Comparative Study Between Follicular Unit Extraction (FUE) And Non Cultured Melanocyte Transfer (NCMT) In Stable Vitiligo Patients

Background: Vitiligo is an acquired, hypomelanotic disorder characterized by circumscribed depigmented macules in the skin resulting from the loss of functional melanocytes from the cutaneous epidermis. It also causes significant psychological and social distress. Aims and Objectives: To compare the efficacy of follicular unit extraction and non cultured melanocyte transfer in patients of stable vitiligo with respect to repigmentation, vitiligo noticeability and global treatment success. Material and Methods: A total of 15 patients with stable vitiligo (as per IADVL guidelines) were enrolled in the study. In the same patient follicular unit extraction (FUE) was done in the vitiliginous lesions and the hair was transplanted approximately 3-5 mm apart on the left side of the body, while another vitiliginous lesion in the same patient was selected for non cultured melanocyte transfer (NCMT) which was done on the dermabraded area on the right side of the body. These patients were followed-up for a period of 6 months, initially at every 2 weeks or till first signs of repigmentation, then monthly follow-ups for two times and then followed-up in every 2 months. Visual analogue scale was used for assessment of repigmentation, VNS scale was used to evaluate vitiligo noticeability and global treatment success was calculated. Results: There were 2 (13.3%) females and 13 (86.7%) males in our study, showing a male preponderance. Majority of the patients were in the age group 21-40 years (66.7%). There was statistically significant increase in the mean pigmentation at each follow-up in comparison to the earlier follow-up in both the groups (p<0.05). The mean pigmentation and mean pigmentation difference, between the two groups was also comparable (p>0.05). Excellent pigmentation was seen in 60% patients of FUE and 73.3% patients of the NCMT group. Vitiligo was ‘not noticeable’in 33.3% patients of FUE and 40.0% patients of NCMT group. Global treatment success was 80% in both the groups. Bony prominence, greying and loss of follicles in FUE group; and graft displacement and herpes zoster in NCMTgroup were the factors responsible for low pigmentation. Conclusion: From the above study, we conclude that repigmentation was seen in both the groups, with equal efficacy seen between the two methodologies. Thus, any method can be applied for repigmentation with due considerations to complications of each method used.

Efficacy of follicular unit extraction in the repair of scarring eyebrow loss: a clinical observation / 中华皮肤科杂志

Objective To evaluate the efficacy of follicular unit extraction (FUE) in the repair of scarring eyebrow loss.Methods A total of 30 patients with scarring eyebrow loss were treated with FUE technique in the Department of Plastic Surgery of Zhengzhou First People's Hospital,including 18 females and 12 males with 41 eyebrow defects.Fine soft hairs with a length of 5-10 mm were extracted from the back of the ear and temporal region of the patients,and then were split into individual follicular units under a microscope at 6 × magnification.The transplant density ranged from 20 to 30 FU/cm2.Results During the 3-18 months of follow-up after the surgery,eyebrows in the recipient areas grew in a natural direction and showed good appearance.The survival rate of hair grafts was up to 90％,and the patients were satisfied with the results.Conclusion FUE may be an ideal method for the treatment of scarring eyebrow loss with less injury and high survival rate of hair grafts.

Extração de unidades foliculares: transplante capilar sem cicatriz linear / Follicular unit extraction: hair transplant without linear scar

Introdução: A técnica de extração de unidades foliculares (FUE, do inglês follicular unit extraction), de um a três folículos capilares, dispensa a necessidade de ressecção da área doadora na região occipitotemporal e de outros envolvimentos táticos e técnicos para transformar o material adquirido nessas unidades. Estas são obtidas diretamente, sendo extraídas por meio de pequenos cilindros ocos (punches), com diâmetro variando de 0,8 mm a 1mm, mediante incisão circular ao redor de cada unidade folicular no couro cabeludo e, subsequente, extração. Método: Foram avaliados e acompanhados, durante 24 meses, 77 pacientes submetidos a transplante de unidades foliculares, aplicado na correção de áreas de alopecia dos mais diversos tipos (androgênica, em cicatrizes de áreas pilosas, transplantes em supercílios, em pequenas áreas de calvície). Destes, 12 eram do sexo feminino e 65 do masculino, com idades que variavam de 19 a 65 anos; sete pacientes foram operados para correção de cicatrizes inestéticas e alargadas, decorrentes de transplantes capilares anteriores, realizados por técnicas convencionais. Os cuidados transoperatórios na manipulação das unidades foliculares são mais acurados, dada a sutileza de suas estruturas. Resultados: Apesar do tempo cirúrgico aumentado, não existe cicatriz linear e as áreas doadoras são menos visíveis e totalmente camufláveis pelos cabelos adjacentes no período de 3 a 5 dias de pós-operatório, mesmo com os cabelos raspados. Conclusão: O método exige maiores cuidados quanto aos procedimentos táticos e técnicos de manipulação e à obtenção das unidades foliculares.

Introduction: Follicular unit extraction (FUE), which involves harvesting a follicular unit containing between one and three hair follicles, prevents the need for donor area resection in the occipitotemporal region for hair transplantation. This method also avoids the need to dissect the material acquired into follicular units. In this method, the follicular units are directly obtained and extracted using small hollow cylinders (punches) with a diameter of 0.8­1 mm through a circular incision around each follicular unit on the scalp. Method: Over 24 months, we evaluated 77 patients with various forms of alopecia (including androgenic and scarring hair loss, eyebrow loss, and small bald areas) who underwent follicular unit transplant. Twelve patients were women and 65 men, with ages ranging from 19 to 65 years. Seven patients underwent the procedure to correct unsightly and extended scars caused by previous hair transplants performed by conventional techniques. This method requires greater intraoperative care in handling the follicular units to avoid damaging them. Results: Although the surgical time was increased, no linear scarring was observed, and the donor areas were less visible due to being masked by adjacent hairs from 3 to 5 days after surgery. This was the case even with shaved hair. Conclusion: Although this procedure requires greater care in handling and obtaining follicular units, FUE enables hair transplants without a linear scar. As such, this method has many clinical indications.

Asian Female Hairline Surgery Using Follicular Unit Extraction

BACKGROUND: Asian female hairline surgery is unique part among hair transplantation surgerys. Most of Asian female hairline surgery had been done by single strip harvesting technique which leave noticeable linear scar. As follicualr unit extraction is introduced1, female hairline surgery can take advantage of the Follicular Unit Extraction technique;leaving no linear donor scar. There has been a belief among surgeons who are somewhat reluctant to use follicular unit extraction for female hairline surgery that the inspection of the naturally occurring curl direction of hair, which is believed one of the critical steps for appropriate operative result in Asian female hairline surgery, is impossible in follicular unit extraction. So follicular unit extraction has to be 'plan B' in respect of Asian female hairline surgery. But author thought differently about this belief. METHODS: From December 2012 to May 2013, 78 consecutive cases of female hairline surgerys were done by follicular unit extraction. The ages of patients were 18 to 57 and mean was 34.5. The cases can be categorized in 3 groups; 1) Correction of fronttemporal recession only. 2) Whole hairline correction (including fronto-temporal recession, temporal recession and lowering of the central hairline). 3) Correction of the hairline with scar by previous aesthetic surgery just like forehead lift or forehead reduction surgery. Donor hair was harvested by follicular unit extraction and preparation of donor area was done by micro-strip shave pattern, by which no short haircut window was needed. Follow up periods were 4 months to 8 months. RESULTS: Aesthetic results of the all cases were satisfactory. There were three cases which needed small session (less than 100 hairs) for relatively less survival area (all of these areas were the anterior part of hair part) and two cases of small 'moth-eaten pattern' on donor area which need no treatment or another session for aesthetic improvement. There was no lumpy graft which can be look unnatural or literal wall of plug graft in anterior part of corrected hairline. There was no linear harvesting scar, which is in-evitable in single strip harvesting, on donor area. CONCLUSIONS: Follucualr unit extraction can be versatile technique for hair restoration surgery and also hold good for Asian female hairline surgery.