Hair Restoration Surgery in Patients with Pubic Atrichosis or Hypotrichosis: Review of Technique and Clinical Consideration of 507 Cases

BACKGROUND: Pubic atrichosis or hypotrichosis is a common condition in Korean women of Mongolian origin. This results in many patients receiving hair restoration surgery, which is currently thought to be the only definitive therapy. OBJECTIVE: To pursue more natural and realistic-appearing results, to define patient characteristics, and to estimate the survival rate of transplanted pubic hair through restoration surgery, we examined our cases of pubic hair restoration surgery with single-hair grafts. METHODS: We selected 507 patients with pubic atrichosis or hypotrichosis who visited for pubic hair transplantation between March 1, 2001, and February 28, 2005. We reviewed the medical charts of the 507 patients and performed statistical analysis. We also carried out a detailed evaluation of our surgical technique to 100 patients. In addition, 20 patients, who agreed to participate in the study for survival rate, had received transplantation of 40 hairs in a 1.5 x 1.5-cm area after the angular points were tattooed. The number of hairs grown after 1 year of transplantation was counted in each case. RESULTS: Among the 507 subjects, 169(33.3%) were in their 40s. The mean (+/-SD) patient age was 41.3+/-10.8 years. Of these, 115 patients (22.7%) had pubic atrichosis, and 392 patients (77.3%) had pubic hypotrichosis. In addition, 81.7% of atrichosis patients had a family history of atrichosis or hypotrichosis. Pubic atrichosis accompanied axillary atrichosis or hypotrichosis in 60.0 and 38.2% of the cases, respectively. The most common reason for the hair restorative procedure was the subject's sense of inferiority to the same sex (73.8%). The mean number of transplanted hairs was 929.3+/-76.6. The most common design pattern that we used was modified horizontal type (87.0%). The mean survival rate of single-hair grafts on the pubis was 73.6+/-7.6%. CONCLUSION: This study suggested that pubic hair transplantation surgery is a suitable cosmetic procedure to address the inferiority complex of patients with pubic atrichosis or hypotrichosis. Knowledge of natural pubic pattern and normal physiologic features is essential to create a natural and realistic appearance in a given subject.