Recent attempt by Dr. Robert Jones to perform axillary hair transplant on one of his patients has triggered quite a debate in the hair transplant forum. The following are comments from some of the most highly respected FUE transplant doctors in our forum. 

The following is a further explanation of our position on axillary hair transplantation. We have been asked about it for several years and it was discussed in our Feb 2003 New York Seminar

The groin/pubic perineal, and armpit are crease areas where the skin reflects upon itself. These are the skin “wet zones”. It needs to be this way otherwise dry skin would constantly rub against dry skin causing severe discomfort, abrasion, rash, and infection. In these “wet zones”, nature has devised a complex system of unique and specialized glands attached to the follicular units. Secretions lubricate and protect the skin, but the full function of the apocrine gland system to this day is not fully understood. In hot weather and exercise etc. moisture would accumulate and, because air circulation and drainage is limited in these “crease” areas there would be “water logging” of the skin.

Tinea, yeast, fungal and bacterial infections would become a major factor. But, incredibly it is not usually a problem. However, In our clinical experience, problems do occur primarily when there is interference in the nature of the “wet zone”.
People who excessively shave, wax , overuse antiperspirants or have surgical procedures in these areas are at increased risk of these infections and boils.

Apocrine glands are unique to these areas. They are a tubular structure extending from the deep subcutaneous layer and are intimately connected around the follicle. The “milky” secretions drain into the follicle near the epidermis. We believe their existence to be crucial to the normal function of these special “wet areas”.

In 1998, we looked at the issue and made a benefit–risk analysis. Attempting to remove armpit hair would result in very high transection rates. That means a lot of holes but very few hair. It would be very easy to wipe out entirely ALL armpit hair in one session. This would achieve one, maybe two hundred hair. Maybe less. Then of course there is the issue of odor coming out of the patient's scalp. To overcome this one would need to get rid of the apocrine glands. Our early experimental work involved the high power dissection of follicles. What we found out then and what we know now is that it is almost impossible to remove the sebaceous gland entirely and attempts to do so render the follicle terminally damaged. We drew the conclusion that apocrine gland removal would most likely have similar problems. This means the yield could be even less

Anyone who has had chest hair transplants knows that a temporary but common side effect is ingrown hair. If a boil occurs, it is no major problem. Just squeeze it, and it should drain. However, a boil in the armpit is much more tender, and infection can spread much more easily into the lymph nodes. Sweating makes things worse and cannot be avoided. We believe side effects and complications would be worse.

Whether you believe in GOD or evolution, neither makes “silly mistakes” and went to a great deal of trouble giving us specialized glands or hormones that we don’t need, or for no reason. Eventually, we find out.

So, rather than resorting to “wet zone” harvesting , our position is to treat each and every body (and head) hair as precious and irreplaceable. Every hair that is transected is gone forever and those who have been scarred and disfigured CANNOT afford unnecessary wastage. The doctor must go by the rule “if in doubt, DON’T!!”

As far as beard hair is concerned, we recently spent several days removing beard hair transplanted to a patients head. It looked, and felt like barbed wire and made this man's life a misery. Again, BEWARE.

It is our belief that the hair transplant industry despite creating so many “experts” has caused more disfigurement, more suffering, agony, humiliation , negligence, blatantly stupid mistakes and deception than any other discipline in the history of medicine. And we want no part of it. 

THE DECLARATION OF PATIENT RIGHTS STAYS . There will be no compromise.

Dr Woods and Dr Campbell

The patient shown in the photo is one of the worst repair cases I have ever seen. He had his first HT at 18, rows of plugs on his forehead. He went on to have 6 scalp reductions, thinning the back of his head so much that skin is clearly visible. I have moved a lot of his chest hair to his scalp, but he has limited amounts in this area. As a last resort, I have removed underarm hair, carefully removed the apocrine glands under high power magnification, and implanted only the follicles. We are going to watch these few grow, and if no foul smell results in 6 months, we will proceed further. All of his work is done free of charge,

Dr. Robert Jones

We use FIT to remove individual follicular groups from larger grafts. We have successfully used the technique to remove individual follicular groups from 5 mm plugs and slit mini-grafts. Often times the grafts are elevated (cobble stoned) and this process reduces the cobblestoned appearance of the grafts. FIT can also be combined with dermabrasion if elevated non-hair bearing areas remain but often the de-bulking accomplished by removing individual follicular groups and part of the raised areas is satisfactory by itself.

There is no reason to expect that FIT will not allow us to totally re-distribute all the follicular groups in larger grafts to achieve either a normal bald look, thin look, or fuller coverage look and essentially eliminate the pluggy look. The procedure is absolutely remarkable in this regard. We have outstanding photographs that document unbelievable overnight improvements.

Pitted grafts are far more difficult to excise.

We are moving chest, back, leg, axilla, and stomach hairs to multiple areas of the scalp including scars. We find that these hairs take longer to grow probably due to their longer resting phase and shorter anagen phase. We are hopeful that the cycle will re-set itself and produce a longer growing phase/shorter resting phase than it had when on the scalp.

There has recently been a cause for concern regarding the use of axilla hair. We believe this is concern has been over-dramatized. The cause for concern is the concern about odor. Odor results from bacteria, which are known to proliferate in warm, moist environments. They also are found if proper hygiene is not followed. Sebaceous glands are not apocrine glands, they are holocrine glands. They are generally found to drain into the infundibulum of the hair shaft and are typically, but not always associated with hairs. Sebum is an oily, fatty substance produced by sebaceous glands. Sweat glands are apocrine glands (technically they are better classified as eccrine or mericrine glands). Sweat by itself does not have an odor. if you create moisture and add bacteria, you will create odor. As long as you shampoo regularly the use of axilla hair should not create a problem with odor. We have long found that individuals who do not shampoo regularly have an odor to their scalp. Dr. rose transplanted about 25 axilla hairs to the scalp at the AEGEAN meeting in June 2003. 

The use of pure lateral slits is not aesthetically correct and is not natural. as Peter Mac states, it is more right than wrong though. We almost never use pure sagital slits and we almost never use completely lateral slits. The crown area will have hairs angled laterally or sagitally at times. Almost anywhere else on the normal scalp these angles do not exist. We angle the incisions so that the result is natural. this means the incision is somewhere between lateral and sagital, but it is closer to lateral than sagital generally. In short, our incisions are far more advanced and technically far more correct than a simple vertical or lateral incision.

John P. Cole, MD

DR Minotakis performed a pubic hair transplant two years ago and he published a paper in the HAIRTRANSPLANT FORUM . The result was satisfactory and the patient returned a year later for another session. Armpit session was performed June 6th 2003 during the AGEAN masters meeting. Only 100 grafts were performed. The patient was very pleased. The hair did not fall out and continue to grow from day one after the surgery. The healing was rapid. No odor problem reported. To remove body hair is a very exciting prospect and will help a good number of patients.

Mr. Giotis, Chairman of DHI