Follicular Transplantation Research Articles

Optimal Treatment for Post-Surgical Cicatricial Alopecia: Autologous Hair Transplantation?

Scarring alopecia significantly impacts patients' appearance and psychological well-being. Surgery is a common cause of scarring alopecia, making positive treatment crucial for patients' overall health. To investigate the clinical efficacy of autologous follicular unit extraction (FUE) transplantation for postoperative secondary stable scarring alopecia and evaluate its effectiveness. A retrospective descriptive study was conducted, including 14 patients with postoperative secondary scarring alopecia. All patients underwent initial autologous FUE hair transplantation, and postoperative complications were monitored. Patient satisfaction surveys were also conducted. Satisfaction assessments were performed for all 14 patients. Two patients (14.3%) reported being very satisfied, 6 patients expressed satisfaction (35.7%), 4 patients reported being somewhat satisfied (28.6%), and 3 patients were dissatisfied (21.4%). Aesthetic complications included low follicular density post-transplantation, uneven density, and unnatural appearance. Solely using a single FUE hair transplantation for treating postoperative secondary scarring alopecia has limited effectiveness and may not always meet expectations, potentially requiring multiple transplantations. Further research is necessary to guide and improve follicular transplantation survival rates to ensure surgical efficacy.

Reconstruction des sourcils par greffe folliculaire

The eyebrow is an aesthetic unit playing an important role in the balance and expression of the face. It consists of hairs whose different orientations make its complexity. The main causes of eyebrow alopecia are repeated eyebrow plucking, reduced density due to age, and post-traumatic alopecia. Follicular transplantation is a simple surgical technique that corrects most cases of eyebrow alopecia. This involves implanting hair follicles, taken from the scalp or, more rarely, from a hairy region of the body, into the bare or sparse area of the eyebrow.

Successfulness of Hair Follicular Transplantation for melanocytes activation in Vitiligo

Successfulness of Hair Follicular Transplantation for melanocytes activation in Vitiligo

Platelet‐rich plasma and follicular transplantation versus follicular transplantation alone in the treatment of refractory vitiligo: A comparative pilot study

Platelet‐rich plasma and follicular transplantation versus follicular transplantation alone in the treatment of refractory vitiligo: A comparative pilot study

Follicular Transplantation, Microneedling, and Adjuvant Narrow-band Ultraviolet-B Irradiation as Cost-Effective Regimens for Palmar-Plantar Vitiligo: A Pilot Study.

Treatment of refractory palmar-plantar vitiligo is particularly challenging because the skin in these regions has a limited supply of follicle-derived melanocytic stem cells. Autologous hair transplantation monotherapy is effective in some forms of vitiligo through the provision of melanocytic stem cells. CO2 laser followed by exposure to light (i.e., sunlight or narrow-band ultraviolet-B [nbUVB]) has independently shown to be an effective treatment strategy. Recently, it was found that the combination of hair transplantation and CO2 laser followed by nbUVB exposure had superior efficacy to either modality as monotherapy. Similar to CO2 laser, microneedling produces skin cell proliferation and releases pro-pigmentary cytokines. Given the important role of the cytokines in vitiliginous skin, microneedling may also be an effective therapeutic modality for refractory vitiligo. Herein, we conducted a pilot study to evaluate the efficacy of hair transplantation and CO2 laser or microneedling followed by nbUVB. Microneedling and fractional CO2 laser in combination with hair transplantation and nbUVB both demonstrated utility in the induction of repigmentation in refractory palmar-plantar vitiligo; however, a larger trial would be needed to determine a difference in treatment efficacy. Nonetheless, microneedling is cost-effective and requires minimal training; therefore, microneedling can be easily incorporated into standard dermatological practice.

Donor site of follicular unit excision hair transplantation: the relationship between appearance and actual hair density, and hair diameter

Donor site morbidity is an important consideration for follicular unit excision (FUE). We examined 103 male patients with adult androgenic alopecia. Patients were divided into three groups (Good, Fair, and Poor) based on visual assessment of the donor site. Hair density and hair diameter were measured using digital photography. A total of 72, 21 and 10 patients were classified into the Good, Fair and Poor appearance groups. The average hair density of each group was 127.8 ± 22.6 hair/cm2, 114.8 ± 23.1 hair/cm2 and 94.9 ± 25.4 hair/cm2. The hair density of the Good group was significantly higher than that of the Poor group (p = 0.003). The average hair diameter of each group was 0.0968 ± 0.0267 mm, 0.0754 ± 0.0299 mm and 0.0473 ± 0.0158 mm. The hair diameter of the Good group was significantly higher than that of the Poor group (p = 0.001). Thirty-three of 72 patients whose hair density was >130 hair/cm2 belonged to the Good group. Seven of 10 patients whose hair density was <105.0 hair/cm2 belonged to the Poor group, while 31 of 72 patients whose hair diameter was <0.101 mm were included in the Good group. Eight of 10 patients whose hair diameter was less than 0.070 mm were in the Poor group. Donor sites rated Good on appearance had both high hair density and thick hair diameter. To maintain a good appearance after FUE, donor site hair density should not be less than 105.0 hair/cm2.

Clinical outcomes and technical tips for eyebrow restoration using single‐follicular‐unit hair transplantation: A case series review

Clinical outcomes of eyebrow restoration with single-follicular-unit hair transplantation largely depend on the surgeon's anatomic knowledge, experience, and technical skills. To evaluate the effect of the reconstruction with single follicular unit transplantation on eyebrow loss and provide technical tips. A total of 352 patients with eyebrow loss were recruited. A template of the restoration region was modeled or specifically designed. The scalp strips from the back occipital or retro-auricular regions were harvested for single follicular unit hair. The follicles were transplanted by punching recipient area with 21-G syringe needle. Patients were followed up every 2months for 4years after surgery. Out of 352, 320 (91%) patients had their transplanted hair grow well with satisfactory direction and appearance. Seventeen patients (5%) experienced encryption transplantation of a sparse hair for the first 6months but felt satisfied afterward. Twelve (3%) patients did a simple make-up on the transplanted hair because there was an obvious difference between the transplanted hair and the natural one. Three (1%) patients with burned injury suffered of mild folliculitis and cured by 75% alcohol inunction. All patients had no obvious scar at the donor sites. Single follicular transplantation for eyebrow loss resulted in natural restorations with excellent satisfaction. The technique is simple, safe, and effective. The usage of syringe needle, microscope slide forceps, and a magnifier could implant the hair in a right angle, desired direction and depth, and increase the survival rate.

Hair transplantation in mice: Challenges and solutions.

Hair follicle cells contribute to wound healing, skin circulation, and skin diseases including skin cancer, and hair transplantation is a useful technique to study the participation of hair follicle cells in skin homeostasis and wound healing. Although hair follicle transplantation is a well-established human hair-restoration procedure, follicular transplantation techniques in animals have a number of shortcomings and have not been well described or optimized. To facilitate the study of follicular stem and progenitor cells and their interaction with surrounding skin, we have established a new murine transplantation model, similar to follicular unit transplantation in humans. Vibrissae from GFP transgenic mice were harvested, flip-side microdissected, and implanted individually into needle hole incisions in the back skin of immune-deficient nude mice. Grafts were evaluated histologically and the growth of transplanted vibrissae was observed. Transplanted follicles cycled spontaneously and newly formed hair shafts emerged from the skin after 2 weeks. Ninety percent of grafted vibrissae produced a hair shaft at 6 weeks. After pluck-induced follicle cycling, growth rates were equivalent to ungrafted vibrissae. Transplanted vibrissae with GFP-positive cells were easily identified in histological sections. We established a follicular vibrissa transplantation method that recapitulates human follicular unit transplantation. This method has several advantages over current protocols for animal hair transplantation. The method requires no suturing and minimizes the damage to donor follicles and recipient skin. Vibrissae are easier to microdissect and transplant than pelage follicles and, once transplanted, are readily distinguished from host pelage hair. This facilitates measurement of hair growth. Flip-side hair follicle microdissection precisely separates donor follicular tissue from interfollicular tissue and donor cells remain confined to hair follicles. This makes it possible to differentiate migration of hair follicle cells from interfollicular epidermis in lineage tracing wound experiments using genetically labeled donor follicles.

A Study of Hair Follicular Transplantation as a Treatment Option for Vitiligo.

Background:Repigmentation of vitiligo is closely related to hair follicles. Hence, replenishing melanocytes in vitiliginous patches utilizing undifferentiated stem cells of the hair follicles using follicular unit transplantation (FUT) is a possible treatment option.Objectives of the Study:To study the efficacy of FUT in cases of segmental/stabilized vitiligo as a treatment option for leukotrichia.Materials and Methods:Fifty patients with 63 lesions of stable vitiligo over nonglabrous areas were treated with follicular unit grafts. Reduction in the size of vitiligo patches as well as improvement in the associated leukotrichia were evaluated using subjective and objective assessments.Results:Of the 63 patches, good to excellent response was seen in 39 (61.9%), fair in 16 (25.4%), and poor in eight (12.7%) lesions. No repigmentation was seen in two (4.8%) lesions. The mean improvement seen was 61.17%. Excellent color match was observed in 44 lesions (69.8%). Repigmentation of the depigmented hairs occurred in 11 out of 46 patients with associated leukotrichia.Conclusion:FUT is a safe and effective method for treating localized and segmental vitiligo, especially on hairy parts of the skin. Though labor intensive, it was found to be associated with a quick patient recovery time, very low morbidity, and good color match.

A comparative study of the mini-punch grafting and hair follicle transplantation in the treatment of refractory and stable vitiligo

Some vitiligo lesions are resistant to all medical treatments. We sought to compare the efficacy of hair follicle transplantation and mini-punch grafting for the treatment of refractory vitiligo lesions. A total of 25 patients with stable and resistant vitiligo participated in the study. In each patient, a resistant vitiligo patch was divided into 2 equal parts. One part was treated with hair follicle transplantation and the other part with mini-punch grafting. Postsurgically, the recipient areas were exposed to narrowband ultraviolet B twice a week for 6 months. The diameter of the repigmentation around each graft was measured monthly. At the end of the sixth month, 68% of follicle grafts, and 72% of mini-punch grafts, had repigmentation. The mean diameter of repigmentation around follicle grafts was 5 ± 1.7 mm and aroundpunch grafts was 5.3±1.6 mm. There was no significant difference between the 2 groups statistically (P= .18). Small sample size and short time of follow-up are limitations. Because the results of the 2 methods are not statistically different and mini-punch grafting is much easier to do than follicular transplantation, we recommend mini-punch grafting to treat drug-resistant vitiligo.

Effect of intact follicle transplantation by punching with syringe needle on eyebrow defect

Objective To explore the effect of the transplantation of intact follicle by punching with syringe needle on defect eyebrow reconstruction.Methods Fifty-two patients with eyebrow defects due to burn,trauma,resection and inappropriate eyebrow trimming were recruited,35 with bilateral defects and 17 with unilateral defect.The scalps strips from the safe donor area or temporal region were taken and made into 1 to 2 cm long hair with intact follicle under 3 fold magnifier.The recipient area was punched with 21G or 22G syringe needle.Then the hair shaft was clamped with mi croforceps and the follicles were transplanted to the defective area.Results Folliculitis were found in two burn patients after the transplantation and cured by alcohol inunction.Hairs of the rest patients transplanted grew well.The direction and appearance were satisfied.The survival rate of hair was more than 90 ％.Conclusions It is feasible to restore the partial eyebrow defect by intact follicular transplantation by punching with syringe needle and clamping the hair shaft with microforceps. Key words: Hair; Transplantation; Eyebrow; Hair follicle

Single follicular unit transplantation reconstructs arrector pili muscle and nerve connections and restores functional hair follicle piloerection

The autologous transplantation of hair follicles that have been separated into single follicular units is an accepted treatment for androgenetic alopecia. Recent studies demonstrate that the multiple stem cell populations and surrounding cutaneous tissues coordinately regulate the hair follicle functions and skin homeostasis. Therefore, the critical issues for consideration regarding functional hair restoration therapy are reproduction the correct connectivity and cooperation with host cutaneous tissues, including the arrector pili muscle (APM) and nerve system. We report successful establishment of mouse single follicular transplantation model and autonomous restoration of transplanted hair follicle piloerection in mouse skin. Transplanted hair follicles were responsive to the neurotransmitter acetylcholine and formed proper connections with surrounding host tissues such as APM and nerve fibers, which in turn connect with not only the hair follicle bulge region but also the APM. These results demonstrate that the piloerection ability of transplanted hair follicles can be estimated quantitatively. This study makes a substantial contribution towards the development of transplantation therapy that will facilitate future functional regeneration therapy for skin and skin appendages.

Técnica actual del trasplante de pelo de unidades foliculares

Since 1959, when Norman Orentreich described the phenomenon of donor dominance in androgenic alopecia and opened the way to hair transplantation, the field of hair replacement surgery has been evolving continuously. Advances in the last 15 years, particularly the microscopic dissection of donor strips into follicular units, have eradicated the idea that follicular transplantation is an aggressive procedure that produces an artificial result. Hair transplantation procedures involving the transplant of only follicular units can now achieve natural, undetectable, and reproducible results, very different from the outcomes achieved with earlier techniques. Consequently, there is no excuse today for not offering hair transplantation to patients with androgenic alopecia, both male and female, who are good candidates for this technique. This review provides a general overview of the current procedure for follicular unit hair transplantation.

Follicular Transplantation for the Correction of Various Stigmas After Rhytidoplasty

I read with great interest the scientific article of Radwanski and colleagues on this important topic frequently not mentioned and often ignored in aesthetic plastic surgery. If we are honest with ourselves, we must admit that many patients with alopecia have stigmas related to rhytidoplasty (face-lifting procedures). We often see beautiful results after face-lifting procedures performed by reputable surgeons, with obvious hairline displacements and certainly no comments about it. The patient does not know any better, but we do, or we should! Rawdanski and colleagues report on 33 patients. According to their description, cephalic displacement of the sideburn, increased distance from the tail of the eyebrow to the temporal hairline, and step deformity of the retroauricular occipital hairline are the most common problems. The authors describe various techniques for the correction of the sideburns, primarily rotation flaps (including tissue expansion), and note that they all tend to leave scarring along the margin of the new hairline, resulting in additional hair growth in an unnatural direction. The authors use xilocaine with epinephrine to anesthetize the area locally. I prefer using 0.5% bipuvacaine (Marcaine) with epinephrine 1:200,000 for the initial infiltration. This approach offers comfort during the procedure and for a longer time postoperatively. I could not agree more that the use of follicular unit grafts currently provides the best correction results for all alopecia stigmas, without scars at the margin of the reconstructed hairline and with hair growth in a natural direction [1 5]. I also use conscious sedation and local anesthesia. I agree that this is the best approach for these and many other procedures in plastic surgery. The authors use 18and 19-gauge needles, which are a good choice. I have a personal preference for 22.5 Sharpoint blades or 1.5to 2-mm chisel blades (cut from Personna prep blades). They mention 20 to 30 follicular units/cm in the area grafted. This is a good rule of thumb per session. Often that will be sufficient for the sideburns, but it is not uncommon to do a second session for the more demanding patients. I tell the patients in advance that it may well take two sessions to get more optimal density so there are no surprises or disappointments. As the authors indicate, wide scars on the hairbearing scalp (e.g., on the temporal areas) tend to widen when revision is attempted by excision and closure alone, and I totally agree. Here, too, follicular unit grafting is the best approach. Wide donor scars and donor-site iatrogenic alopecias can be avoided by harvesting long but narrow horizontal strips from the occipital area. As a general rule, these strips will be less than 7 or 8 mm in the vertical dimension and as long as needed, and 5 to 15 cm in the horizontal length or more depending on the donor area hair density. In selected cases, wider strips can be used safely. Each patient is assessed individually. The only way that displacement of the hairline can be completely prevented cephalically and posteriorly with face-lifting procedures is by using a prehairline (pretrichial incision) meticulous closure to prevent detectable scarring. Depigmentation along the scar or unfavorable scaring can occur. When this happens, it can be camouflaged easily with follicular unit grafts. Correspondence to A. Barrera M.D.; email: abarrera@ lookinggood.com, http://www.lookinggood.com Aesth. Plast. Surg. 31:69 70, 2007 DOI: 10.1007/s00266-006-0198-1

Follicular Transplantation for the Correction of Various Stigmas After Rhytidoplasty

Rhytidoplasty may cause permanent and unwanted stigmas, such as dislocation of the temporal and cervical hairline. Widened scars inside the hairline may cause considerable social embarrassment. Furthermore, pretrichial incisions, even if well placed, may widen or become hypochromic, thus revealing that an aesthetic procedure has been performed. Various procedures for the correction of these undesirable telltale signs of a face-lift have been published. This report aims to present the results of correction for postrhytidoplasty stigmas using follicular transplantation. Patient assessment is discussed, and relevant technical aspects are detailed and illustrated. A prospective study at the Ivo Pitanguy Clinic investigated patients who underwent hair transplantation to correct unaesthetic signs secondary to rhytidoplasty from January 2001 to December 2004. The aesthetic results and complications were evaluated, as well as the patients' satisfaction rate. The patients presented in this series either were referred from another service or had their rhytidoplasty originally performed in the authors' service. A total of 33 female patients were included in this study. Two patients were lost to follow-up evaluation and not included. The complications were minor. In the late follow-up assessment, 24 patients classified the result as excellent, 4 as satisfactory, and 3 as unsatisfactory. Only the patients who classified the results as unsatisfactory requested a second procedure (i.e., another follicular transplantation). When performed by an experienced surgical team, the follicular unit transplantation technique is a simple, safe, and efficient way to correct stigmas secondary to a rhytidoplasty, such as a visible scar or a displaced hairline, with satisfactory results and a very low complication rate.

The distribution of follicular units in the Chinese scalp: implications for reconstruction of natural-appearing hairlines in Orientals.

Follicular transplantation using hair in its naturally occurring groups, called follicular units (FUs), has become the most popular technique in hair restoration surgery. Recently follicular transplantation was performed with a qualitative and quantitative concept to achieve the best clinical result. The characteristics and distribution of FUs are well studied in Caucasians and widely applied in hair transplantation surgery. In order to understand the normal distribution of FUs in the Chinese scalp, we counted the number of hairs and FUs in normal Chinese scalp to provide general information for surgical planning and design in bald Chinese patients. A total of 50 normal and 50 bald Chinese adults were enrolled to count the hairs on their scalp. One hundred bald patients receiving hairline reconstruction were also prospectively quantitatively evaluated. In normal Chinese scalp, an average 71.78 FUs/cm(2) and 137.08 hairs/cm(2) were calculated with a follicular density of 1.91 hairs/FU. Two-hair FUs are the predominate group (50.29%). In bald patients, an average of 68.07 FUs/cm(2) was found, which was less than that of the occipital scalp in normal nonbald patients. In reconstruction of the frontal hairline, a total of 700-1000 FUs were implanted with an average density of 30 FUs/cm(2). We found the average number of FUs (0.72 FU/mm(2)) was less than that in Caucasian patients (1 FU/mm(2)). The average density of 30 FUs/cm(2) implanted was suitable to reconstruct a natural frontal hairline in bald Chinese patients, which can achieve about 40% of normal hair density. Our results could provide the hair surgeon with general information about hair distribution on the Chinese scalp for surgical planning and design in their patients.

Dispelling the myth of the required high hairline in follicular unit hair transplantation.

Hair restoration surgeons have historically taught that the hairline should be placed high on men undergoing hair restoration surgery. To evaluate the position of the anterior-most aspect of the frontal forelock on men experiencing type III-V male pattern baldness. Twenty men, ages 20-46 years, with type III-V male pattern baldness were evaluated for the distances between the chin to nose, nose to eyebrows, and eyebrows to frontal forelock. The mean distance from chin to nose was 6.96 cm. The mean distance from nose to eyebrows was 6.55 cm. The mean distance from eyebrows to hairline was 6.8 cm. The distance from chin to hairline was 20.3 cm. Therefore the eyebrows to hairline distance was 33.4% of the whole. When using follicular transplantation, it may be appropriate at times to divide the face into thirds at the time of hairline development.

THERAPEUTIC APPROACHES TO THE MANAGEMENT OF COMMON BALDNESS

SUMMARYCommon baldness or androgenetic alopecia is a universal problem, having affected both sexes of all races to different extents for as long as mankind has existed. The progressive androgen dependent hair loss follows specific patterns and is a physiological process, which may take on disease quality due to psychosocial compontents. These should be taken into consideration when discussing the several treatment options available, particularly as a cure cannot be offered. Cosmetic measures range from back‐combing over perms to hairpieces and wigs. Medical therapies include systemic antiandrogens and topical minoxidil; surgical options comprise follicular transplantation, scalp reduction and rotation. Before starting treatment, however, careful consideration should be given to the differential diagnosis which includes drug‐induced hair thinning, anagen effluvium, diffuse alopecia areata, metabolic disturbances, nutritional deficiencies and acute as well as chronic telogen effluvium.

Follicular Unit Transplantation

</br>![][1]</img> You will note the new name for follicular transplantation. I think this is a more accurate and less confusing name for follicular transplantation. It came about through the efforts of Bob Bernstein, MD, and others while trying to reach a consensus on a new classification and

Follicular Transplantations

</br>![][1]</img> It has been approximately one year since I commenced follicular transplantation and I can confidently say that I feel the results I am seeing are far superior to the work we did previously. The grafts seem to grow better and give a more natural appearance. It is hard to believe