Follicular Unit Extraction Technique Research Articles

Hair Transplant Follicular Unit Extraction Technique as a Current Treatment Option for Androgenetic Alopecia

The therapy for androgenetic alopecia currently varies, and there is no generally efficacious form of treatment. Despite receiving therapy, a portion of individuals with alopecia still do not achieve the anticipated hair regrowth outcomes. The absence of efficacious medical intervention typically necessitates the exploration of alternative therapy modalities. A significant number of patients who do not get satisfactory results from medical treatment explore other therapeutic approaches, such as hair transplantation. Advancements in hair transplantation procedures have seen substantial progress since the 1960s. Men frequently seek hair transplantation, making it a popular cosmetic treatment. Over 11,000 operations took place in the United States in 2014. Commonly practiced contemporary hair transplant procedures include follicular unit transplantation (FUT) and follicular unit extraction (FUE). The FUE technique is gaining popularity due to its non-invasive nature, quicker recovery time, reduced post-operative discomfort, and fewer surgical scars, in contrast to the FUT approach.

Hair follicle extraction combined with an expanded scalp flap for facial organ reconstruction

Use of scalp skin for facial organ reconstruction represents a mainstream procedure for organ reconstruction. In most cases, adequate amounts of skin can be obtained by using tissue expanders, but harvesting sufficient scalp tissue in patients with low hairlines is challenging. Hair follicular unit extraction (FUE) is one approach to resolve this problem. With FUE, hair follicles are removed from the scalp skin, which can then be prepared as a donor site to obtain sufficient amounts of hairless skin. To evaluate the safety and efficacy of FUE when combined with an expanded scalp flap for facial organ reconstruction. Patients with low hairlines requiring facial organ reconstruction were selected for this study. The area of skin extension and hair removal were determined prior to surgery, a process which was performed in three stages. Stage I consisted of hair follicle removal using the FUE technique at the donor site. Stage II involved expander implantation using water injections. In Stage III facial organ reconstruction was completed. With the use of the FUE technique, hair follicles from the donor scalp were thoroughly removed and the donor scalp tissue was successfully expanded. Postoperatively, no evident scar formation at the reconstruction site or contracture of the expanded flap was observed. All patients were satisfied with the outcome of their reconstruction procedure. FUE provides a means for hair follicle removal from the donor site and can be employed to achieve a safe and effective procedure for facial reconstruction in patients with low hairlines.

Adjuvant measures and genetic evaluations to improve results of hair transplantation

Follicular unit extraction (FUE) has evolved dramatically as the most recent advancement in surgical hair restoration as it leaves a tiny scar and creates natural and pleasing results. This study aims to show the effectiveness of adjuvant measures and genetic evaluations in improving outcomes. Prospective analysis of 271 male patients with androgenic alopecia who underwent hair transplantation with FUE technique between August 2015 and February 2020 at our center was conducted. The mean age was 35.93 ±4.40 years. At one year postoperatively, patients were asked to fill up a questionnaire which included their satisfaction level, need for 2nd session, and complications. Informed written consent was obtained from all patients. Also, blood samples were provided from patients before the operation. RNA extraction and cDNA synthesis were performed using the RNX-Plus kit (Cinnagen, Iran) and Vivantis kit (Malaysia). Amplification of SRD5A2 and GAPDH genes (as internal standard) for measuring gene expression was performed by real-time PCR. Data were analyzed using the statistical package for social science SPSS V. 23. In the last 156 cases, the addition of 40 mg of Triamcinolone to the LA solution led to a dramatic reduction of the incidence of postoperative oedema, from 40% to 9%. Adding three sessions of PRP at 2nd, 4th and 6th months postoperatively resulted in an increased patient satisfaction rate with better hair density and thickness where the rate of highly satisfied patients increased from 64.5% to 83.7%. The addition of 40 mg Triamcinolone to the LA solution was highly effective in reducing postoperative oedema. Three sessions of PRP at 2nd, 4th and 6th months postoperatively were recommended. The results of SRD5A2 gene expression showed that the expression of this gene in satisfied (P = 0.049) and dissatisfied (P = 0.028) patients were significantly higher than highly satisfied patients, which means that the SRD5A2 gene expression had an essential role in the successfulness of hair transplantation. The increased expression of this gene could reduce the response to hair transplantation.

Previous fat grafting and hair transplantation using the FUE technique on scalp scars: Update

We developed a narrative literature review on the association of fat grafting and hair transplantation using the Follicular Unit Extraction (FUE) technique in scalp scars. Data were collected from studies found in Medline, Lilacs, and IBECS databases. Bibliographical records of several authors who researched mesenchymal cells in adipose tissue were cited, describing the techniques used. The conclusion was that the two-stage hair transplantation technique, with previous fat transplantation, is effective, according to the reviewed articles.

Cicatricial eyebrow restoration using the follicular unit extraction technique.

Cicatricial eyebrow loss that occurs after trauma or burns considerably reduces a person's self-confidence. Several methods, either surgical or nonsurgical, have been defined to reconstruct eyebrows. This study focused on eyebrow restoration using the atraumatic follicular unit extraction (FUE) technique in patients and emphasized certain details that should be considered during the treatment process. In this study, we discussed the management of 18 cases using this technique and their outcomes with respect to published literature. This study examined eyebrow restoration performed using a modified FUE technique in 18 patients who had cicatricial eyebrow loss due to trauma, excised congenital giant nevus, or burns. Moreover, special methods, including platelet-rich plasma, microneedling, steroid injections, and fat grafting, were used in each patient to increase the odds of graft survival. Aesthetically and functionally satisfactory outcomes were observed along with the appropriate orientation and symmetry of the eyebrows in all patients' follow-ups. Moreover, patients exhibited increased self-confidence, and the quality of skin, particularly in the transplantation area, was improved. There was no complication either in the recipient or in the donor site. Eyebrow restoration using the atraumatic FUE technique should be considered as the first treatment option in cases with cicatricial eyebrow loss as long as an appropriate evaluation and treatment method is followed for each patient.

An innovative application of follicular unit extraction technique in the treatment of bromhidrosis

Surgery is the most effective way to treat bromhidrosis, but postoperative complications are still the biggest obstacles for patients to choose surgical treatment. To introduce an innovative application of follicular unit extraction (FUE) in the treatment of bromhidrosis. We conducted a case series study on 20 patients who received FUE technique for the treatment of bromhidrosis. The axillary hair follicles were extracted with a one-millimetre punch. The released hair follicles were collected for histological examination. After the operation, the wounds were wrapped with moderate pressure. The dressing was removed 24h after the FUE operation. The postoperative complications were collected, and the improvement of malodour was evaluated by the 10-point visual analogue scale. Immediately postoperation, many needle-shaped holes appeared in the armpits. The holes healed 7days after the operation, with no scar or pinpoint-like scars. Except for a female who complained of mild pain in the left armpit, no other patients had any discomfort. The malodour level varied between 0 and 4 during the follow-up period. The tissue examination showed that more than 90% of the completely plucked hair follicles were accompanied by apocrine glands, and many blocked and dilated apocrine glands were observed. The lumens of the blocked glands were filled with decapitation products, which were positive for K5, Brst-2 and CEA. Patients with bromhidrosis have a positive response to FUE technique. The FUE technique is well-tolerated, with only a few postoperative complications, which deserves to be widely promoted.

Hair Transplantation in Burn Scar Alopecia After Combined Non-Ablative Fractional Laser and Microfat Graft Treatment.

Burn scar and alopecia on hair-bearing areas can severely affect the social life of patients. Unlike healthy skin, poor biological and mechanical properties of scar tissue in the recipient area can reduce the survival rate of hair graft following hair transplantation. The authors sought to determine if combined non-ablative fractional laser (NAFL) and microfat injection could improve the survival rate of hair grafts on post burn scar. Thirteen patients with alopecia resulting from burn scar in hair-bearing areas of the scalp and face were treated with combined NAFL and microfat graft and subsequent follicular unit extraction hair transplantation. Cicatricial alopecia occurred on the scalp, eyebrow, mustache, and beard areas. Patients were treated with 3 to 6 sessions of NAFL and 2 to 5 sessions of microfat graft injections, followed by 1 session of hair transplantation employing the follicular unit extraction technique. Hair transplantation was successfully performed with good to excellent results. The survival rate of transplanted follicular units ranged from 76% to 95% (mean, 85.04%), and the density success rate per square centimeter ranged from 76.9% to 95.2% (mean, 84.54%). All patients expressed high satisfaction with the results and no complication was encountered. Hair transplantation, after combined NAFL and microfat injection, is a promising treatment for post burn alopecia.

Efficacy of topical calcipotriol betamethasone dipropionate as a new adjuvant therapy to follicular unit extraction technique in treatment of stable vitiligo: clinical, dermoscopic and immunohistological study.

Follicular unit extraction (FUE) grafting is a surgical procedure which provides the vitiliginous patches with undifferentiated stem cells of the hair follicles. It has been postulated that adjuvant therapy enhances the results. This is the first study to assess two different adjuvant therapies vs FUE alone. To study the efficiency of FUE alone or combined with either topical calcipotriol betamethasone dipropionate (CBD) or NB-UVB phototherapy in cases of nonsegmental stable vitiligo. To assess the role of dermoscopy in monitoring the pattern and degree of repigmentation. 53 patients with 94 lesions with stable nonsegmental vitiligo were divided into three groups. Group 1 (n=16) with 30 lesions received FUE alone. Group 2 (n=18) with 32 lesions received FUE plus topical CBD. Group 3 (n=19) with 32 lesions received FUE plus NB-UVB phototherapy. Assessment was done by grades of repigmentation, color match, percent of size reduction, and immunohistochemical evaluation of perilesional CD8+T lymphocytes. The fastest onset of repigmentation was observed in both groups 2 and 3 in the second week (16.7%, 10.5%, respectively).Group 2 achieved the best response by all methods of assessment. Perifollicular diffuse repigmentation was the commonest dermoscopic pattern in 60 lesions (63.8%). There was a statistically significant decrease in perilesional CD8+T lymphocytes after 4months. FUE is an effective method of surgical treatment of stable vitiligo, and topical CBD as a new adjuvant therapy is successful in targeting the immunological background of vitiligo. Dermoscopy has an essential role in monitoring the repigmentation response.

Assessment The Role Of Platelet Rich Plasma In Follicular Unit Extraction Hair Transplantation

Background: Hair transplant surgery using follicular unit extraction technique (FUE) is a common surgical procedure for the treatment of severe hair loss; this study aimed to study the effect of Platelet-rich plasma and assess its role in follicular unit extraction hair transplantation. Material and Methods: A prospective randomized controlled study was conducted among 40 patients suffering from alopecia and candidate for follicular unit extraction (FUE) hair transplantation, with age between 25 years and 60 years in group androgenic alopecia; with no age limitation in cicatricial alopecia. Results: Functional and aesthetic outcomes were achieved from adding PRP regimen to follicular unit extraction hair transplantation mainly in cases presented to us with post cicatricial alopecia. The improvement noticed in early recovery time & increase in density, with no statistical difference in patients presented to us with androgenic alopecia. Conclusion: PRP therapy after hair transplantation is beneficial in giving faster density with the reduction in recovery period post cicatricial alopecia, with no benefit in FUE hair transplantation in cases with androgenic alopecia.

Outcome of Follicular Unit Extraction in Cicatricial Alopecia

Background: Cicatricial alopecia is a group of disordersthat destroy hair follicles which are replaced with fibrosis,causing permanent hair loss. Cicatricial alopecias are subdividedinto two groups “primary” and “secondary”. For managementof 2ry cases, there are different strategies whichdiffer with the location, size and other scarred area characteristics.These strategies include certain surgical proceduressuch as excision, flap surgery, use of tissue expansion, andhair transplantation that gained popularity as a permanentmethod for restoring hair loss. In cicatricial alopecia cases,hair transplant is considered challenging because of thedegenerative changes and decreased vascularity of these areasthat may produce a lower survival rate of donor hair.Aim of Study: This study aimed to evaluate the role ofPRP and nanofat injections together with follicular unitextraction technique in restoration of hair in secondary cicatricialalopecia.Material and Methods: This study was conducted on 30patients with secondary cicatricial alopecia. Patients weredivided into 3 groups, 10 patients in each. Group A: ReceivedPRP with hair transplantation, group B: Received nanofatinjections with hair transplantation, while in group C (Controlgroup) patients underwent hair transplantation only.Results: Although adding PRP or nanofat injections withhair transplantation procedure provides an excellent improvementin the texture and quality of the scarred tissues comparedto other cases underwent without, there were no significantdifferences in the clinical outcomes of hair restoration includinghair growth density.

"Combination Grafting" of Scalp and Body Hair to Enhance the Visual Density of Hair Transplant and Coverage of Higher Grade of Baldness.

Hair transplant is becoming the most common cosmetic procedure across the world with demand for higher density and coverage of baldness. This needs more number of donor hair follicles. Scalp donor has limitations to fulfill the required number of follicles for Norwood Grade VI and VII baldness. The body hair follicles can be used to cover up the deficit.The objective of this study was to observe the use of body hair follicles to increase the visual density and for better coverage for higher grades of baldness as an adjuvant to scalp hair follicles.Materials and Methods:A total of 16 patients were evaluated for the availability of body donor hair, and consent for body hair harvesting was obtained from them. The beard was the first preference and then chest and abdomen hair follicles were used in combination with scalp hair follicles to cover bald area of Norwood grade IV and above baldness. Body hairs were harvested using follicular unit extraction (FUE) technique. Postoperative pictures were taken, and patient satisfaction, doctor’s observation, and global photographic evaluation was carried out.Observations:The patient’s photographs were taken after 4, 8, and 12 months of hair transplant. The results were analyzed on the basis of global photography. The use of body hair with scalp has enhanced the visual density, leaving to better coverage in even higher grades of baldness.

A Systematic Review of Outcomes and Patient Satisfaction Following Surgical and Non-surgical Treatments for Hair Loss.

This systematic review aims to examine surgical and non-surgical treatments and identify those procedures that are most effective in terms of patient satisfaction. A systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. The search was conducted in accordance with the PRISMA guidelines, the Cochrane handbook. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, and Cochrane databases was performed to identify studies on hair loss causes and hair loss treatment with different surgical and non-surgical techniques RESULTS: Our search generated a total of 781 articles; 646 studies were excluded based on the content of the abstracts, and an additional 105 studies were excluded based on the content of the complete article. We performed a review of the 30 remaining studies, which had sufficient data for inclusion, and met all the aforementioned inclusion criteria. Of the 30 studies, four were about minoxidil, four about finasteride, two about dutasteride, three about phototherapy, six about platelet-rich plasma injection, four about follicular unit transplantation technique, six about follicular unit extraction technique, and one about patient satisfaction following surgical treatment without a specified surgical technique. Only three studies used a patient-reported outcome measurement. Our study is the first comprehensive systematic review of hair loss, looking at the problem from different points of view, and focusing on finding the best solution for the patient. In the literature, there is currently no algorithm for the management of patients who go to a plastic surgeon for a solution to the problem of hair loss. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Follicular Unit Extraction (FUE) Hair Transplant: Curves Ahead.

The hair transplant has become widely popular aesthetic procedure. Follicular unit transplantation (FUT) and follicular unit extraction (FUE) are two commonly used and accepted techniques. FUT requires excision of strip of tissue from occipital donor area leading to linear scar. To overcome scarring and other complications of FUT, FUE technique has been attempted which involves harvesting of small individual follicular units. Hair transplantation has been successfully used in correction of alopecia, cleft lip scars, post-burn or surgical scars, vitiligo and as an adjuvant to other maxillofacial procedures. FUE demands greater skills and orientation but can yield excellent results in experienced hands. Several maxillofacial surgeons have incorporated hair transplantation procedure in their aesthetic practice successfully. Sound knowledge of surgical technique, armamentarium and proper surgical planning are essential for desired results. The aim of this article is to explain FUE technique, risk and complications, holding solutions and other associated factors in detail. A simple protocol has been put forth for reference and for better understanding of the technique.

Isolation and Characterization of a Fetal-Maternal Microchimeric Stem Cell Population in Maternal Hair Follicles Long after Parturition.

Fetal-maternal microchimerism describes the acquisition of fetal stem cells (FSC) by the mother during pregnancy and their long-term persistence after parturition. FSC may engraft in a variety of maternal tissues especially if there is organ/tissue injury, but their role and mechanism of persistence still remains elusive. Clinical applications due to their pluripotency, immunomodulatory effects and accessibility make them good candidates for ex-vivo manipulation and autologous therapies. The hair follicles contain a distinctive niche for pluripotent stem cells (PSC). To date, there is no published evidence of fetal microchimerism in the hair follicle. In our study, follicular unit extraction (FUE) technique allowed easy stem cell cultures to be obtained while simple hair follicle removal by pull-out technique failed to generate stem cells in culture. We identified microchimeric fetal stem cells within the primitive population of maternal stem cells isolated from the hair follicles with typical mesenchymal phenotype, expression of PSC genes and differentiation potential towards osteocytes, adypocites and chondrocytes. This is the first study to isolate fetal microchimeric stem cells in adult human hair long after parturition. We presume a sanctuary partition mechanism with PSC of the mother deposited during early embryogenesis could explain their long-term persistence.

Alopecia and techniques in hair restoration: an overview for the cosmetic surgeon.

Alopecia is a debilitating disorder affecting millions of individuals worldwide. Although challenging to treat, advances in hair restoration technologies have led to multiple viable options with excellent clinical results. This paper seeks to provide an overview of hair loss and the currently utilized techniques in hair transplantation in order to serve as a reference source for the facial plastic surgeon. A comprehensive review of recent literature regarding the evaluation of, and management modalities for, alopecia was performed. The follicular unit extraction technique and the strip harvest technique are both widely used for patients desiring transplantation. While both techniques can lead to successful outcomes, each has pros and cons that are important to understand prior to engaging in the procedure. Advancements in hair restoration technologies implementing robotics, manual, or motorized follicular unit extraction have facilitated optimization of outcomes. Adjuvant treatment modalities including robotics and platelet-rich plasma injections have shown utility in augmenting transplantation.

Pubic Hair Restorative Surgery Using Grafts Harvested by the Nonshaven Follicular Unit Extraction Technique.

Pubic atrichosis or hypotrichosis is quite common among Korean women. Although Korean people are increasingly opening up to Western culture, pubic hair transplantation is still pursued for cultural reasons. However, many hesitate to undergo restorative surgery because follicular unit strip surgery would leave a linear donor scar, preventing patients from hiding their surgical history. Thus, follicle harvesting using nonshaven follicular unit extraction (NS-FUE), aside from many other strengths, is very useful when performing pubic restorative surgery. There has been no previous report concerning the effectiveness of NS-FUE for treating pubic atrichosis or hypotrichosis. To investigate the effectiveness of NS-FUE when performing pubic restorative surgery. The 50 patients who were included in the study underwent pubic hair restoration using NS-FUE between March 2014 and June 2016 at Dana Plastic Surgery Clinic (Seoul, Korea), and were followed for at least 10 months afterward. Patients and the surgeon completed a survey about donor and recipient site surgical results using a 5-point Likert scale. The average satisfaction scores of patients and surgeon were 4.5 and 4.6, respectively. Nonshaven follicular unit extraction is one of the most effective harvesting methods when performing restorative surgery for patients with pubic atrichosis or hypotrichosis.

Follicular unit extraction technique in treating stable vitiligo with leukotrichia

Background: There are several surgical modalities to repigment vitiligo patches, and follicular unit extraction (FUE) is one among them. This procedure is based on the concept of the presence of undifferentiated stem cells in the hair follicle which are a very good source of melanocytes. These melanocytes spread to the surrounding skin and repigment the epidermis. Materials and Methods: Three cases with few lesions of stable vitiligo over nonglabrous areas were treated with follicular unit grafts using the FUE method. Repigmentation in the vitiligo patches was assessed by subjective analysis. Results: Repigmentation was noticeable in all cases with an average duration of 3 weeks. Almost complete repigmentation was seen in all cases with an average duration of 7.3 weeks. Conclusion: FUE appears to be an effective method in treating vitiligo patches with leukotrichia.

Moustache restoration using follicular unit extraction technique for esthetic repair of prolabial alopecia in adult male patients with repaired bilateral cleft lip: An initial report in eight patients

Prolabial alopecia is an inherent feature of bilateral cleft lip cases, occurring in varying degrees which is worsened following cleft lip repair. In the Southeast Asian population, a strong healthy moustache is considered a symbol of pride and hence many patients seek treatment of their alopetic prolabium due to the cleft lip. The alopetic prolabium also adds to the patients dented confidence by adding to the typical cleft lip look. Among the two techniques mentioned in the literature for hair restoration, namely, follicular unit extraction (FUE) and follicular unit transplantation techniques, the FUE technique offers a minimally invasive and virtually scar less option and is often preferred by most of the patients as well as the surgeons. A very few studies have focused on moustache restoration in adult male patients presenting with prolabial alopecia following bilateral cleft lip repair. This article presents the initial report in 8 adult male patients presenting with prolabial alopecia after repaired bilateral cleft lip that underwent moustache restoration using the FUE technique of hair restoration.

Hair transplant FUE (Follicular Unit Extraction) technique

Hair transplant FUE (Follicular Unit Extraction) technique

The effect of plasma rich in growth factors combined with follicular unit extraction surgery for the treatment of hair loss: A pilot study.

Hair transplant surgery using follicular unit extraction technique (FUE) is a common surgical procedure for the treatment of severe hair loss. Blood-derived autologous growth factors have also proved to promote hair regeneration in patients with different types of alopecia. The aim of this study was to evaluate the safety and clinical efficacy of plasma rich in growth factors (PRGF) technology as an adjuvant therapy for FUE surgery in hair loss affected patients. The biologic potential of PRGF was firstly invitro evaluated over follicular germinal matrix and dermal papilla cells. Afterward, fifteen patients were subjected to routine FUE procedure while 15 patients underwent FUE+PRGF therapy. PRGF group included intradermal injections of growth factors and follicular transfer unit (FTU) preservation in an autologous fibrin clot. Postsurgical patient satisfaction and clinical improvement were evaluated, and PRGF or saline-preserved hair grafts were histomorphometrically analyzed. Follicular cell proliferation and migration was induced after autologous growth factors treatment. PRGF-preserved FTUs presented higher bioactivity signals and improved integrity of perifollicular structures and extracellular matrix proteins such as collagen and elastic fibers. PRGF not only reduced the postsurgical crust healing and hair fixation period, but also decreased the inflammatory pain and itching sensation. This preliminary data demonstrate that PRGF is able to minimize the postsurgical follicle loss and potentiate the performance of grafted hairs. The fibrin clot not only acts as a protective barrier against environmental factors, but also provides a biologically active scaffold that induces resident cell proliferation and maintains an optimal integrity of the grafted hair.