Follicular Unit Transplantation Research Articles

Strip Harvesting Follicular Unit Transplantation Versus Follicular Unit Excision: Comparing the Number of Hairs and the Ratio of Hairs to Follicular Unit.

There are 2 extraction techniques for follicular units (FUs) in hair transplantation: strip harvesting follicular unit transplantation (FUT) and follicular unit excision (FUE). Currently, no extant studies have demonstrated that one technique is superior in extraction and donor area optimization for a dense result. This study compares the FUT and FUE techniques by evaluating the percentage of FUs with 3 or more hairs and the hairs-to-follicular-unit ratio in patients who underwent both procedures at different times. The medical records of patients who underwent at least 1 FUT procedure and at least 1 FUE procedure (with this being the second surgical procedure) were reviewed. The surgeries were performed in the same clinic with the same surgeon and surgical team. There was a higher percentage of FUs with 3 or more hairs and a higher hairs-to-follicular-unit ratio with the FUE technique than with the FUT technique. In FUE, surgeons tend to choose better-looking FUs with thick, plentiful hairs. Even with these results, it is impossible to declare one procedure superior because the correct indication considers multiple factors.

Androgenetic Alopecia: update on Etiology, Pathophysiology, Diagnosis and Treatment

Alopecia means loss of hair. Androgenetic alopecia (AGA) now called as patterned hair loss (male pattern hair loss; MPHL, female pattern hair loss; FPHL) is caused by androgens in a predisposed individual. It is modulated by factors like age, sex, genes, smoking, and alcohol. If untreated this leads to psychological problems like stress, anxiety, depression and decrease self-confidence which affect quality of life. A thorough clinical examination and a certain hormonal estimation could reveal levels of androgens, hyperandrogenism, adrenal hyperplasia, (PCOS) polycystic ovarian syndrome, and ovarian/adrenal tumors. A simple Trichoscopy could show the typical picture of hair miniaturization commonly seen in this condition. Finally, a biopsy of the scalp could help in clinching conclusive diagnosis. Out of the many treatments at our disposal, the non-pharmacologic methods like temporary camouflage techniques, synthetic hair wigs, hair-thickening fibers, hair weaving, pigmented powders are useful. Semi-permanent options like scalp micro-pigmentation (thorough tattooing) are useful to enhance appearances. Presently the United States Food and Drug Administration (USFDA) approved pharmacologic treatments are Minoxidil and Finasteride. The non-USFDA approved methods of treatments like various surgical procedures {[hair transplantation]: follicular unit transplantation (FUT), follicular unit extraction (FUE), microneedling, light therapy, indigenous medicines, Platelet-Rich Plasma (PRP)}, and various loco-regional hair care practices are in vogue. The outcome of this review is to offer the latest update and insights into the newer novel therapies in patterned hair loss. Also, the patients could enhance their knowledge about the condition, the benefits and prognosis of each treatment.

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.

Patient Selection for Follicular Unit Extraction versus Linear Strip Donor Harvesting.

Follicular unit grafts can be harvested using two methods: strip follicular unit transplantation and follicular unit excision. Each method can generate outstanding results, but both are uniquely different with respect to the advantages and disadvantages they offer. Devising a sound surgical plan is instrumental to assure that a patient's short-term and long-term goals can be met, but creating the best plan possible for the graft harvest process is not straightforward. This paper will review the various advantages and disadvantages of each graft harvest method, along with their short-term and long-term ramifications, so as to provide insight into the process by which a sound surgical plan can be developed for any patient seeking surgical hair restoration.

Application of Autologous Hair Transplantation Technique in Children with Cicatricial Alopecia.

Cicatricial alopecia not only affects the appearance of children's heads and faces but also their mental health in the long term. This study aims to explore the therapeutic characteristics and clinical effects of autologous hair transplantation technology in children with cicatricial alopecia. Children in our department who received autologous hair transplantation technology for cicatricial baldness of the scalp from February 2019 to October 2022 were collected. Their basic information was analyzed, and postoperative follow-up was conducted, including calculation of hair follicle survival rate, hair growth, complications, and an efficacy satisfaction survey given to the children's family members. Thirteen children were included in this study (10 males and 3 females), aged from 4years 1month to 12years 10months, with an average age of 7years 5months. Two hundred to 2500 hair follicular units were extracted, with an average recipient area of 22.7 cm2, an average hair follicle unit density of 55.3 ± 9.1 per cm2, and an average hair/follicular unit (hair/FU) ratio of 1.75 ± 0.07. Thirteen children in this group were followed up for 6-12months with the following treatment options: FUE (follicular unit extraction, 9 cases), FUT (follicular unit transplantation, 3 cases), and FUT combined with FUE (1 case). The average hair survival rate was 85.3%. Except for one child with temporary folliculitis, there were no complications. The GAIS score is divided into five levels: complete improvement (2 cases), obvious improvement (10 cases), partial improvement (1 case), no improvement (0 cases), and deterioration (0 cases). The patient satisfaction results included very satisfied (2 cases), mostly satisfied (10 cases), and dissatisfied (1 case). Autologous hair transplantation technology is a safe and effective method for children with cicatricial alopecia.

Follicular unit extraction megasession treatment of high-grade androgenetic alopecia in Asians: Introducing novel principles for surgical design.

Male androgenetic alopecia (MAGA) has been one of the most common reasons for hair consultation, which affects more than half of men under the age of 50. Recently, follicular unit extraction (FUE) megasession has been an attractive treatment option for patients with severe AGA. However, compared with hair transplant surgery by traditional FUE or follicular unit transplantation (FUT), a megasession lacks a suitable surgical design solution for Asian high-grade AGA patients. Therefore, we introduced novel principles for surgical design into FUE megasession for Asians. The goal was to investigate the naturalness of hair, patient and doctor satisfaction level, and safety assessment of FUE megasession with the specific surgical design, to explore a novel technique for an efficient, satisfactory, and safe FUE megasession procedure. Thirty-six Asian male patients with AGA in Hamilton Grade V-VI were enrolled in the research. All participants underwent FUE megasession treatment with the specific surgical design. The investigators observed the patients' general conditions, surgical information, naturalness of hair, and patient and doctor satisfaction level and adverse reactions. Before surgery, the average age of patients was 36.8 ± 9.6 years, and average duration of disease was 8.3 ± 3.8 years. During surgery, we harvested an average of 3705 ± 383 grafts. Recipient density ranged from 30 FUs/cm2 to 50 FUs/cm2 , and the total operation time was 10.6 ± 0.9 h. After surgery, patient-rated Likert score for naturalness of hair was as high as 4.72, and the doctor rated 4.61. Patient satisfaction score was up to 4.64, and the doctor scored 4.75. No serious side effects occurred in the study. FUE megasession with the introduced surgical design is a satisfactory treatment option for patients with high-grade AGA in Asians, with few side effects. The application of the novel design method can effectively lead to relatively natural density and appearance in one operation. Due to its remarkable effect, high satisfaction level, and few postoperative complications, FUE megasession with the introduced surgical design has great potential for Asian high-grade AGA patients.

Free Information about Follicular Unit Transplantation

Free Information about Follicular Unit Transplantation

A Scalp Scar-Reducing Procedure for the Hair Transplant Donor Area Using a Columnar Trichophytic Suture: A Case Report

One of the main concerns of patients who undergo hair transplantation surgery such as follicular unit strip surgery is scar widening on surgical sites. Until now, trichophytic suture, double-layer suture, tattoos, follicular unit transplantation on scars are suggested as a solution. A 23-year-old man with frontal hair loss underwent follicular unit strip surgery. To reduce hair donor area scarring, we tried a new trichophytic suture method. After surgery, the patient's hair loss degree was corrected with about C1 in the basic and specific (BASP) classification. Also, there was less scar in the columnar trichophytic suture part, compared with almost 7 mm of scar widening in the simple primary closure part. This study highlights that a columnar trichophytic suture may be useful for patients undergoing scalp surgery for cosmetic purposes.

A Novel Method of Intraoperative Calculation in Follicular Unit Transplantation: 'The Sequential Strip and FUE Method'.

Hair loss, in particular androgenetic alopecia, has troubled humans since the dawn of history. Treatment options for hair restoration have undergone massive transformation from punch grafting to follicular unit transplantation. Current surgical treatment options in hair restoration fall broadly under two categories, follicular unit transplantation most commonly known as strip method and follicular unit extraction (FUE). The strip method though widely used initiallyis not so common now due to its fair share of disadvantages ranging from linear donor scar, scar widening to strip overharvesting and wastage of grafts. Follicular unit excision (FUE) was introduced as an alternative method for extraction of grafts to combat the donor linear scar produced by strip method but the disadvantages of FUE include the number of grafts harvested in a single session, moth eaten appearance of donor area caused by over extraction of graftsand harvesting from outside the safe zone. Newer developments like extraction of axillary hair, body hair and pubic hair have been sought to overcome the limitations of number of grafts harvested in a single session of FUE. With more patients now affected by alopecia in their early 20s, there is an ever-increasing demand from the patients for the youthful hairline and hence the focus has shifted towards mega and giga sessions of hair transplantation which pose danger of over extraction of grafts leading to depletion of available donor sites. This article elaborates the combined sequential strip and FUE method along with an intraoperative calculation model to overcome the limitations of over extraction and wastage of grafts. (1) Combination of techniques Strip method with FUE. (2) An intraoperative calculation model that aids in limiting over extraction and wastage of grafts. (3) It is a real time model which can be applied in practice with ease.Level of Evidence IV 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 .

Hair Transplantation by Follicular Unit Extraction in Cicatricial Alopecia in Children

Cicatricial alopecias in children do not contribute to substantial pediatric consultations as they are relatively uncommon. Cicatricial alopecias are often missed in pediatric population as it is diagnostically and therapeutically challenging. No single treatment is usually effective and hence several off label treatments are used in children and adolescents with unknown safety and efficacy. Hair loss due to scarring may thus have a significant impact on the emotional well-being of young patients and diminishes the quality of life which often requires additional treatment. Traditional surgical treatments for cicatricial alopecia include excision, scar reduction, tissue expansion, scalp flap, and follicular unit transplantation. However, these procedures often result in unsightly scarring or unfavorable hair growth direction. Recently, hair grafting by follicular unit extraction (FUE) has now replaced the strip technique as it is minimally invasive, well-tolerated, and effective treatment for use in children and adolescents. However, use of this technique is limited in young patients. The article presents a comprehensive review of an effective surgical technique, i.e., FUE for the management of burnt-out inactive cicatricial alopecia in pediatric population. For the purpose of review, a PubMed search was done using keywords, “cicatricial alopecia,” “hair transplantation,” and “children.” All the articles were retrieved, and the final data were then analyzed and presented in a narrative fashion.

The “Punching-Out” Technique to Reduce the FUT Scar

<h3>Abstract</h3> A widened scar from a previous strip-removal procedure (follicular unit transplant) is a commonly encountered complaint from patients coming in for a second hair restoration surgery. Options for addressing widened scars have included surgical scar revision, transplanting the scar with follicular units, and scalp micropigmentation. The authors present a new approach, where the scar may be thinned with a punching-out technique followed by resuturing the area. Advantages of the technique include that the time spent on this procedure is usually less than 10-15 minutes, it utilizes skills and equipment that most hair restoration surgeons already have, and it also does not use additional precious follicular units. Our experience using this technique in 58 patients showed improved appearance of the scar.

Inflammatory complications after hair transplantation: Report of 10 cases.

Androgenetic alopecia (AGA) is a pathology involving the aesthetic prognosis. Hair transplantation is among best treatments. The principle of hair micro-grafts during AGA consists in taking hair from the non-androgen-dependent occipital area to transplant them with their root in the sparse androgen-dependent areas. Herein, we report 10 cases of the different types of post-transplant inflammatory complications. We included patients referred to our center by their dermatologists or hair transplant surgeons for inflammatory cicatricial alopecia or hair loss observed after the hair transplant. Ten patients (eight men and two women) were included. These patients represented 0.08% of all consultations in our center. The indication for hair transplantation was AGA in all of our patients. The technique used for the transplant was follicular unit extraction (FUE) in seven cases and follicular unit transplantation (FUT) strip in three cases. None of the patients had pathology of the scalp or an inflammatory dermatosis before the operation. The inflammatory complications found were lichen planopilaris (LPP) in seven cases, erosive pustulosis of the scalp (EPS) in two cases, and superficial folliculitis (SF) in 1 case. Our series highlight the rarity of inflammatory complications that occur after a hair transplant. We demonstrate through this work that a hair transplant can trigger inflammatory pathology a few months after the act. We show also, the importance of detecting the rough forms of lichen before an intervention, hence the interest of the systematic dermatoscopic examination during the preoperative consultation.

Clinical and dermoscopic evaluation of follicular unit transplantation vs. Mini-Punch grafting in the repigmentation of resistant and stable vitiligo: A comparative study.

Various surgical modalities and transplantation techniques had been evolved for the treatment of recalcitrant stable vitiligo. Each of these techniques has its own limitations and side effects. There are insufficient studies evaluating the efficacy of transplantation of hair follicle (HF) units as a surgical modality for vitiligo treatment in comparison with the classic mini-punch grafting. To compare the efficacy and safety of follicular unit transplantation (FUT) with mini-punch grafting (mPG) in cases of resistant and stable vitiligo. Twenty-five patients with stable vitiligo were included. Treated areas were classified into 2 groups: group I: Areas were treated with the FUT technique and group II: Areas were treated with mPG technique. Treated areas were exposed to narrowband ultraviolet B phototherapy for 6months. After 3months, follow-up patients' response was evaluated clinically and by dermoscopy. Both techniques showed efficacy in repigmentation of stable vitiligo. Group II showed a statistically significant higher percentage of repigmentation and significant earlier repigmentation than group I. Cobblestone-like appearance was the major complication in group II, while no serious side effect was reported in group I. Leukotrichia was present in 8 patients, and 6 of them showed hair repigmentation evidently in group I. Both techniques are effective, safe, and inexpensive methods of surgical repigmentation of stable localized/segmental vitiligo. mPG gives earlier and better percent of repigmentation, with higher incidence of cobblestoning. FUT is a good alternative for mPG, especially in hairy areas with better cosmetic outcome and minimal complications.

Hair transplantation-sustainably planned and performed by the physician

Microsurgical autologous hair transplantation, when performed as follicular unit transplantation, may permanently and naturally improve advanced androgenetic alopecia in men and women and also non-active scarring alopecias. Sufficient donor hair and realistic patient expectations as well as an individual surgical planning of the hair distribution are crucial prerequisites for asustainable hair restoration. They should be determined and evaluated during apersonal pre-examination and consultation with the hair surgeon. Natural results can be achieved by transplanting up to several thousands of follicular units with high densities into small micro-slits. This technique also allows for increasing the hair density without injuring surrounding original pre-existing hairs. In progressive, early or advanced androgenetic alopecia, additional medical therapy is highly recommended to stabilize the condition. Otherwise, depending on supply and demand of donor hair, only apartial hair restoration can be achieved with asatisfying density. Since hair transplantation requires aprecise sequence of surgical steps and careful handling of the tiny grafts, the skills and experience of the hair surgeon and his or her team are crucial. The medical risks of an assembly-line way of performing this surgery by non-licensed, non-physician staff, as reported from national clinics and medical tourism, should not be underestimated. The German Association of Hair Surgeons and the International Society of Hair Restoration Surgery offer patient information, as well as continuous medical education and guidelines for interested physicians to ensure the highest quality standard of care.

Treatment of scarring alopecia in children using follicular unit hair transplantation.

Scarring alopecia can significantly affect children emotionally. Follicular unit excision (FUE) and follicular unit transplantation (FUT) have been applied for scar treatment. This study aimed to evaluate the safety and feasibility of follicular unit hair transplantation in treating scarring alopecia in children. A total of nine children (sevenmales and two females) with cicatricial alopecia, ranging in age from 5years, 2months to 12years, 10months were included in this study. Scar formation time ranged from 7months to 5years. Sites were vertex (2), eyebrow (3), frontal hairline (3), and temporal regions (2). Nine children in this group were followed up for 6-34months with the following treatment options: FUE (5 cases), FUT (3 cases), and FUT combined with FUE (1 case). No significant complications were observed during the treatment. The transplanted hair grew well, the direction and shape were satisfactory, and the survival rate was >90%. For children with burn trauma and cicatricial alopecia after surgery, hair transplantation can significantly improve their appearance with low surgical risk and high patient satisfaction rate.

Beard and Moustache Reconstruction.

Beard and moustache reconstruction has gained more popularity and acceptance over the last decade. The procedure is done for the correction of facial areas with hair density deficit and also for the cosmetic enhancement of pre-existing facial hair. The surgical technique includes the harvesting of grafts from the scalp by the follicular unit excision (FUE) or follicular unit transplantation (FUT) technique and then placing them in either premade slits or by stick and place method. The advancement and refinement of procedure over the years has aided in achieving the optimal aesthetic results, with minimal side effects.

Hair Transplant with Strip Harvest: Indications, Contraindications, and Technique.

The evolutionary process of modern hair transplantation began with the plug era and, transitioning through a period of minigrafting and micrografting, finally led to follicular unit transplantation (FUT). Apart from the expansion of donor:recipient ratio, this technique produces an excellent esthetic result, indistinguishable from the natural hair. The merit of strip harvest lies in the maximum amount of follicular unit harvest, minimizing the amount of hair follicle transection, and producing a single scar, irrespective of number of sessions. This article summarizes the prerequisites, indications, contraindications, and technique of strip harvest.

Head and Neck Restoration in Scar Alopecia: Hair Transplantation in Scalp, Eyebrows, Beard and Mustache.

BACKGROUNDSurgical management of hair loss has become an increasingly challenging procedure, when dealing with scar alopecia. We investigated the efficacy of hair transplantation in patients with head and neck scar alopecia.METHODSFrom 2016 to 2018 in Shiraz, Iran, all patients with scar alopecia in head and neck were evaluated for efficacy of follicular unit extraction (FUE), follicular unit transplantation (FUT) or a combination of two methods from donor sites in scalp and beard various hair-grafts were compared. RESULTSFifty-six patients were enrolled. Most of them were between 31 and 40 yr old (48.3%) and male (71.4%). Trauma, burn, surgical excision of adjacent skin, radiotherapy and leishmaniasis were the registered causes. Scars were visible in scalp (39.3%), beard (28.6%), eyebrow (21.4%), and moustache (10.7%) regions. FUE (87.5%), FUT (10.7%) and a combination (1.8%) were the used methods. One-hair-grafts were used in eyebrows (100%), moustache (100%), beard (88%) and scalp (7.9%), while 2-hair-grafts in beard (6%) and scalp (47.4%) and 3-haired grafts in beard (6%) and scalp (44.7%) transplantations. CONCLUSIONIn head and neck scar alopecia, hair transplantation was selected based on type and depth of scar. FUE was targeted when huge grafts were not needed, including beard, moustache, and eyebrow, while FIT was used when extensive scars were present in scalp. One-hair-grafts were mostly applied for eyebrow, moustache and beard, 2-hair- and 3-hair- grafts for beard and scalp transplantation. These findings can be added to the literature when FUE, FIT, or their combination are targeted in hair restoration of scar alopecia in head and neck.

Meeting Review: Review of the St Louis University 360 Workshop, July 23-24, 2021 • St. Louis, Missouri

![Figure][1]</img> The course started with practical anatomy training for both follicular unit transplantation (FUT) (strip surgery) and follicular unit excision (FUE). Dr. Steven Gabel presented a pictorial and well-organized presentation on scalp anatomy for beginners, which also highlighted key

New Donor Excision Design for Better Hair Alignment in Hair Restoration Surgery.

The linear scar and misalignment of hair follicles are disadvantages of the follicular unit transplantation (FUT) or strip technique. The most common misalignment is at the end of the strip. Although most surgeons try to match hair direction to achieve optimal hair alignment, their attempts are often unsuccessful. We aimed to assess strip designs to improve hair alignment during hair transplantation. We conducted a retrospective study of 157 patients who underwent hair transplantation with either the commonly used elliptical incision or our novel triangular flag-shaped designed incision on the donor strip tip. Two blind evaluators assessed the outcome of hair alignment using a 5-point visual analog scale. In total, 303 wounds on 157 patients were assessed. Overall, our triangular flag-shaped design (TFD) achieved better hair alignment than the common elliptical design (CED) (p=0.01). Patients with hair direction straight on the upper wound edge and hair direction inward on the lower wound edge showed improved outcomes with TFD, whereas patients with hair direction inward on both upper and lower wound edges showed better outcomes with CED. The TFD tip of donor strips achieved proper hair alignment for most hair transplant patients. 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 .