Orientation of multi-hair follicles in nonbald men: perpendicular versus parallel.

BACKGROUND There has been much debate about the orientation of multi-hair grafts in order to obtain an appearance of fullness after the hair transplantation. OBJECTIVES To analyze natural orientation of multi-hair follicles and the influence of hair flow from the crown swirl. METHODS Natural orientation of follicles was analyzed microscopically in 100 nonbald men: a clockwise whorl flow group (50 men) and a counterclockwise group (50 men). RESULTS The majority of multi-hair follicles were oriented perpendicular to the radial line from the whorl in both the groups. The percentage of perpendicular orientation was large in the peripheral and middle scalp areas (49–79%), and it decreased in the vertex (38–49%, p<.05 or .01). The percentages of parallel, right oblique, and left oblique orientation were small in the peripheral area with a slight increase in the vertex (3–12% vs. 14–24%, p<.05 or .01). CONCLUSION Original orientation of multi-hair follicles was mainly perpendicular to the radial line from the whorl irrelevant to the crown swirl hair flow. Multi-hair grafts transplanted perpendicularly would look similar to the natural hair follicles in the front half of the scalp.