechanically resistant. On the contrary, follicular structures and tissue attachments can be easily damaged by aggressive handling. Since the bulb of thick hair is larger and has a high water content, excessive manipulation, compression and improper contact with forceps can increase risk of follicle injury.
That is why graft handling becomes extremely important in Asian hair transplantation. Graft extraction technique, punch selection, force used during graft extraction, handling technique, storage solution and period of existence outside the body should be considered for proper graft preservation. Careful handling helps to avoid mechanical trauma and protects follicular structures up to implantation. The technique of implantation itself should take into account relatively thick and straight properties of Asian hair.
Hair Loss Type in Asian Hair
Asian hair loss may be classified according to the same general Norwood scale which can be used for other population groups, from the beginning of frontal hair recession to advanced Norwood 6 or 7 stages of hair loss. However, Asians have a round face. Due to this facial shape, the same stage of hair loss in Asian person will be much more visible than the same stage in European person. In other words, the hair recession on the sides and widow's peaks in Asian person will appear like a big forehead.
Thickness of hair shaft is another important feature. For European person, loss of 100 hairs per day can cause no problems. However, since Asian type hair is thicker, loss of the same number of hairs can lead to visible hair thinning.
Norwood 6-Norwood 7 hair loss cases are less common among Asians compared with Europeans. The maximum level which Asians have progresses up to Norwood 4-Norwood 5A. Advanced cases are rare. However, since hair loss in the frontal area becomes visible starting from the Norwood 2-Norwood 3 stages, it may become necessary to perform hair replacement.
In case of Asian women, some hair recession on the sides can make roundness of the face more pronounced and may cause significant changes in facial appearance. In general, after African-American women, Asian women rank the second concerning hair restoration. In fact, due to satisfaction of Asian women with hair transplant results, the recent tendency towards hair restoration among Asian women has become close to that of African-American women.
Asian Hair Transplant Method
Since Asian hair is generally straight and thick, hair restoration requires special surgical approach. Graft extraction, implantation and hair angle design need to be carefully planning according to the structural characteristics of Asian hair [2].
Because the hair shaft and follicular structures are relatively thick, using of a very small punch during extraction can increase risk of graft damage, including its follicular structures damage. On the other hand, excessive large punch can increase risk of developing visible patches of over harvesting. That is why selection of punch for graft extraction should be made by the surgeon according to patient's hair and follicular anatomy.
For extraction of Asian hair, punch can be slightly larger than punch used for European patients. Harvesting dilution also should be carefully planned. Excessive harvesting can make patchy areas in the donor region more visible. Conversely, harvesting too few grafts in an attempt to prevent donor depletion may leave the recipient area inadequately covered.
After extraction, harvested grafts should be stored in the appropriate isotonic and hypothermic preservation solution. Since Asian grafts may have relatively large surface area, osmolarity of the storage solution become especially important for graft preservation.
At the stage of implantation, use of forceps can create significant danger of follicle damage if grafts are not handled carefully. If FUE forceps are used, recipient site incisions should be done before the graft insertion. Since grafts are relatively thick, these incisions should be larger than those for thinner hair. Larger recipient site incisions can increase risk of developing visible scarring.
Why DHI Can Be Advantageous for Asian Hair
DHI (Direct Hair Implantation) may become a good technique for Asian hair. Use of implanter pen gives opportunity to insert graft into the scalp in a controlled manner without any direct manipulation of follicular unit. Because thick hair has a larger, highly hydrated bulb, excessive handling, compression, or improper forceps contact may increase the likelihood of follicular injury. Implanter, which has tubular form, allows inserting graft into the recipient area with controlled angle, direction and depth of insertion [3].
Choi Implanter Pen is a special hair implantation tool which was invented by Dr. Yung Chul Choi and Dr. Jung Chul Kim at Kyungpook National University in South Korea. Origin of this device is also important in relation to its use for Asian hair since it was developed in a region where special type of hair occurs.
Implantation Design in Asian Hair
When curly hair is transplanted and reaches its final growth stage, original design of implantation in mid-scalp and crown area becomes less noticeable. Curly hair overlapped each other during growth and conceals original graft design. Therefore, design of implantation becomes especially important in the frontal area.
Asian hair behaves differently. Due to relatively straight form of Asian hair in mid-scalp and crown area, incorrect design of implantation can stay noticeable even after hair growth. If grafts are inserted in linear manner, like railway tracks, result will look unnatural even at distance since unlike curly or wavy hair, straight Asian hair does not overlapped each other.
Density distribution also plays an important role. If a large number of grafts is inserted in one area while neighboring area has significantly smaller density, it will stay visible due to the straight form of Asian hair. This will create unnatural transition between two areas.
In summary, graft distribution and design of implantation per cm² become especially important in Asian hair transplantation. Surgeon should pay attention not only to the number of grafts but also to their angle, direction, spacing and distribution across recipient area.
How to Design Asian Hairline?
Hairline should be designed according to facial and cranial characteristics of Asian patients. M-shaped or V-shaped hairlines can often be used. Appearance of the forehead is especially important during evaluation of final result. If hairline is designed too low to reduce size of forehead, it may look unnatural since Asian hair is straight. Having larger forehead in Asian person than in European person can be normal and provide more natural result. Hairline height can be appropriately adjusted.
Covering temple areas is also particularly important, especially if there is hair recession or reduced density on the sides. Due to generally round face structure of Asians, temple areas can be covered with grafts in order to create slightly square face. Such planning of hair replacement can make face of Asian patients more aesthetical and natural.
Macro- and micro-irregularity becomes extremely essential for Asian hairline design. Transition zone is also important. Soft transition zone should be created using fine and single hair grafts. This is especially important since black hair creates significant contrast on white or light skin. If hairline is created in the form of straight line, this contrast will become very noticeable and unnatural.
For hair transplant surgeon, one of the most specific and characteristic feature of Asian hair transplantation is hair direction. Comparing with other types of hair, direction becomes one of the most important issues in transplanting thick and straight Asian hair [4].
If thick straight hair is implanted at the steep angle, it can grow upright against the gravity effect. Similarly, if thick and straight hair is implanted towards sides, it will grow sideward instead of natural dropping. Situation is different with fine hair. Even if fine hair is implanted at the steep angle, it can drop downwards to some extent.
During classical DHI procedure, hair insertion with Choi Implanter Pen in the frontal and temple areas can sometimes result in pushing out of neighboring grafts due to pressure of the pen. To solve this problem, Dr. Resul Yaman first performs recipient site incision in these areas manually with sapphire blade. He determines appropriate angle for implants in temples and frontal region. Grafts are inserted with his own innovation – Yaman Implanter.
In Asian patients, the angle of implantation in the frontal region is generally smaller than in other regions. Angle increases gradually toward mid-scalp. Crown is implanted at higher angles than these regions. In the temple areas, the angle should be set at the lowest level with direction of hair towards downwards.
During implantation in mid-scalp and crown, regular DHI pen can be used. Recipient site incisions are not performed in these regions and regular sharp-tip Choi pen can be used for direct hair insertion.
Asian type hair has very little tolerance to errors in hair angle implantation since mistakes can be very noticeable and make the final result look unnatural. That is why Asians patients who want to undergo hair restoration should choose a surgeon with special experience in transplanting thick and straight hair, especially hairline design, hair direction, hair angles and density distribution.
How Many Grafts Do Asian Patients Need for Hair Restorations?
Let's assume that we solved male pattern baldness problem for Western man with average European hair by performing hair transplant with 4000 hair grafts. Now let's assume that an Asian man has the same amount of hair loss as European man and 3000 grafts will be enough for Asian patient.
Actually, for Asian man with Norwood 5 or Norwood 5A hair loss, if he has enough density in donor area, 4000 to 4500 grafts may be enough for hair transplant Asian male.
Recovery Period and New Hair Growth
Recovery after Asian hair transplant generally follows through the same biological healing process as other hair restoration procedure. The scalp is usually washed under clinical guidance on the day after surgery. Small crusts may appear around implanted grafts and will disappear in approximately 7-10 days with adequate aftercare.
Some patients can experience temporary shock loss of hair during the first few weeks after transplantation. It does not always indicate the death of grafts since the transplanted follicles can remain alive under the scalp while the hair shaft will be shed. Regrowth may begin to appear after the third or fourth month. Hair density will gradually increase during the following months while the transplanted hair will become thicker and mature.
Significant part of hair growth may appear between sixth and seventh months. However, final result should not be judged too early since hair caliber, density, texture and blending with natural hair can continue to improve during 12-18 months after transplantation.
Potential Risks of Asian Hair Transplant
Like any surgical hair restoration procedure, Asian hair transplantation is associated with some risks. These risks may include follicular transection, graft trauma, infection, folliculitis, bleeding, postoperative swelling, temporary numbness of the scalp, scarring, keloid or hypertrophic scar formation, poor graft survival and uneven hair density.
Also, you can read this blog about another cosmetic surgery: Asian Double Eyelid Surgery
Conclusion
| Comparison | Asian Hair | European Hair | Curly Hair |
|---|---|---|---|
| Angle Management | Angle mistakes are very noticeable since the hair is thick and straight. Therefore, precise angle planning and reproduction is needed. | Angle mistakes can be tolerated more if the hair is not very visible or is camouflaged by surrounding hair. | Angle mistakes can be less noticeable since the curl pattern can conceal the mistakes. |
| Donor Area Management | Highly requires careful donor management. The hair exits the scalp at relatively steep angle, so the extraction sites are visible. | Donor management is also important but visibility of extraction sites depends on hair thickness, density and direction. | Donor management is also required due to subcutaneous curl and follicular direction since the follicle does not follow the visible hair direction. |
| Extraction Distribution | The extraction should be distributed evenly among different donor zones. It will dilute the visibility of extraction sites, especially in thick hair. | Extraction can generally be distributed according to donor density and the patient's individual characteristics. | The extraction should take into account the subcutaneous curl and direction of the follicle to avoid injury and donor depletion. |
| Visibility of Extraction Sites | Because the hair shafts are thicker, scars in the harvesting areas can be more noticeable. Thus, the extraction sites can be visible if donor management is not performed carefully. | Visibility varies according to hair and skin contrast, hair thickness, donor density, and extraction pattern. | The curl pattern can provide some visual camouflage, although donor depletion may still become visible when extraction is concentrated. |
| Color Contrast | Dark, thick hair combined with lighter skin can create a pronounced contrast. Poorly planned density or transitions may make transplanted hair look artificial. | Color contrast varies between patients and can influence how noticeable density and transition zones appear. | Curl and volume can soften visual transitions, while hair-to-skin contrast is generally less of a concern with Afro-textured hair. |
| Frontal & Side Transition | A gradual transition zone in the frontal and side areas is particularly important. Without it, the transplanted hair may appear like a hairpiece. | A natural transition zone is important for creating a soft and age-appropriate hairline. | The natural curl pattern can help create a softer transition, but graft direction and distribution still need to follow the patient's existing pattern. |
Being experienced in hair restoration surgery, Dr. Resul Yaman performs individual analysis of his patients and takes into consideration such aspects as hair characteristics, donor potential, hair loss pattern, facial features, and aesthetic expectations. His approach to Asian hair transplantation focuses on careful graft management and appropriate implantation techniques to achieve natural and balanced results.
Patients considering hair restoration in Turkey can also review the expected Asian hair transplant cost and the factors that influence the overall treatment price before making a decision. A detailed consultation and individual assessment remain essential for determining whether hair restoration is an appropriate option for each patient.
FAQs for Asian Hair Transplant
How is Asian hair different from other hair?
Asian hair is straight, relatively thick and has more rounded cross-sectional shape. This may have an effect on the process of graft extraction, their transplantation and the resulting outcome.
Is Asian hair more difficult to transplant?
This may be the case but because of the specific structure of hair that is thicker and straighter. The surgeon should take into account such features as hair caliber, follicular density and scalp features while planning treatment.
Can Asian hair provide a natural hairline after the transplantation?
It can. To obtain natural results, it is necessary to plan a hairline correctly, distribute grafts appropriately, take care of angles of follicles and choose adequate hair grafts for the frontal zone.
Is DHI method suitable for Asian hair transplantation?
Yes. DHI is the best method for Asian hair because the tube-like Choi Implanter Pen perfectly fits straight hair shafts. Notably, it was invented in South Korea for this exact purpose.
Is an Asian hair transplant permanent?
Yes, an Asian hair restoration is permanent. The process moves DHT-resistant follicles from the back of the head to balding areas, ensuring these transplanted hairs survive and grow naturally for life.
Does Asian hair require a particular extraction technique?
Not necessarily. The surgeon should just consider the relatively straight follicular trajectory and thick hair shaft to avoid damaging follicles.
Is a contrast between dark hair and light skin a problem?
Not necessarily. Contrast between dark hair and light skin makes thinning areas more visible but does not make Asian hair replacement impossible. Proper hairline planning, hair distribution and density can provide natural-looking result. The surgeon should consider hair caliber, scalp visibility and hair density of the patient when planning a procedure.
Can Asian men get hair transplanted?
Yes, Asian men can go through the process of hair restorat’on if they have enough donor hair and are suitable for it. Asian hair is relatively straight and thick, providing good visual coverage. However, the surgeon should take into account such aspects as follicular characteristics, hair loss pattern, donor potential and future hair loss of the patient.
References
1. Leerunyakul, K., & Suchonwanit, P. (2020). Asian Hair: A Review of Structures, Properties, and Distinctive Disorders. Clinical, Cosmetic and Investigational Dermatology, 13, 597–611. https://pubmed.ncbi.nlm.nih.gov/32425573/
2. Lee, I.-J., Jung, J. H., Lee, Y.-R., Kim, J. C., & Hwang, S. T. (2016). Guidelines on Hair Restoration for East Asian Patients. Dermatologic Surgery, 42(7), 883–892. https://pubmed.ncbi.nlm.nih.gov/27286415/
3. Speranzini, M., & Souza, S. E. G. (2024). Advancements in Graft Placement Techniques. Facial Plastic Surgery, 40(2), 223–233. https://pubmed.ncbi.nlm.nih.gov/37879353/
4. Kim, J. C. et al. (2018). A novel concept for determining the direction of implanted hair in hairline correction surgery in East Asian women. https://pmc.ncbi.nlm.nih.gov/articles/PMC5968325/