Aesthetic Surgery Journal

The Aesthetic Surgery Journal Publishes Groundbreaking Study on Nape Hair For FUE Hair Transplantation


The Aesthetic Surgery Journal Publishes Groundbreaking Study on Nape Hair For FUE Hair Transplantation

The number one Aesthetic Surgery publication in the world has published an article featuring a study by Dr. Sanusi Umar that proved more men and women are able achieve more softer looking natural hairlines than what was previously made possible through conventional surgical approaches.

The Aesthetic Surgery Journal article, written by Dr. Umar, features results from the use of nape and peri-auricular Follicular Unit Extraction ( FUE ) method of hair transplantation which may potentially change the way hair transplants are conducted, allowing patients to achieve even greater levels of realistic detail.

The publication titled “Use of Nape and Peri- Auricular Hair By FUE to Create Soft Hairlines and Temples”, discusses the findings from Dr. Umar’s research study on 128 male patients.

These findings shed light on new information which supports a new view that in selected candidates, finer grafts from the nape and areas close to the ears can indeed serve as a viable resource for hair restoration surgery and a tool for creating more natural looking softer hairlines that would be more difficult to detect as transplanted hairlines.

Modern hair transplantation has come a long way in being able to create remarkably inconspicuous results.

Yet, with conventional methods, there are still limitations in being able to render the gradual thicknesses of hair found in natural hairlines.

The majority of surgeons around the world rely on grafts taken exclusively from the middle of the back and sides of the head. Without much study to support doing so.

Doctors have long avoided the use of thinner hairs located outside of this narrow zone (called the Safe Donor Area – SDA), fearing that they would not survive long term.

However, hairs from this “SDA” zone are the thickest of hairs in the entire scalp and when used to create hairline by hair transplantation tend to impart harsher, pluggier and unnatural look to the dissatisfaction of discerning patients, who expect and prefer a more natural and softer hairline.

This challenge to conventionally created hairline is further heightened in women whose hairlines requires a larger transition zone of softness, temple areas, as well as certain demographic groups such as most patients of East Asians descent whose scalp hairs are typically thicker relative to other demographic groups.

Although nape hair (hair from the area below the SDA to a line abutting the neck) and the peri-auricular hair (hair found just above the ears) are typically the thinnest hairs in the scalp and hence a better fit for crafting a softer more natural looking hairlines and temples in hair transplantation; they have not been utilized to assuage the problem of unnatural hairline created by conventional hair transplantation for fear of future loss.

Thus in conventionally created hairlines, coarser SDA hairs can appear quite noticeable, and even out of place, compared to the soft progression of natural hairlines, where finer hairs along the outer edge graduate to thicker ones towards the back.

Summary of the Nape Hair Study

Between November 2006 and November 2011, Dr. Umar performed FUE hair transplants in 128 patients using a specialized punch tool (UPunch®) which is part of an FUE technology he developed himself known as the UGraft Revolution™. His instrumentation is designed to create uniquely configured extractions that avoid typical forms of graft damage associated with conventional FUE transplant punches which are better suited for straighter hairs. Additionally it imparts a relatively better cosmetic wound healing outcomes standards due to the way it has been engineered.

In the study, nape and periauricular follicles (NPA) were used to recreate the softer vanguard hairs along the outer perimeter of the hairline and temples.

The potential for long term survival of these finer hairs was determined by newly described test (The FUE Shave Test) by Dr Umar. In the test, subjects had their heads shaved into crew cuts. In those destined to become severely bald (Norwood 7’s), clear lines of demarcation are revealed, marking the final wreath of hair around the lower portions of the scalp.

However, most men do not display this trait. And the participants without this line could then qualify for hair transplantation using soft nape and peri-auricular hair. In most of these candidates, the study findings supports that in most qualified candidates, NPA grafts resulted in soft natural looking hairlines that remain intact in the long term.

About 2.3 years following surgery, 91 of the 128 subjects (71%) responded to a follow up survey, expressing a high rate of satisfaction with their results. Furthermore, to investigate for longevity of NPA graft results, a 2nd survey was sent to at an average of 4.6 years after surgery. The majority of those who responded to this longevity survey gave an average rating of of 8.5/10 on their continued satisfaction with their results.

Significance of Study – Hair Transplantation Takes Yet Another Leap Forward


Until about the late 80s, hair restoration procedures had been conducted using large 42mm sized punches, creating pluggy, doll-like hair.

With more recent methods like strip surgery and Follicular Unit Extraction (FUE), much smaller grafts came to be used.

These consisted of naturally occurring clusters of 2-4 haired follicles. However, both forms of surgery have long depended on hairs from the middle of the back of the head which naturally typically contain the thickest caliber hairs in in the scalp.

Despite best efforts, these hairs even when planted in singles have often resulted in relatively harsher looking pluggy hairlines leading to tell tale signs that onlookers can pick up often to the discomfort of the patients. “This is a less talked about yet vexing issue in hair transplantation” says Dr Umar.

Since the hairline sits above the eyes and it is the most noticeable aspect of a person’s hair from a social perspective.

The study represents thus, a new stride in the evolution of hair restoration, allowing patients to enjoy the satisfaction of possessing more realistic and truly natural looking hairlines.


According to Dr Umar, “the entire NPA area in suitable candidates (patients passing the FUE SHAVE TEST he described in the study) can yield anywhere between 1500 to 3000 grafts lifetime supply. In such patients, FUE practitioners can conceivable utilize most hairs that lie outside the so-called SDA, such as the parietal areas of the scalp (closer to the temples). This translates to 3000 to 4500 lifetime donor supply in addition to what was achievable using conventional SDA grafts alone.”

The study supports a new view and challenges the long held unproven belief that only thicker hairs in a narrow band of skin in the middle of the back of the scalp can be used for transplantation.

The following video depicts one of the patients presented in the study. Using hair from the nape area, Dr Umar corrected his sharp widow’s peak hairline by FUE using his UPunch® and UGraft™ technology.

Four years later, the patient is still enjoying a very natural and soft hairline, proving that use nape and peri-auricular hair in patients qualified by the FUE Shave Test is long lasting.

About the Aesthetic Surgery Journal

As the official publication of the American Society for Aesthetic Plastic Surgery, the Aesthetic Surgery Journal is an internationally renowned medical journal which showcases new developments and emerging methodologies within the field of aesthetic surgery.

Recognized as highly influential, it is regarded as the the number one, go-to publication for plastic surgeons who specialize in aesthetics as opposed to reconstructive procedures. Since 2011, it has been covered by the prestigious Thomson Reuter’s Journal Citation Report.