Hair Transplantation Research Articles

Follicular Unit Excision (FUE) Basics.

Follicular unit excision (FUE) has risen to the forefront as the world's most popular hair transplant procedure. However, most writing on this subject has catered to the advanced practitioner. The goal of this article will be to focus on safe planning and decision making along with key technical steps that will guide the beginner surgeon to harvest a graft safely and to harvest the donor area in a uniform way to avoid overharvesting. Topics covered in this article also include instrumentation and decision making between FUE versus linear strip excision.

Mycobacterium abscessus scalp infection after hair transplantation in Central America.

Mycobacterium abscessus scalp infection after hair transplantation in Central America.

Anesthesia Techniques for Harvesting Via Follicular Unit Excision (FUE).

Follicular Unit Excision (FUE) is one of the established techniques for harvesting donor hair for hair transplantation. Traditionally, hair restoration surgery is performed using local anesthesia, although some surgeons use general anesthesia for the procedure. Normally, local anesthesia is coupled with light oral sedation to make the procedure more comfortable for patients. Techniques such as "ring block" or nerve blocks are common and effective for scalp anesthesia. Due to its simplicity, adequate pain control, and safety, ring blocks are typically used for FUE donor harvesting, reserving nerve blocks only for patients who cannot be adequately anesthetized with the ring block. Using the correct technique for application of local anesthesia can dramatically decrease the pain associated with it and create a comfortable and easy experience for the patient.

Visual servoing-based pneumatic hair transplantation mechanism for robotic FUE surgery

Hair transplantation surgery is an effective solution for hair loss problems, among which follicle unit extraction (FUE) surgery is more widely used and favored. At present, most hair transplantation surgeries still rely heavily on manual operation by doctors and very few hair transplantation robots with complex structures have been introduced. This paper proposes a pneumatic hair transplantation mechanism for FUE surgery, equipped with a camera, capable of automatically performing both hair implantation and extraction with airflow. This pneumatic method eliminates the complex needle structure, has the function of temporarily storing the follicles inside the needle, thus facilitating the automation of transferring follicles from extraction to implantation. Then a visual feedback system is proposed to accurately position the follicles during the transplantation. The experimental results show that average distance deviation between the actual and target positions is 0.6128 mm and the average deviation of hair implantation depth is 1.7176 mm, which verify the feasibility of the proposed system.

An Analysis of Risk Factors of Recipient Site Temporary Effluvium After Follicular Unit Excision: A Single-Center Retrospective Study.

Temporary hair loss at the recipient site after hair restoration surgery is called shock loss (SL). This study analyzed the risk factors for SL among patients who received follicular unit excision. This study included 621 patients (554 males and 67 females). Twenty-three patients had SL (9 males and 14 females with a mean age of 40.8 years). The prevalence of SL was analyzed in relation to sex, age, graft follicular units, cause of alopecia, diabetes mellitus, smoking, drinking alcohol, and local anesthesia agent. Sex was identified as a risk factor for SL (odds ratio [OR]: 30.18; 95% confidence interval [CI] 9.43-96.55; p<0.001). Among female patients, age was identified as a risk factor for SL (OR:1.07; 95% CI 1.00-1.15; p=0.039). Over 40 years, the female pattern hair loss group had a significantly higher risk for SL than a female cosmetic group younger than 39 years. Sex was the only risk factor found for SL in this study. In addition, age was identified as a risk factor for SL among female patients. We believe our results provide information and risk factors for SL, not only for hair transplant surgeons, but also patients who will receive follicular unit excision. 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 .

Recipient site scalp necrosis: A rare postoperative complication of hair transplantation.

Recipient area scalp necrosis is considered a potential complication of hair transplantation, but has rarely been reported. A small number of patients have developed scalp necrosis after hair transplantation with the widely used Follicular unit excision (FUE) technique. There are no guidelines to prevent and manage this complication. The aim of this study was to provide an insight into the pathogenesis, prevention, and management of scalp necrosis following hair transplantation. From 2012 to 2021, among more than 10 000 patients who underwent hair transplantation, only three developed scalp necrosis in our clinical experience, besides, one patient transferred to our hospital because of scalp necrosis after undergoing hair transplantation. According to the disease etiology and patients' symptom, a combination of wound management and antimicrobial therapy was employed. This study was approved by the institutional ethics committee of Nanfang Hospital. Of the four patients, three received timely treatment and had a good prognosis. Necrosis became confined and healed within 2-3 weeks. Grafts in the lesion area partially survived. In case 4, due to improper treatment at the early stage, the lesion developed extensively and deeply, which not only delayed wound healing, but also resulted in complete loss of grafts. Preoperative prophylaxis, timely diagnosis, and immediate treatment of scalp necrosis can prevent serious complications and reduce morbidity after hair transplantation.

Determination of Scalp Vascular Topography by Laser Doppler Flowmetry and Comparison of Vascular Damage by Different Blades in Hair Transplantation.

Although necrosis is a rare complication in hair transplantation, it is extremely traumatic for both the patient and surgeon and also has potential medicolegal consequence. Studies have shown that ischemia in the recipient bed is related to tissue damage caused by the instruments used and the number of grafts per cm². We aimed to measure the effects of different instruments on circulation by dividing the recipient area of hair grafts of the same person into 2 sides as right and left. Sapphire percutaneous blade was used on the right side, and a handmade razor slit was used on the left side in 12 male patients with consent. Subsequently, vascularity was evaluated with laser Doppler flowmetry. Scalp vascularity has so far only been evaluated with macroanatomic studies in the literature. First, the authors evaluated the effect of local anesthesia and adrenaline-containing swelling fluids on vascularity with a Laser Doppler Flowmeter. Afterward, the tissue damage caused by sapphire percutaneous blades and handmade blades (obtained from razor blades) were quantitatively analyzed and compared with each other. Our results showed that handmade razor blades caused significantly less tissue damage.

Utility of Follicular Unit Excision using Non-Scalp Donor Hair.

Non-scalp donor hair harvesting, or body hair transplantation (BHT) offers patients an additional source of donor hair in cases when the scalp does not have an adequate supply for the intended recipient area. The most common applications for non-scalp donor hair are for patients with advanced hair loss, or to camouflage scarring from prior hair restoration procedures. For patients with available body hair, the beard is probably the best source followed by the chest and abdomen. Combined, these sources may be able to provide thousands of additional grafts for transplantation. Non-scalp hair donor harvesting is technically challenging and should be performed by those with extensive experience in follicular unit excision (FUE) surgical techniques.

Application of hair transplantation combined with platelet-rich plasma injection for the treatment of androgenic alopecia.

Androgenic alopecia is a type of hair loss condition that is influenced by both genetic and environmental factors. This study aimed to investigate the effectiveness of combining hair transplantation with platelet-rich plasma injection for treating androgenic alopecia. From June 2019 to September 2021, a total of 147 patients with androgenic alopecia were selected and treated by our department. Out of these, 72 patients were assigned to the treatment group and received hair transplantation along with platelet-rich plasma treatment. The remaining 75 cases constituted the control group, receiving only hair transplantation. Clinical data was obtained by reviewing the patients' medical records and case reports. The area of hair loss in the treatment group was significantly smaller than that in the control group. The score of the hair pulling test in the treatment group was significantly lower than that in the control group. The hair regeneration score in the treatment group was significantly higher than that in the control group. After treatment, the total area of skin lesions in the treatment group was significantly reduced compared to the control group. There was a statistically significant difference between the two groups. Our study indicates that combining hair transplantation with platelet-rich plasma is superior to hair transplantation alone for the treatment of androgenic alopecia. This combination therapy shows promising potential for clinical applications.

44566 Indications to use combined robotic and specialized tool assisted techniques for hair transplant

44566 Indications to use combined robotic and specialized tool assisted techniques for hair transplant

Alopecia: An OVerall Review Including Causes, COVID-19, Diet, And Treatments

Despite the hopes of many, the autoimmune disease alopecia is not a curable disease. Fortunately, there is lots of information and research about the disease, its underlying mechanisms, as well as old and new treatments including light therapies, injectables, hair transplantation, and even supplements and OTCs. Furthermore, this paper will explore the various side effects, cost, and effectiveness of these therapies based on experiments done with them. This paper will introduce various non-scarring alopecias such as alopecia areata, androgenetic alopecia, and telogen effluvium and describe what makes them occur. This paper will also explain the large impact of diets as well as different types and components of each diet that can contribute to controlling and preventing alopecia. Explore the underlying mechanism of the effects of COVID-19 and the COVID-19 vaccine on the body that can cause alopecia.

663 Squamous Cell Carcinoma of the Scalp Following Synthetic Hair Transplantation: A Case Report

Abstract Androgenetic alopecia is the most common form of hair loss. Surgical treatment options include autologous and synthetic hair transplantation. Synthetic hair fibres can overcome the challenges of poor hair quality and density however there are reports of severe cutaneous complications following their use. We report a case of an advanced squamous cell carcinoma (SCC) of the scalp in an adult male patient following chronic artificial hair transplants. The fungating mass eroded the inner cortex of the left parietal bone without intra-cranial extension on CT. Indeterminate lymph nodes in the parotid gland and level III of the left neck were identified on CT and MRI. Resection of the artificial hair fibres and SCC with a craniectomy, total parotidectomy with facial nerve preservation and upper neck dissection were performed. There was extensive dural involvement not detected on pre-operative imaging, which involved the superior sagittal sinus and was unresectable. The dural disease was fulgurated. The defect was reconstructed with a titanium plate and DIEP flap. Final histopathology showed a moderately differentiated pT4a N0 M0 SCC. The patient received adjuvant proton beam therapy and at 18 months post-operatively is recurrence free. Development of scalp SCC following synthetic hair transplantation has been described, although a clear causation has not been defined. Clinicians should be aware of this presentation and aim to achieve an early diagnosis, timely referral to an appropriate specialist and prompt management.

Hair regeneration using microneedle-assisted human basic fibroblast growth factor

Hair loss has afflicted numerous patients for several decades. However, the current drug treatment is only effective for specific types of alopecia and their efficacy is limited. Additionally, the cost of hair transplant surgery is relatively high, making it unaffordable for some patients. In this study, we propose a new treatment method using microneedles and growth factors to alleviate alopecia. The results of our study demonstrate that patients receiving human basic fibroblast growth factor (hbFGF) therapy experienced significant hair regeneration. Both male and female patients responded positively to the growth factor treatment, with males showing better results. Importantly, microneedle-assisted hbFGF therapy can be universally applied to androgenetic alopecia, alopecia areata, and telogen effluvium. In summary, this study presents a novel and highly effective method that shows great potential for treating alopecia, with high levels of safety and efficacy.

Novel Follicular Unit Excision Device That Reduces Graft Injury and Improves Ergonomics in Hair Transplantation Surgery.

Follicular unit excision (FUE) surgery is becoming increasingly popular and the number of grafts transplanted in a single session is increasing. Furthermore, complicated surgeries and those requiring a longer surgical time such as non-shaven FUE and long hair FUE are more actively being performed worldwide. The main aim in FUE surgery is to obtain the best quality grafts while minimizing follicular damage during donor harvest. This article describes a novel FUE device that achieves these goals. We describe a novel FUE device with Bluetooth function, fingertip touch sensor, multiphasic movement, automated operation by setting the interval time between punching motions, ergonomic design, various innovative functions, and an easily upgradable application used to operate the handpiece. We also report the concept of design, mechanism of action, methods of use, and effect of each innovative function. The various state-of-the-art features of the device minimize the risk of follicular injury when working with a wide variety of scalp and hair follicle types and conditions. In addition, it enables successful donor harvesting by reducing the surgeon's workload and improving ergonomics. We introduce an innovative and new device for use in FUE surgery. This novel device has the potential to increase the convenience, scalability, and safety of FUE surgery.

Follicular Unit Excision in Patients of African Descent: A Skin-Responsive Technique.

Follicular unit excision is a favored minimally invasive hair transplantation method. However, it is suboptimal for many patients of African descent because of wide variations in hair and skin characteristics. To evaluate the performance of a skin-responsive follicular unit excision device, which accommodates hair curliness, skin thickness, and firmness in patients of African descent. The authors retrospectively evaluated patients who underwent scalp follicular unit (FU) excision using a skin-responsive technique at 7 multinational clinics. The preoperative donor grading for the anticipated difficulty used a scale with Class V indicating the highest degree of hair curliness, skin thickness, and firmness. Of 64 eligible patients (45 males and 19 females), 28 had Class V FU excision donor grades. The mean transection rate for all patients was 3%-6%, which was highest in class V patients. Skin thickness and firmness had a greater effect on the maximum transection rate than hair curliness. Only 19 or 18 G punches were used. The authors report consistence success of a new skin-responsive FU excision device for all patients of African descent with a mean graft transection rate of less than 10%. The findings support skin thickness and firmness as major influencers of graft attrition rate.

Allogeneic Hair Transplant in a Kidney Transplant Recipient.

Allogeneic Hair Transplant in a Kidney Transplant Recipient.

Comparing Current Therapeutic Modalities of Androgenic Alopecia: A Literature Review of Clinical Trials.

Androgenic alopecia (AGA), commonly known as male pattern baldness (MPB), is a hereditary condition characterized by hair follicles that are sensitive to androgens. This article focuses on examining the recent advancements in the comprehension and management of AGA. The genetic factors and pathophysiology of AGA, including the role of dihydrotestosterone (DHT) and the androgen receptor gene, are discussed. The consequences of hair loss on self-esteem and identity, as well as on mental health, are examined. Diagnostic methods, such as the hair-pull test and trichoscopy, are discussed. The article also presents the Hamilton-Norwood classification, which is the most commonly employed system for classifying MPB. The article then delves into the various treatment options available, including topical minoxidil, oral finasteride, platelet-rich plasma therapy, low-level light therapy, hair transplant, and other alternative treatments. The efficacy and combination therapies for these treatments are examined. Additionally, emerging treatments such as caffeine-based solutions and prostaglandin inhibitors are discussed. By examining the recent advancements in AGA treatment, this article provides a comprehensive overview for healthcare professionals to make informed decisions when selecting the best treatment options for their patients.

An international expert consensus statement focusing on pre and post hair transplantation care

AimTo achieve international expert consensus and give recommendations on best practices in hair transplantation surgery, focusing on pre- and post-transplantation care.MethodsA modified Delphi method was used to reach consensus. An international scientific committee developed an 81-statement questionnaire. A panel of 38 experts in hair transplantation from 17 countries across 4 continents assessed the questionnaire.ResultsTwo consensus rounds were carried out, with 59 out of 81 statements (73%) reaching consensus. Expert recommendations emphasize the correct selection of candidates for hair transplantation and the need for patients to have received adequate medical treatment for alopecia before transplant. Comorbidities should be assessed and considered while planning surgery, and an individualized plan for perioperative care should be drawn up before transplant. Certain medications associated with increased risk of bleeding should be withdrawn before surgery. Specific recommendations for post-transplantation care are given. After transplantation, patients should gradually resume their normal haircare regimen. Close follow-up should be carried out during the first year after transplant.ConclusionsThis study presents numerous consensus-based recommendations on general aspects of hair transplantation, including candidate selection, medical therapy prior to transplantation, anesthesia, and resuming haircare after transplantation.

The Training and Application of Silicone Products in Eyebrow Transplantation Simulation.

Because the structure of eyebrows is complicated, students need a lot of practice to become familiar with the distribution pattern of eyebrow hair. The current study was designed to investigate training methods for eyebrow design and planting practice before eyebrow hair transplantation to improve planting quality. Twelve surgical students were selected. The 6 students in the experimental group had never performed eyebrow transplantation surgery, whereas the 6 in the control group had experience of the procedure. Students in both groups received theoretical and simulated eyebrow hair transplantation instruction. Students were required to master standard eyebrow transplantation. The results of the experimental group and the control group were compared before and after training. The results revealed that the overall results of the experimental and control groups significantly improved compared with before training (P < .05). After theoretical training, 2-dimensional simulation training, and 3-dimensional simulation training, eyebrow shape, symmetry, hair angle, and density after the 3-dimensional simulation training were statistically significantly improved (P < .05). There was no statistically significant difference, and the students in the control group did not demonstrate any improvement in their capacity to arrange the eyebrows or shape them symmetrically. After training, however, the angle and density of the hair substantially improved. The experimental group's technical ability in simulated eyebrow planting significantly improved. The present study demonstrated that the students could develop their skills and get closer to the level of surgeons with experience in eyebrow transplant surgery by integrating theoretical lectures with practiced procedures.

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.