Meet Dr. Sharon Keene

As follicular unit grafting revolutionized the hair restoration surgery field due to its ability to achieve cosmetically pleasing results, Dr. Keene was aware of the need to improve the ergonomics and efficiency of instrumentation to facilitate the efficiency of performing mega-sessions. Grafting sessions had transitioned from hundreds of grafts to thousands of grafts, and completing surgery in a reasonable amount of time was advantageous for both doctors and patients. To that end, Dr. Keene contributed several innovations to improve ergonomics and efficiency in the field:

• • In 2002 she conceived and designed the first mult-blade recipient site scalpel, depth controlled to prevent damage to underlying blood vessels and to assure appropriate depth for a particular graft size; variably interdigitated to prevent the appearance of rows, and overall intended to improve the efficiency of recipient site creation;
    To facilitate ergonomic graft dissection Dr. Keene introduced the use of videoscopes, which allows this task to occur without bending over a dissecting microscope, and also allows visible monitoring of graft dissection as it occurs.

  • When researchers documented the critical importance of graft hydration for graft survival, Dr. Keene invented the first finger mounted graft reservoir to store grafts in solution on the surgery field in order to maintain graft hydration during graft placement, her specific reservoir has 4 separate compartments to separate graft sizes, and rotates to present the graft size preferred for a given area. It is a tool she continues to use in her surgery today. Many others copied this innovation in various forms, often using a single reservoir, but recognizing the value of such a tool to maintaining graft hydration for improved graft survival.

  • Similarly, Dr. Keene presented the advantage of creating hydrating dissecting stations, which lead to medical device companies to mass produce similar devices which helped hair restoration surgeons maintain graft survival.

  • Dr. Keene studied the role of the androgen receptor gene for medication response, and a particular genetic variant to predict response to finasteride in women. The same variant in a Japanese study had been shown to correlate with finasteride response in men. Subsequent studies performed in the hair research community established the value of finasteride for hair loss treatment in some women.
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  • When topical minoxidil was approved by the FDA for hair loss therapy, most doctors and patients were unaware that it was a prodrug that needed to be converted to its active form by the presence of an enzyme (sulfotransferase) which was present in sufficient amount in only about half of the population. Currently patients must commit to months of regular application to assess for a response, and many will do this with no response. Research performed by Dr. Keene helped establish that this enzyme and a response could be predicted by plucked hair follicles, however, to date there is not yet an available method to predict minoxidil response prior to using it.

Hair Line Design & Placement

Based on feedback from her own patient population, Dr. Keene became aware of the lack of scientific evidence to support many of the hair line “rules” for design (4 finger breadths above the glabella—who’s 4 fingers? 8 cm for everyone—does this apply the same to every shape face? Rule of 3rds—does this occur in nature for everyone? No.), as well as the lack of scientific support for an “age appropriate” hair line. Her patients shared their stories of family members, such as uncles or grandfathers, who were not affected by androgenetic alopecia (AGA) and who carried the same hair line they had as a young man well into their 80’s or older. 

These stories along with various observed examples in history support the lack of a standard “age appropriate” hair line, examples include several US presidents who had their natural hair lines well into old age, before hair restoration surgery was popular. In 2007 Dr. Keene co sponsored a survey of men over age 55 with no personal or family history of hair loss to record the various hair line shapes and elevations to establish the lack of age related hair line recession in men who are unaffected by AGA. While this survey was presented at the ISHRS annual meeting in 2007, unfortunately the findings were never submitted for publication so not all surgeons may have realized this for themselves. However, does this finding mean that every man can have the hair line they had when they were in their 20’s? 

Donor availability and especially donor limitations for advanced pattern hair loss remain a factor. Not every patient should try to achieve a more youthful hair line if their goal is some level of coverage to a larger area of the posterior scalp. The nuances of hair line design and placement is an important conversation to have with the doctor, but Dr. Keene’s survey was instrumental to helping her design natural hair lines even in advanced patterns of hair loss.