Follicular Unit Research Articles

Hair transplantation Follicular Unit Excision (FUE): Introducing the multipurpose octagonal ring punch.

The technique of follicular unit excision for harvesting grafts for hair transplantation procedures has become very popular. This technique relies on the use of small punches to remove viable grafts. Many different punch shapes have been developed to accommodate the varying nature of skin and hair characteristics, resulting in hair transplant surgeons requiring a variety of punches to suit a wide range of patients, which can be overwhelming to the beginner when trying to decide on the optimal choice of a punch to suit a particular skin characteristic. We describe a novel multipurpose ring punch that can be used on patients with a variety of skin and hair characteristics, as well as for shaved and long hair FUE. Features of this punch include an octagonal ring that protrudes from the outer wall of the punch and functions to control the punch's trajectory into the deeper dermis during incision. Additionally, this punch has a dull, notched edge which allows for use in long hair and shaved FUE without sacrificing ease of incision through the epidermis. This punch is the first of its kind to have this breadth of versatility with a one-size-fits-all design.

Eyebrow Transplantation Using Long Hair Follicular Unit Excision Technique.

Background:Long hair follicular unit excision (LHF) allows surgeons to fully visualize hair curliness, which is crucial in eyebrow transplantation where matching curliness is a matter of utmost importance. In this study, we aimed to evaluate the clinical importance of LHF in eyebrow transplantation.Methods:A total of 36 patients who had undergone eyebrow transplantation surgery with LHF were enrolled. Twelve of the 36 patients had previously undergone unsatisfactory surgery at another clinic. Of these, 2 patients underwent complete laser eyebrow removal, and 3 patients underwent selective electro-cautery with unmatched hair curliness before surgery. The remaining 7 patients underwent surgery to increase eyebrow hair density or to reshape their eyebrows. A satisfaction survey was administered to patients > 6 months after the procedure.Results:All patients showed natural eyebrow transplant results at their follow-up visits and were satisfied with the results. Patient and surgeon satisfaction scores were 4.7 and 4.3, respectively. Four patients underwent a touch-up procedure to increase hair density with 21, 43, 12, and 45 follicular units, respectively, and were satisfied with the results. There were no cases of asymmetry or adverse events, such as folliculitis.Conclusions:The authors derived satisfactory results from the patients who underwent eyebrow transplantation by the LHF method. Therefore, we conclude that LHF is a suitable surgical method for eyebrow hair transplantation.

Long hair follicular unit excision: personal experience.

BackgroundLong hair follicular unit excision (FUE) is the most state‐of‐the‐art surgical technique in the field of hair transplantation surgery. Long hair FUE reduces the signs of surgery by camouflaging the recipient area with long hair, and allows hair curl identification when placing grafts. In addition, donor area shaving can be omitted.MethodsThis article presents the surgical approach and methods of long hair FUE. Patients were categorized by sex, age, recipient site, purpose of the surgery, and history of previous hair transplantation. Medical charts and photographs were reviewed to obtain the transection rate and calculated density for each patient.ResultsLong hair FUE was applied to 134 patients (112 women and 22 men). Thirty‐four patients received eyebrow hair transplantation, 73 underwent female hairline correction surgery, nine patients underwent sideburn reconstruction, two were treated for female pattern hair loss, and 19 were treated for male pattern baldness (MPB). Four of the patients with MPB also underwent eyebrow transplant surgery. Of the patients with MPB, 17 (89%) had Norwood type III baldness, and two (11%) had type IV hair loss. The mean number of grafts required was 292 for eyebrow transplantation, 1,214 for female hairline correction, 251 for sideburn reconstruction, 1,344 for female pattern hair loss, and 1,567 for MPB. The mean follicle transection rate was 9.2%, and the mean calculated number of follicles per graft achieved was 2.23.ConclusionThis long hair FUE method introduced by the authors is an excellent surgical method when performed by surgeons with sufficient skill and expertise.

Clinical application and curative effect observation of follicular unit extraction and transplantation in the treatment of cicatricial alopecia

Objective: To observe the clinical effect of treatment with follicular unit extraction (FUE) and transplantation in treating cicatricial alopecia. Methods: The retrospective cohort study was conducted. From January 2012 to January 2018, 56 patients (36 males and 20 females, aged (25±9) years, 1% to 30% alopecia area of the whole scalp area) who met the inclusion criteria visited the outpatient department of the First Affiliated Hospital of Xi'an Medical University. They were treated with FUE transplantation. The procedure of treatment was performed through the preoperative planning, follicular extraction, follicular preparation, punching recipient site and hair transplantation. The survival rate of hair and density of survived hair were calculated, hair growth and complication were observed. The evaluation was conducted through questionnaire survey by 4 levels: very satisfied, satisfied, not satisfied, and not at all satisfied with effects. Results: After a follow-up of 9 to 24 months, the survival rate of hair in 56 patients was (70±9)%, and the density of survived hair was (35±8) roots/cm2. In the evaluation of the curative effect after the first stage surgery, 34 cases (60.7%) were very satisfied, 16 cases (28.6%) were satisfied, and 6 cases (10.7%)thought the treatment was effective but not satisfied. Six unsatisfactory patients and 16 satisfactory patients underwent the second-stage transplantation, with 19 (86.4%) of them being very satisfied and 3 cases (13.6%) satisfied after the second-stage operation. None of the patients underwent the third-stage surgery. The transplanted hairs grew naturally, and there were no serious complications in all cases. Conclusions: FUE transplantation can effectively treat and improve cicatricial alopecia with less trauma, fewer complication, no scar in the donor site and rapid post-operative recovery, so it is worthy of clinical promotion.

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.

Low‐Level Light Therapy Downregulates Scalp Inflammatory Biomarkers in Men With Androgenetic Alopecia and Boosts Minoxidil 2% to Bring a Sustainable Hair Regrowth Activity

Background and ObjectivesLow‐level light therapies using visible to infrared light are known to activate several cellular functions, such as adenosine triphosphate and nitric oxide synthesis. However, few clinical observations report its biological consequences for skin and scalp homeostasis. Since scalp inflammation was recognized as a potential physiological obstacle to the efficacy of the reference hair regrowth drug Minoxidil in vivo and since perifollicular inflammation is the hallmark of about 50%–70% follicular units in androgenetic alopecia, we decided to investigate whether the anti‐inflammatory activity of LLLT/GentleWaves® device were assigned to L'Oréal by Light BioScience L.L.C., Virginia Beach, VA (US) could enhance hair regrowth activity of Minoxidil.Study Design/Materials and MethodsWe conducted a first experimental clinical study on 64 men with androgenetic alopecia using LLLT/GentleWaves®, 590‐nm predominant wavelength 70 seconds, specifically pulsed once per day, for 3 days, and we performed a whole‐genome analysis of treated scalp biopsies. In a second clinical study, including 135 alopecic volunteers, we evaluated the hair regrowth activity in response to the upgraded LLLT/GentleWaves® device and Minoxidil.ResultsIn the first clinical study, whole‐genome analysis of treated scalp biopsies showed downregulation of scalp inflammatory biomarkers, such as AP1/FOSB messenger RNA (mRNA) and mir21, together with the disappearance of CD69 mRNA, specific to scalp‐infiltrating T cells of about 50% of the studied volunteers prior to the LLLT/GentleWaves® treatment. In the second clinical study, we observed that LLLT/GentleWaves® was able to boost the hair regrowth activity of a Minoxidil 2% lotion to the extent of the highest concentration (5%) in terms of efficacy, number of responders, and perceived performance.ConclusionsAltogether, these observations suggest the potential benefit of LLLT/GentleWaves® as a noninvasive adjunctive technology for skin and scalp conditions, where a mild perifollicular inflammation is involved. Lasers Surg. Med. 2021. Copyright © 2021 Wiley Periodicals LLC

New Strategies for Using Grafts Harvested from Outside the Safe Zone

In contemporary hair restoration practice, harvesting grafts outside of the traditional safe donor zone has become commonplace. This occurs because of the need to avoid overharvesting, to homogenize the appearance of the donor, and to obtain the maximal lifetime donor grafts with follicular unit excision (FUE). In the majority of practices, grafts harvested from outside the safe zone are not treated any differently than those harvested from inside the safe zone, despite being more likely to be dihydrotestosterone (DHT) sensitive and to not survive as long as those from inside the safe zone when transplanted.¹ The author proposes several strategies to intentionally place grafts harvested from outside the safe zone that optimize the utility of these grafts and minimize potential problems created by their use.

Effect of Controlled Breathing on Pain Tolerance during Local Anesthesia at Donor Site in Hair Transplant Strip Surgery—A Preliminary Study

<h3>Introduction:</h3> Pain during administration of local anesthesia during donor strip surgery in follicular unit transplantation (FUT) can cause discomfort for the patient. Controlled breathing, as a component of various relaxation techniques, has been shown to have a beneficial effect in acute pain tolerance. <h3>Objective:</h3> This study evaluates the relevance of controlled breathing as a technique to enhance pain tolerance throughout the administration of local anesthesia during donor strip excision in hair transplantation. <h3>Methods:</h3> A prospective, comparative study was undertaken between two groups of 30 patients each undergoing hair transplantation by strip FUT technique under local anesthesia (LA). One group was trained to use controlled breathing prior to surgery and during administration of local anesthesia at the donor site. The other group used routine breathing and was used as the control. Pain tolerance was measured subjectively using Visual Analog Score (VAS) for pain and objectively using the Objective Pain Comfort Score (OPCS). In addition, pulse and blood pressure were monitored. The results were compared and analyzed statistically. <h3>Results:</h3> The mean changes of VAS and OPC pain scores and vital parameters, such as pulse, in response to acute pain were significantly reduced in the test group, which used controlled and relaxed breathing, compared to the control group. However, there was no significant difference in blood pressure measurements between the two groups. <h3>Conclusion:</h3> Our study suggests that controlled breathing prior to hair transplantation and during LA injection at the donor site results in better pain perception and tolerance and, therefore, greater patient comfort. Patients can easily be taught to practice controlled breathing. Additional studies using larger groups of patients are needed to establish the routine role of this modality in pain management during hair transplantation.

New Motorized Handpiece to Improve Follicular Unit Excision

Graft harvesting by follicular unit excision (FUE) is usually performed using motorized handpieces. However, when the punch is introduced into the scalp, the trimmed graft can get blocked inside of the punch. This typically requires using forceps to manually dislodge the graft from the punch. This delicate manipulation takes time and risks damaging the follicle. This article describes a new device developed by the author that makes it possible to overcome these drawbacks.

Comparative study of follicular unit yield in elliptical versus trapezoid donor strip in hair transplantation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Hair transplantation is a surgical method of management of hair loss. The classical method involves harvesting an elliptical strip from the donor area and dissection follicular units, which are then implanted into the recipient area. A modification of elliptical strip is trapezoid strip, where the ends are tapered to a trapezoid to reduce the transection of follicles.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 12 male patients with androgenetic alopecia undergoing hair transplantation by strip method were included in the study. One cm strip was harvested from the donor area in all the patients. One end of the strip was designed elliptical and the other end was trapezoid. The ends were dissected and follicular grafts were counted.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The trapezoid end of strip yielded more follicular units in 10 out of 12 cases (83.3%), one was equal and in one case the elliptical end had a greater yield.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Transection of follicular units in the ends of donor strip can be minimized by 30-40% by harvesting a trapezoid strip. The grafts harvested were 28.3% more in the trapezoid end of the strip than the elliptical end.&lt;/p&gt;

Prevalence of Obstructive Sleep Apnea in Orthodontic Patients with Different Skeletal Classes Using STOP-BANG Questionnaire: An Observational Study

AIM: The aim of the study was to determine the prevalence of obstructive sleep apnea (OSA) in orthodontic adult patients with different skeletal classes and no pathology in the airway as detected from the lateral cephalometric radiographs using the STOP-BANG questionnaire. METHODS: The sample comprised 309 subjects (152 males and 157 females) collected from the Egyptian population presented to the orthodontic follicular unit extraction for treatment. The sample was divided into three groups based on the anteroposterior relationship between maxilla and mandible (ANB angle) as evident from pretreatment lateral cephalometric. Patients were asked to fill out general medical history, sign a consent form, and fill in the STOP-BANG questionnaire. Patient’s neck size and height were measured using tape measuring tool and weighing scale, respectively. Body mass index (BMI) was obtained. After submission of the questionnaire, scores were measured for each patient to evaluate the severity of OSA. RESULTS: Comparison between OSA risk in the three classes showed no statistically significant difference (p = 0.791, effect size = 0.052). CONCLUSIONS: STOP-BANG questionnaire showed that there was no statistically significant difference in the prevalence of OSA between different skeletal classes.

History of follicular unit excision.

History of follicular unit excision.

Corrective strategies for poor appearance after tissue expansion for temporal and sideburn cicatricial alopecia.

The expanded scalps are usually used to repair the scalp defects. However, hair growth direction and hair density of the expanded scalps may be inconsistent with those of the defective sites, resulting in unsatisfactory results. The aim of this study was to assess the effect of local flap modification and follicular unit extraction (FUE) on the repair of poor appearance of temporal and sideburn after unsatisfactory tissue expansion. In our study, 19 patients with problems of hair growth direction or hair density after surgery were treated with the following four methods: single local flap modification; removal of hair follicles by FUE to reduce follicle density; removal of disordered hair follicles by FUE and ectopic transplantation simultaneously; and removal of hair follicles by FUE and ectopic transplantation after local flap modification. The follow-up periods of 19 patients varied from 6 to 30months, and natural, standardized aesthetic sideburn for each patient was achieved. All incisions healed by first intention and all flaps survived well. The scars involved in the removal of FUE hair follicles were not obvious. Our results revealed that the ideal and cosmetic results can be obtained by flexible using of local flap modification, single FUE method, and FUE ectopic hair transplantation to repair the dissatisfied postoperative outcomes of temporal and sideburn cicatricial alopecia after tissue expansion.

Treatment of scarring alopecia from trauma and surgical procedures in young patients using follicular unit hair transplantation

Hair loss due to scarring as a consequence of surgical procedures and trauma can impact young patients socially and emotionally. Recently follicular unit extraction (FUE) hair transplantation has been applied to scar treatment. This report included four patients with scarring alopecia. All patients were female with a mean age of 12.5years. Previous operations that caused scarring were sebaceous nevus excision with direct closure (n=2), an extensive burn scar treated using an expander (n=1) and cauterization for a congenital pigmented nevus (n=1). The average size of the affected area was 10.5cm2 . The FUE transplantation procedure was performed under local anesthesia. The number of grafts was set at approximately 25-30 grafts/ cm2 of scar. An electronic punch with a diameter of 0.8mm was used for graft harvesting, and a 0.6-mm electronic punch was used to make cylindrical holes on recipient site. The donor sites were shaved followed by graft harvesting in two cases. For the other two cases, harvesting was done without shaving. The number of transplanted grafts was 60 to 600 (mean 288), and surgical time was 38 to 220minutes (mean 108). The average dose of lidocaine was 1.4mg/kg. The average survival rate of the grafts was 85%. Our experience in these cases suggests that this technique may be a viable option for the treatment of certain causes of scarring alopecia in the pediatric age group.

Female Pattern Hair Loss: Why the Follicular Unit Transplantation Surgical Technique Remains a Good Option.

Female pattern hair loss is a common nonscarring alopecia that can present with several patterns of decreased hair density. The condition is very bothersome to affected women, and although there are multiple nonsurgical options, surgical follicular unit transplantation remains one of the most effective options. A retrospective chart review was performed of the senior author's (C.O.U.) experience and technique of follicular unit transplantation for treatment of female pattern hair loss. A total of 751 patients with female pattern hair loss underwent follicular unit transplantation over the past 31 years. Average patient age was 48 years. Patients with small areas of hair loss made up 40 percent of the group (Ludwig stage I), those with medium-sized areas constituted 45 percent (Ludwig stage II), and those with large areas constituted 15 percent (Ludwig stage III). The average operative time was 3 hours 21 minutes. One hundred thirty-five patients (18 percent) underwent a second replacement, at an average period of 4 years after the procedure, because of the progressive nature of female pattern hair loss. Complications included donor-site scar widening in six patients and folliculitis in 17 patients. Follicular unit transplantation is an excellent option for treatment of female pattern hair loss patients, as there is no need to shave the recipient sites, operative times are shorter than for follicular unit excision techniques, and the incidence of complications is very low. Therapeutic, IV.

BEARD-A Potential Donor Site in Grade 6 and Grade 7 Alopecia: A Case Series.

Autologous hair transplantation has been the convention in cases of androgenic alopecia. Routinely, the occipital area serves as an ideal donor site. The advent of follicular unit extraction (FUE) has made body and beard hair harvest a possibility. Beard hair, in particular, has been far more sought after than other parts of the body. A case series of 20 patients have been documented wherein cases with Grade 6 and 7 androgenic alopecia have been treated with beard hair as an adjunct donor site. The local anatomy, procedural technicalities and method of harvesting have been emphasized. The pre, intra and postoperative records have been maintained. The advent of FUE paved way for minimal downtime, better cosmesis and less scarring facilitating the possibility of using non-scalp hair in hair restoration, thus increasing the overall donor graft availability. Beard hair has its characteristic differences when compared to the scalp hair. Alongside there exists an array of advantages and disadvantages. Minimal complications and potential advantages have encouraged the usage of beard graft in the recent past. In hindsight, beard to scalp transplantation is a worthwhile alternative in cases demanding an expanded source of donor hair which demands further literary contribution.

Preview long hair follicular unit excision: An up-and-coming technique.

Follicular unit excision (FUE) is a popular hair transplant technique, but requires shaving the donor area. This is a deterrent for some patients wishing to keep their hair transplant discreet. The new long hair FUE technique avoids shaving the donor area, which appeals to a wider patient population; however, it has a reputation of being technically challenging and slow. We review the tools and techniques developed for long hair FUE and present our experience using the Trivellini Long Hair System and Long Hair punch. With the new advances in tools and techniques for long hair FUE, this method is gaining momentum and has the potential to be the next trend in the hair transplant industry. There are a few different punch designs marketed specifically for long hair FUE (window/slotted, Trivellini Long Hair, and bi-pronged). Although this technique is slower to perform than shaven FUE, graft survival and final outcome are comparable. Innovations in technology have made the long hair FUE technique more accessible to hair transplant surgeons. It is important for hair restoration surgeons to keep knowledgeable about this technique in order to maintain a competitive business.

Follicular Unit Extraction with or without Platelet Rich Plasma in the Treatment of Androgenic Alopecia

Follicular Unit Extraction with or without Platelet Rich Plasma in the Treatment of Androgenic Alopecia

Surgical interventions for androgenetic alopecia

AbstractIntroductionAndrogenetic alopecia (AGA) is the most common type of progressive hair loss, and current treatments are limited. Consequently, many patients seek nonmedical hair care, including herbal and dietary therapies as well as surgical procedures.MethodsRelevant articles on surgical hair restoration procedures were retrieved through a selective search of PubMed.ResultsSufficient donor hair supply is an important criterion for undergoing any type of hair restoration surgery. Men are more likely to be candidates for hair restoration surgery than women. One type of surgical intervention is scalp reduction, in which bald patches are excised and hair‐bearing portions of scalp are moved to cover the excision. In recent years, hair transplantation has eclipsed scalp reduction as the surgical hair restoration procedure of choice. The most popular techniques for obtaining donor hair for transplantation are strip harvesting and follicular unit extraction (FUE). FUE produces better aesthetic results, though hair grafts display higher survival rates in strip harvestingDiscussionHair transplantation remains a developing procedure, and no standard recommendations have been put forth yet. Nevertheless, it has become a successful strategy for treating hair loss and is expected to continue to make advances in years to come.

Subclinical effects of adapalene-benzoyl peroxide: a prospective in vivo imaging study on acne micromorphology and transfollicular delivery.

Adapalene-benzoyl peroxide (A-BPO) is a first-line topical treatment for acne vulgaris. In vivo reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) detect micromorphological changes over time and visualize transfollicular delivery. To visualize temporal, subclinical effects of A-BPO on acne micromorphology using RCM and OCT, and evaluate their impact on transfollicular delivery of microparticulate carrier systems. Fifteen patients with mild to moderate acne received a 6-week course of A-BPO. Micromorphological changes were evaluated at time 0, 3 and 6weeks with RCM (n=1190 images) and OCT (n=210 scans). Transfollicular delivery of microparticles was assessed at baseline and week 6. In vivo imaging visualized steady normalization of skin micromorphology in response to A-BPO over 6weeks, including decreased hyperkeratinization of follicular borders (RCM median decrease -71.2%, P<0.05), reduced intrafollicular keratinous content (RCM median decrease -47.7%, P<0.05) and increased epidermal thickness (OCT median increase of 25.25%, P<0.05). Imaging visualized microparticles in the follicular unit. Despite a visible reduction in keratin and sebum, transfollicular microparticle delivery appeared unaffected. Reflectance confocal microscopy and OCT detect A-BPO-induced changes in micromorphology and visualize transfollicular microparticle delivery. Keratolysis and sebolysis did not have a measurable effect on transfollicular delivery of microparticles.