Hair transplantation for male pattern baldness: aesthetic considerations and current status.

The multiple punch technique of hair transplantation, utilizing the principle of donor dominance, has proven to be a cosmetically acceptable procedure in properly selected patients in the presenter's 24-year experience. Careful planning with attention to aesthetic principles, especially in frontal hairline placement, in donor site selection and with regard to the ratio between the donor supply and the existing or potential future extent of baldness, together with meticulous surgical technique, are essential for satisfactory results. Scalp reduction, in which bald areas of crown and midscalp are serially excised, with extensive subgaleal undermining is a highly useful adjunct to grafting in many patients with moderately extensive male pattern baldness who have adequate scalp mobility by enabling the available donor supply to be concentrated and thus provide more effective coverage in the frontal scalp.