Discussion

The facial features of this gentleman from Egypt were a mixture of Negroid and Caucasian with more similarities towards Negroid. However, it was longer and slightly narrower (dolichocephalic tomesocephalic) than rest of the people.

The hair characteristics were kinky to curly hair with relatively low density and black in color. The hairwere in the form of a spongy zigzag, coiled, springy pattern that had a lot of shrinkage. As a result it had a natural tendency to tangle.

The hair follicles were also placed superficially as compared to the average Indian population despite the average length of 4-5mm. The lower portion of follicle was situated more parallel to skin surface contrary to straight or wavy hair in which follicles are perpendicular to skin. The density of hair was also less ( 60 FU/cm2)

Technique of FUE

There was no difference in patient preparation and local anesthesia.  But there were subtle variations at the time of slit making, extraction and implantation which are enumerated as follows:

SLIT MAKING

• The size of slits was sufficiently large so as to accommodate the curve of the follicle.
• The direction of hair on scalp was less uniform and there were more whorls on the scalp so we had to be very careful while making slits in the border area where there were some hair.
• A moderate density ( 30- 35 FU/cm2) was given keeping in mind the curl of the hair.
• We used methylene blue for highlighting the slits in the recipient area as they were difficult to identify without it.

EXTRACTION

• During extraction blunt punch was usedto avoid transection of grafts as the follicles were not straight and perpendicular to the skin surface but rather at an angle with lower portion curving into the dermis. One can clearly see the curvy nature of extracted follicles in below photo which look comma shaped (Fig.5).
• The punch was advanced superficially only in order to avoid the transection of the graft.
• More force was required to introduce the punch as the skin is firm of these patients as compared to the rest of the Indian patients.
• The wastage/ total transaction was 18 (1.2%)

IMPLANTATION

• During implantation, proper care was taken to make sure that the curve of the follicle was downward to make sure that the follicle fell in the natural direction and gave a better coverage of the scalp. In case they are placed with the curve upwards, then they will face upwards after growth and curve back leading to poor coverage of the scalp.
• The fat with the grafts was more which made the grafts slippery but our experience in doing these surgeries saw us through comfortably.

Conclusion

Hair transplantation in Egyptian is a different and complex entity. A modification of the technique by the surgeons, keeping in mind the above-mentioned differences can give cosmetically pleasing results.