Hair restoration is one of the most planning-dependent procedures in plastic surgery — a single wrong call on the hairline or the donor strip can show up for the rest of the patient's life.

In this episode of Plastics in Practice we walk through what residents actually need to know about modern hair transplantation: how to evaluate the donor area, how to think about lifetime donor yield, the trade-offs between strip excision and FUE, graft preparation and the out-of-body clock, recipient site design (hairline placement, angle and direction, ethnic and gender variations), postoperative management, and where finasteride, minoxidil, and PRP fit in.

Key takeaways:

The Safe Donor Area (SDA) defines what is truly permanent — and a 30-year-old destined for Norwood V/VI averages roughly 5,393–6,404 lifetime FUs from average-density donor scalp.¹

Strip excision still dominates (~88.5% of cases) vs. FUE (~11.5%); transection rates can be pushed below 10–15% with tumescent solutions and skin-hook technique.²

Graft survival drops about 1% per hour out of body — chilled saline gives ~88% survival at 8 hours; pear-shaped grafts under 6× magnification protect the bulb, sebaceous glands, and dermal papilla.³

Hairline placement: never too low. The mid-frontal point lives where the vertical forehead transitions to the horizontal scalp, ~7–10 cm above the glabella. Build in micro- and macro-irregularities so it never reads as a wall.⁴

Density target for natural long-term coverage in younger patients is 25–30 FU/cm²; high-density "dense packing" >30 FU/cm² is reserved for ideal donor/recipient profiles.⁴

Adjuncts matter: finasteride 1 mg is ~87% effective at slowing AGA progression; topical minoxidil reduces postoperative effluvium and is encouraged 5–12 weeks post-op.⁵,⁶

Cicatricial alopecia (post-facelift, burn, traction): keep recipient density conservative at 15–20 FU/cm² to avoid overwhelming a compromised blood supply.⁷

This content is for educational purposes only and is not medical advice.

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📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

#PlasticSurgery #Residency #HairTransplantation #FUT #FUE #SurgicalEducation #PlasticsInPractice #HairRestoration #Aesthetic #SurgicalPearls

References:

1. Unger W, Unger R, Wesley C. Estimating the number of lifetime follicular units: a survey and comments of experienced hair transplant surgeons. Dermatol Surg. 2012;1-6.

2. Pathomvanich D. Donor harvesting; a new approach to minimize transection of hair follicles. Dermatol Surg. 2000;26:345-348.

3. Limmer R. Micrograft survival. In: Stough D, Haber R, eds. Hair Replacement. St. Louis, MO: Mosby Press; 1996:147-149.

4. Shapiro R. Principles of creating a natural hairline. In: Unger W, Unger R, Unger M, Shapiro R, eds. Hair Transplantation. 5th ed. New York, NY: Marcel Dekker; 2011:374-382.

5. Rossi A. Finasteride, 1 mg daily administration on male androgenetic alopecia and different age groups: 10-year follow up. Dermatol Ther. 2011;24(4):455-461.

6. Bohannon P. Topical minoxidil used before and after hair transplantation. J Dermatol Surg Oncol. 1989;15:50-53.

7. Unger W, Unger R, Wesley C. The surgical treatment of cicatricial alopecia. Dermatol Ther. 2008;21(4):295-311.

Osseous genioplasty is the most versatile tool the plastic surgeon has for the lower face — and the most commonly mis-planned. In this episode of Plastics in Practice, we review the basics of chin surgery: when to pick the osteotomy over an implant, the five-pillar physical exam, the technical steps that decide your aesthetic result, and the pitfalls that cause the bizarre "overadvanced" chin we've all seen on revision.Key takeaways:• The lower lip rule: never advance the chin past a vertical line dropped from the lower lip. Cross it, and the result looks artificial every time.¹• 3-D versatility: implants only correct mild sagittal deficiency. Vertical excess, asymmetry, deep folds, or revisions belong to osseous genioplasty.²• Soft-tissue ratios: ~1:1 for advancement and lengthening; only ~0.5:1 for posterior repositioning.³• The 4 mm rule: keep the horizontal cut ≥ 4 mm below the mental foramina to protect the inferior alveolar nerve.⁴• Carry the cut posteriorly to the molars — the most common technical error is too short a cut, which produces an hourglass deformity.⁴• Mentalis discipline at closure prevents witch's chin (soft-tissue ptosis).⁵Disclaimer: This content is for educational purposes only and is not medical advice.🎧 Full episodes available now:Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ#PlasticSurgery #Residency #Genioplasty #Craniofacial #SurgicalEducation #PlasticsInPractice #FacialAesthetics #ChinSurgeryReferences (AMA):1. Rosen HM. Aesthetic guidelines in genioplasty: the role of facial disproportion. Plast Reconstr Surg. 1995;95(3):463-469.2. Converse JM, Wood-Smith D. Horizontal osteotomy of the mandible. Plast Reconstr Surg. 1964;34:464.3. Rosen HM. Aesthetic refinements in genioplasty: the role of the labiomental fold. Plast Reconstr Surg. 1991;88(5):760-767.4. Spear SL, Mausner ME, Kawamoto HK. Sliding genioplasty as a local aesthetic outpatient procedure: a prospective two center trial. Plast Reconstr Surg. 1987;80(1):55-59.5. Zide BM, McCarthy JG. The mentalis muscle: an associated component of chin and lower lip position. Plast Reconstr Surg. 1989;83(3):413-420.

Facial implants can dramatically change facial balance, but the difference between a natural result and an operated look comes down to planning, positioning, and fixation. In this episode, we break down the core principles of facial skeletal augmentation with implants for the plastic surgery resident.

We review the major implant materials, the anatomic targets across the midface and mandible, and the operative concepts that matter most in real cases. This includes why subperiosteal placement is preferred, why screw fixation remains a key technical principle, and how to think through chin augmentation versus sliding genioplasty. We also cover common causes of poor outcomes, including malposition, asymmetry, poor transition zones, and technique-related complications rather than material toxicity.

Key takeaways:

• Facial skeletal morphology is a major determinant of facial aesthetics
• Anthropometric normals are more useful than rigid neoclassical canons for planning

• Subperiosteal dissection improves visualization, precision, and safety during implant placement
• Screw fixation helps eliminate implant-bone gaps and reduces migration risk
• Infraorbital rim and paranasal implants can be powerful tools in midface deficiency

• Chin implants and sliding genioplasty each have distinct advantages and tradeoffs

🎧 Full episodes available now:

Instagram: https://www.instagram.com/plasticsinpractice/

Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA

Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216

YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO

Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

References

1. Farkas LG, Hreczko TA, Kolar JC, Munro IR. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg. 1985;75(3):328-338. doi:10.1097/00006534-198503000-00005. PMID: 3883374.
2. Rubin JP, Yaremchuk MJ. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg. 1997;100(5):1336-1353. doi:10.1097/00006534-199710000-00043. PMID: 9326803.
3. Yaremchuk MJ, Israeli D. Paranasal implants for correction of midface concavity. Plast Reconstr Surg. 1998;102(5):1676-1684. doi:10.1097/00006534-199810000-00055. PMID: 9774030.
4. Yaremchuk MJ. Infraorbital rim augmentation. Plast Reconstr Surg. 2001;107(6):1585-1592. doi:10.1097/00006534-200105000-00047. PMID: 11335841.

Disclaimer: This content is for educational purposes only and is not medical advice.
#PlasticSurgery #PRS #FacialImplants #FacialSkeletalAugmentation #Craniofacial #Aesthetics #ResidentEducation #PlasticsInPractice