Follicular Unit Research Articles

The assessment of Hair Transplantation Outcomes in Cicatricial Alopecia.

Background:Cicatricial alopecia (CA) is scarring alopecia due to a diverse group of disorders which destroy the hair follicle, replace it with scar tissue causing permanent hair loss. Spontaneous regrowth of hair in CA is rarely seen and thus it has a negative impact on the self-esteem of the patient. However, hair transplantation (HT) has emerged as an effective modality of treatment to replace lost hair for cosmetic benefit.Materials and Methods:This was a prospective analysis of patients affected with CA, who underwent HT from January 2015 to December 2017. Demography of patients along with the duration of disease, stability, biopsy, technique of HT, number of grafts, and other procedures done were noted on a pro forma and analyzed. A test patch of HT was done in all primary CA to assess stability and few secondary CA to look for graft uptake. The patients were followed up for a year and the outcomes were graded by patient and a single observer on a 10 point scale as poor, satisfactory, good, and very good at 3, 6, and 12 months.Results:A total of 50 patients with CA underwent follicular unit extraction. Majority of them were males(84%) with a male to female ratio of 5.25:1. Secondary CA was seen in majority(90%) of the study group. Moustache (56%) was the most common site affected, followed by scalp (22%), beard(14%) and eyebrow(8%). Around 38%(12 atrophic scars; 7 hypertrophic scars) underwent fractional CO2 laser/Erbium YAG laser with or without intralesional steroid injections in a stepwise manner prior to HT. Excellent-to-very good outcome was seen in 82% while 18% were lost for follow up.Conclusion:Scarring in CA has a significant effect on quality of life of affected patients. HT when done taking into consideration the stability of disease has good-to-excellent outcomes thus leading to a positive impact on the patient's life.

"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.

Kinky Hair after FUE Technique: Case Report

I share this case that was presented during the M&M Session at the 2019 27th World Congress of the ISHRS held in Bangkok. A patient had persistent growth of tortuous hair in the recipient area after the follicular unit excision (FUE) technique. Kinky hair is an uncommon disorder characterized by

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.

A Comparative Study between Follicular Unit Transplantation and Autologous Non-cultured Non-trypsinized Epidermal Cells Grafting (Jodhpur Technique) in Stable Vitiligo.

Introduction:Several modalities are currently available for the treatment of vitiligo, but generally they do not result in complete cure of the disease. Despite the limitations and some side effects, surgical modalities appear to be the method of choice in recalcitrant stable vitiligo. Both Jodhpur technique (JT) and follicular unit transplantation (FUT) are simpler and cheaper methods, requiring minimal infrastructure.Materials and Methods:Hundred patches in 30 patients were divided into Group A and Group B, that is, hair follicle transplantation and autologous non-cultured non-trypsinized epidermal cell suspension grafting (JT), respectively. Fifty patches were included in each group. Efficacy of both the techniques, extent of pigmentation, and color match assessment were the main objectives.Results:Excellent repigmentation (>75%), at the end of 20 weeks post surgery, was observed in 70% lesions in FUT group and 72% of lesions in JT group. Good response (extent of repigmentation of 50%–75%) was seen in 18% of lesions in FUT group as compared to 26% in JT group. JT and FUT technique were almost equal in producing excellent repigmentation. Color match was same for both the groups, that is, 49 of 50 patches showed same color as surrounding in both groups at the end of 20 weeks. Repigmentation of the depigmented hairs occurred in 11 of 46 patients with associated leukotrichia.Conclusion:Our study indicates that both JT and FUT are safe and effective techniques in terms of repigmentation but JT is somewhat superior to FUT in producing excellent and good repigmentation, side effects, patient satisfaction, and dermatology life quality index reduction, while the color match was almost same with both techniques.

A novel model for designing and performing parietal whorl hair transplantation

Hair transplantation is the gold standard method for the treatment of alopecia. Recently, demand for the surgery has increased rapidly. However, high demands also require more professional training for the surgeons. With the maturing of hairline design skills, parietal whorl design has become the next challenge and no appropriate training models have yet been reported. To present an innovative, simple, and appropriate training model for designing the scalp parietal whorl. Outward divergent arc curves were drawn from the navel of an orange. Recipient sites were created with 23G needles or 1.0-mm knives or 1.0-mm blades according to the outward divergent arc curves, then hair shafts were transplanted using forceps. Different densities of hair shafts were transplanted. Transplantation of 10-20 follicular units (FU)/cm2 was too sparse, 30FU/cm2 achieved a good appearance, but 40-50FU/cm2 was better. Through practicing on the model, excellent results of parietal whorl transplantation on patients can be achieved. This new model can perfectly suit the lines and direction of the parietal whorl and also present different density transplantation practicing. We provide a training method for new surgeons as well as a rehearsal opportunity for previously trained doctors.

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.

Impact of Preservation Solutions on the Trichogenicity of Hair Micrografts Ascertained by Dermal Papilla Gene Expression.

Appropriate storage of human hair follicle (HF) grafts during follicular unit excision (FUE) is crucial toward successful hair shaft implantation. Several commercial storage solutions are currently used to ensure ex vivo maintenance of follicular grafts viability and trichogenicity. However, quantitative experimental evidence demonstrating molecular changes in HF cells associated with the usage of different storage solutions is largely missing. To identify gene expression changes in HF cells caused by ex vivo storage of hair grafts in different preservation conditions. The authors performed gene expression analysis in dermal papilla (DP) isolated from HF stored under different temperatures and solutions. The expression signature of key genes controlling hair growth and cycling, apoptosis, inflammation, and senescence was assessed for (1) chilled versus room temperature (RT) and (2) DP cell medium, saline, Hypothermosol, platelet-rich plasma, and ATPv-supplemented saline. The authors found chilled versus RT to prevent inflammatory cytokine signaling. Under chilled conditions, ATPv-supplemented saline was the best condition to preserve the expression of the trichogenic genes HEY1 and LEF1. Data disclose DP gene expression analysis as a useful methodology to ascertain the efficacy of preserving solutions and elucidate about the best currently available option for FUE clinical practice.

Hidradenitis suppurativa and acne vulgaris and conglobata\u2014systematic review and meta-analysis

BackgroundHidradenitis suppurativa (HS) is a chronic inflammatory skin disorder which involves painful nodules and draining abscesses in flexural areas. Acne vulgaris and its more severe variants including acne conglobata and acne fulminans are also disorders involving the follicular unit. Given that follicular obstruction, dilatation and inflammation feature in both HS and acne vulgaris/conglobata, it has been suggested that HS is associated with acne vulgaris/conglobata.MethodsThe present systematic review and meta-analysis was performed according to recommended PRISMA guidelines. All eligible case-control studies comparing patients with HS vs non-HS were included in the present review. All studies must have included either the proportion of patients with acne vulgaris/conglobata in each group, or the summary effect size for association between HS and acne vulgaris/conglobata. The odds ratio (OR) was used as a summary statistic.ResultsFrom pooled unadjusted meta-analysis, we found a significantly higher proportion of patients with acne vulgaris/conglobata in HS cases compared to controls (OR 3.44, 95% CI 1.95–6.07, P < 0.0001, I2 = 100%). Pooled meta-analysis was also performed with adjusted effect sizes. This demonstrated that HS was significantly associated with acne vulgaris/conglobata after adjustment for potential confounders (OR 3.44, 95% CI 2.43–4.87, P < 0.00001, I2 = 99%).ConclusionsIn summary, a significant association was found between HS and acne vulgaris/conglobata. This has implications in terms of understanding the burden of disease on patient quality of life as well as consideration of optimal management strategies to target both disorders. Physicians taking care of patients with HS should be aware of this association.

Large-Scale Beard Extraction Enhances the Cosmetic Results of Scalp Hair Restoration in Advanced Androgenetic Alopecia in East Asian Men: A Retrospective Study.

IntroductionBeard hair serves as an important additional donor supply to support hair transplantation in hirsute patients with extensive alopecia and lacking sufficient occipital hair. However, the efficacy and safety of large-scale beard hair extraction have not been studied extensively in the East Asian population.MethodsData obtained from hirsute patients with extensive alopecia who underwent hair transplantation between March 2017 and December 2018 at Nanfang Hospital were analyzed. Occipital and beard hair were evaluated separately during the pre-, intra-, and post-operative periods. Individual beard hair follicular units (FUs) were harvested under tumescence using a hollow punch with an outer diameter of 0.8–0.9 mm. Follow-up examinations were scheduled at 3–5 days, 1 month, and 9 months postoperatively to check for complications, determine the survival rate of mixed, transplanted FU grafts, and assess patient satisfaction. Data were collected and analyzed statistically.ResultsA total of 36 hirsute, male patients with advanced androgenetic alopecia (AGA) (Norwood-Hamilton V–VI) were included in this study. The density of the occipital and beard areas was 78.6 ± 4.6 and 48.4 ± 9.3 FU, respectively. It took 3.1 ± 0.9 h to harvest 3135 ± 863 FUs from the occipital area and 2.1 ± 0.6 h to harvest 2352 ± 599 FUs from the beard area. The transection rate for occipital FUs and beard FUs was 3.7 ± 0.4 and 3.9 ± 0.2%, respectively. Completion of the operation took approximately 10.0 ± 0.9 h, and no serious complications were reported 5 days after the procedure. An FU survival rate of 95.7 ± 1.6% was observed at 9 months after transplantation, with no visible hypopigmented scars observed in the bare areas. All patients were satisfied with the resulting cosmetic appearance.ConclusionLarge-scale beard extraction, when combined with occipital hair extraction, is a safe and effective treatment to enhance the cosmetic appearance of East Asian men with advanced AGA.

Transection rate at different areas of scalp during follicular unit extraction/excision (FUE).

Although the follicular unit excision/extraction (FUE) is regarded an easy procedure to perform, however, there are various factors which affect the outcome. The hair transection is dependent of various factors and the donor site characteristics affect largely. To know the difference in transection rate on various areas of scalp during FUE. The study was conducted in 10 patients undergoing FUE after obtaining informed consent. In each patient, 1 row was marked with intervening 1cm2 . The row contained five boxes of 1cm2 . Harvesting of FUs was performed using 0.9mm serrated punch. The procedures were performed with the patient in supine position with the surgeon sitting on head side. The harvested FUs were checked under microscope. Any transection was calculated. All the data was collected and analyzed statistically. The total number of FUs and hair were more in center zone as compared to the sides. Whereas, the transection rate was lowest in the mid-occipital zone as compared to the sides. Similarly, the FUs: hair ratio was more in the sides 1:1.85 as compared to 1:1.62 in central zone. The right and left sides also showed some variations. The transection was more on right side (17.7%) of the patient as compared to the left side (16.3%) CONCLUSION: The hair transection was more on sides than in the mid-occipital area.

Serum amyloid A and C-reactive protein levels and erythrocyte sedimentation rate are important indicators in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic disabling inflammatory disease of the follicular unit especially affecting apocrine gland-bearing skin areas. Little is known about systemic inflammatory complications of the disease. This study aimed to evaluate systemic inflammation in patients with HS by assessing serum amyloid A protein (SAA) and C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) and to identify potential risk factors for HS. Forty-four patients (M/F: 28/16) and 44 age- and sex-matched controls (M/F: 28/16) were enrolled. Demographic, clinical, laboratory, and therapeutic data, including smoking status, body mass index (BMI), waist circumference (WC), serum fasting lipid profile, fasting blood glucose, SAA, and CRP levels, and ESR were assessed. Associations were investigated by univariate and multivariate analyses. Patients with HS showed significantly higher levels of pack-years of cigarette smoking, weight, BMI, and WC (P = 0.01, P < 0.001, P = 0.001) and elevated SAA and CRP levels and ESR (P = 0.008, P = 0.01 and P < 0.001). SAA and CRP levels and ESR were significantly associated with Hurley staging in patients with HS (P = 0.03, P = 0.003, P = 0.02). Multivariate logistic regression analysis revealed that each unit increase in the ESR increased the HS risk by 1.08-fold (95% CI 1.02-1.13). HS is significantly associated with SAA, CRP, and ESR. Among these inflammatory parameters, ESR was an independent risk factor for HS. We recommend assessment of SAA, CRP, and ESR as biomarkers that reflect the disease severity in HS patients likely to develop complications.

A prospective observational study of follicular unit excision grafting for the management of stable vitiligo

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Vitiligo is a common acquired idiopathic and often, familial hypomelanosis, which is characterized by pale white macules that enlarges centrifugally over time. In India, vitiligo is associated with marked social stigma, thus demanding its effective management. Stable vitiligo lesions known to be relatively refractory medical therapy require surgical therapies like skin grafting or grafting of invitro cultured and non-cultured melanocytes or follicular unit excision (FUE) grafting.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective observational study was done on patients of stable vitiligo. A total of 20 patients were enrolled and underwent FUE grafting for study of effectiveness and complication.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 20 patients of stable vitiligo were studied with or without leukotrichia in which good to excellent response was seen in 13 (65%), fair in 6 (30%) and poor in 1 (5%) patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; FUE is a superior and upcoming methodology which is cost effective, reliable, less disfiguring, very low morbidity and results in good color match in patients with stable vitiligo.&lt;/p&gt;

Autologus Hair Transplantation Vs Skin Expansion in Management of Cicatricial Alopecia; A Comparative Study

Background: The bad impact of cicatricial alopecia among population lead to increase the desire of correction of that type of hair loss. Although, there are many methods of hair restoration but the efficacy of each, indications and possible hazards has not yet been clearly identified. Objective: To compare between hair transplantation using follicular unit extraction and skin expansion surgeries in the field of hair restoration in secondary cicatricial alopecia regarding aesthetic outcome, operative duration, optimum patient selection and complications of both techniques. Subjects and methods: Twenty four patients suffering from alopecia were involved in this study 15 males (62.5%) and 9 females (37.5%). Patient’s age ranged from 7 to 26 years old. Patients were divided into two groups according to the procedure done. Group (A) 12 patients done hair transplantation surgeries. Group (B) 12 patients done scalp expansion surgeries. Results: There was a non-significant difference between both groups regarding the mean age or the mean operation duration (P > 0.05). The mean values of the surface area of alopecia, in tissue expander group (B) was significantly larger than that of hair transplantation in group (A) (P < 0.001). However the time since exposure to the causative injury was significantly longer in group (A) than that of group (B) (P < 0.01). Hair transplantation tends to have less recovery time highly indicated in adults with smaller non-dependent areas of alopecia, while expanders with long recovery period solve bigger problems of alopecia in younger patients. Conclusion: Multiple factors interfere with the surgical plan age, gender, occupation, size and site of alopecia and time since injury. Both hair transplantation and skin expansion are very useful in the field of cicatricial alopecia treatment. While hair transplantation has less hazards during anesthesia, less post-operative scars and less recovery time, skin expansion is a good solution for bigger problems like big area of alopecia or younger patients.

179 Eyebrow Hair Transplantation in Frontal Fibrosing Alopecia: Warning About the Short- and Long-Term Results

Eyebrow hair loss is usually a primary feature of frontal fibrosing alopecia (FFA) that causes significant distress to patients who consequently seek medical help. Eyebrow hair transplantation is a well-accepted and aesthetically successful treatment option for hair loss of the eyebrows, but there is a lack of information about the short- and long-term results in this subset of patients. We report the short- and long-term results of eyebrow hair transplantation in patients with FFA. 10 patients diagnosed with FFA underwent eyebrow hair transplantation. The transplanted hairs were harvested from occipital scalp skin using the standard hair transplant technique. On average, 120-270 single-hair follicular units (FUs) were implanted per eyebrow. 80% of patients achieved excellent hair growth at 6-12 months follow up and satisfactory short-term results (< 2 years). However, the long-term results were not so satisfactory, and the majority of patients started losing the transplanted hairs after 3-4 years. Only 1 patient had not lost transplanted hair in the long-term follow up (>4 years). In conclusion, the results of eyebrow hair transplantation in FFA patients are variable, with both negative and positive outcomes. In general, the short-term outcome is satisfactory, but in most patients a progressive loss of transplanted hairs can be expected. It is important to follow up long-term results as short-term graft survival success does not guarantee the permanent survival and growth of the transplanted hair. Therefore, FFA patients inquiring about eyebrow transplantation should be advised about the high possibility of hair graft loss over time.

President's Message

</br>![][1]</img> This is NOT about Follicular Unit Excision (FUE) extinction, but about its reputation. This is inevitable: stocks, companies, agencies, countries, anything that grows exponentially without proper quality control will suffer this, the crash. History is full of examples; there is

Intralesional corticosteroid injection for the treatment of hidradenitis suppurativa: a multicenter retrospective clinical study

Background and objectives Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the follicular unit characterized by recurrent, painful, skin lesions including inflammatory nodules, abscesses, tunnels, and mutilating scarring. Intralesional corticosteroids injection (ICI) for HS has received little attention in the scientific literature. We evaluate the clinical response of ICI in acute and chronic HS lesions and aim to identify new applications of ultrasound-assisted procedures in HS management. Patients and methods An observational, retrospective, multicenter study of HS patients treated with ICI was conducted from January 1 to August 1, 2015. We collected 98 HS patients. A total of 135 individual lesions were infiltrated, including non-inflammatory nodules, inflammatory nodules abscesses and fistulous tracts. Results Complete response was reached in 95 lesions (70.37%), 34 showed partial response (25.19%) and 6 (4.44%) were non-response. A total of 105 individual lesions underwent sonographic scan before ICI. Conclusion Clinical experience supported the use of ICI for individual lesions. Our results showed that ICI is a useful treatment to control in acute and recalcitrant HS lesions. Response rates improve significantly if lesions are previously evaluated with HFUS.

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.

Robotic, AI-assisted follicular unit excision and implantation for hair restoration

Robotic, AI-assisted follicular unit excision and implantation for hair restoration

Surgical skills for female frontotemporal hairline reconstruction

Objective To explore the operative method and skill for female frontotemporal hairline reconstruction. Methods From October 2010 to October 2016, 120 female patients were performed with the hairline reconstruction. The follicular units were arranged irregularly, 40-55 FUs/cm2, with 30°-45° angle from the forehead skin and 15°-20° angle from the temporal skin. The finest hairs were selected and arranged in hairline margin. Results All the patients were followed up for 10-24 months. 95 patients were very satisfied, 25 patients were satisfied, and no patients were unsatisfied. 9 patients complained low density in the middle of the hairline and they had another surgery to improve the density. 3 patients＇s hairline was regular, and another graft was done to correct the unnatural appearance. 6 patients＇s hairs of the hairline margin were thick, but no further treatment was done. 1 patient underwent hair transplantation again, because of the still high hairline. 6 patients＇s transplanted hairs appeared curly, and the curly degree was decreased after 1-2 years. The density of the transplanted hair was (44.7±8.1) FU/cm2. The density of 9 cases who complained low density in the middle of the hairline, was (36.9±3.1) FU/cm2. The hair diameter of the hairline edge was (57.5±13.5) μm. The hair diameter of 6 cases who felt the hair thick was (70.2±5.1) μm. The angle of hair and the frontal skin was (40.2±8.5)°, The angle of hair and the temporal skin was (18.2±4.7)°. Conclusions In female frontotemporal hairline reconstruction, nature hairline is created by irregular arrangement of hairs, proper density and angle and exact arrangement of different diameter hairs. Key words: Hair; Transplantation, autologous; Forehead; Women; Hair line