FUE as the first surgical option for hair reconstruction on scalp and facial skin grafts - case report.

Post-combustion alopecia presents a complex medical challenge with implications spanning dermatological and psychiatric disorders. The use of hair transplantation has proven to be a significant improvement for this condition. However, the current management involves various techniques, each with advantages and disadvantages. Progressive skin expansions, surgical scar reduction, and skin grafts containing hair follicles yield unsatisfactory aesthetic outcomes and have limited applicability as a first-line treatment for fire victims. So far, follicular unit extraction (FUE) has proven to be one of the most versatile procedures in such cases, having the potential to restore a natural anatomical profile closely resembling the pre-traumatic appearance that led to the traumatic alopecia. Additionally, it contributes to the improvement of associated psychiatric comorbidities, facilitating proper social reintegration and enhancing overall quality of life. This report focuses on a case of post-combustion alopecia and severe facial distortion due to third-degree burns resulting in severe psychiatric comorbidities, which benefited from a proper social reintegration and improvement of the quality of life after three consecutive sessions of FUE for scalp and eyebrow hair.

Autologous follicular unit extraction transplant for postburn cicatricial alopecia: A single-center's retrospective case series.

BACKGROUND AND RATIONALE: Cicatricial alopecia not only affects patients' appearance but also has negative effects on their physical and mental well-being, as well as their daily lives. Therefore, it is essential to provide proactive treatment to patients. OBJECTIVE: To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of secondary scarring alopecia caused by burn, and to evaluate its effectiveness. METHODS: A retrospective observational study has been conducted, which included 41 patients with secondary scarring alopecia caused by burn. All patients underwent initial autologous FUE hair transplantation surgery, and the occurrence of postoperative complications was monitored. Patient satisfaction was evaluated after 12 months post-surgery. RESULTS: Satisfaction assessments were conducted for all 41 patients. Out of the total, 31 individuals expressed being very satisfied, 7 individuals reported being satisfied, and 3 individuals indicated being not very satisfied. Among the patients, 3 experienced complications, including herpes in the donor area for one patient, temporary hair loss for another patient, and thick scab for the third patient. CONCLUSION: FUE hair transplantation yields positive results for secondary scarring alopecia caused by burn. It offers natural hair growth patterns, minimal trauma, quick recovery, high patient satisfaction, and few complications.

Scalp Closure in Midline Cutis Aplasia-An Absolute Indication for Preoperative Imaging.

The ideal evaluation and treatment of aplasia cutis congenita remains disputed. We present a case of midline scalp cutis aplasia that healed by secondary intention, leaving an area of residual alopecia. There were no clinical indicators of an underlying calvarial defect. Tissue expansion of the scalp was done in preparation for scalp closure. However, on the removal of the expanders and scalp advancement, an unrecognized midline calvarial defect in which a scar tract of herniated dura was found. This resulted in a dural tear, repaired with minimal hemorrhage. However, manipulation of the sagittal sinus resulted in a right subdural hemorrhage followed by cerebral ischemia and a stroke. On the basis of this clinical scenario, we recommend that all cases of midline scalp cutis aplasia undergo preoperative imaging with thin slices of the calvaria before performing scalp advancement-even if the only clinical indication for surgery is scalp alopecia without a palpable skull defect.

Long-hair follicular unit excision enhances the cosmetic results of hairline restoration: A retrospective study in Chinese recipients.

BACKGROUND: Long-hair follicular unit excision (LHF) is gaining popularity, especially for hairline restoration, because it helps avoid hair removal in the donor area and provides better immediate postoperative results. AIMS: This study aimed to assess the postoperative clinical outcomes of LHF for hairline restoration. PATIENTS/METHODS: Data from 248 patients (223 women and 25 men) who underwent hairline restoration with LHF between September 2018 and June 2022 were analyzed, and they were followed up immediately and 9 months postoperatively. The complications and survival rate of long-hair grafts were assessed. Patient postoperative satisfaction was assessed using a 5-Point Likert Scale. The Generic Quality of Life Inventory-74 (GQOLI-74) assessed the quality of the postoperative life. RESULTS: The planned extraction density was set at 15-25 FU/cm2. The mean number of total extracted hair grafts, transection rate in the extraction area, and extraction time were 1970 ± 124 FU, 3.9 ± 0.2%, and 3.2 ± 0.8 h, respectively. The hairline implantation density was set at 50-70 FU/cm2. The mean number of total transplanted hair grafts was 2031 ± 371 FU; the implant time was 3.8 ± 1.9 h. No serious complications occurred within 7 days postoperatively. The mean graft survival rate was 93.1 ± 1.3% at 9 months postoperatively. All patients were satisfied with the immediate postoperative results, and most were satisfied with the 9-month outcomes (mean overall satisfaction score: 4.7). The scores of physical function, psychological function, social function and material life function after operation were higher than those before operation (p < 0.0001). CONCLUSIONS: Hairline restoration with LHF could enhance the cosmetic outcomes and be widely used in clinical practice.

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 initially is 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 grafts and 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 .

PRECISE Scale: a quantitative classification for androgenetic alopecia and its application to hair transplantation.

BACKGROUND: Androgenetic alopecia (AGA) is a prevalent genetic condition that can affect both male and female, and is considered the most frequent form of hair loss. Traditional scales and methods of classifying AGA are basically qualitative. OBJECTIVE: This work aims to propose a quantitative scale to classify AGA in order to assist hair transplantation surgery. METHODS: Based on whole hairless and thinning areas that needs to receive follicular units in a hair transplantation procedure, basic equations to support the scale are proposed. Additionally, the study involves simulations that apply the classification system and compare its results with those of qualitative methods. RESULTS: The PRECISE scale utilizes a range of 0-10, using 30 cm2 as the measured standard of a bald area. For hair transplantation, 1500 follicular units (FU) are recommended for each score in the PRECISE scale. Technological and manual methods to measure the hairless and thinning areas are presented and discussed. This new quantitative classification, combined with different and complementary methods of measurement of hairless and thinning areas endorse the understanding of the clinical condition by the patient and the planning of a surgery procedure. CONCLUSION: The developed PRECISE scale brings a different way of classifying Androgenetic alopecia (AGA), through an essentially quantitative evaluation. It can be used to elaborate the best strategy for the hair transplantation surgery and to improve the outcomes. LEVEL OF EVIDENCE V: 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 .

A new easy technique to identify the correct artificial hair implantation site: A case series and preliminary results.

BACKGROUND: The implantation of artificial hair is a successful standardized procedure to restore bald areas or scarred alopecic surfaces of the scalp in both sexes. MATERIALS AND METHODS: Sebometric measurements were taken, pre, 1, 3, and 6 months postimplant in two symmetric frontotemporal areas of the scalp of seven volunteers to be implanted with 50 units of artificial hair. The artificial hair used in this study are Biofibre 4.0 produced by Medicap srl, Italy. RESULTS: The dermaroller assisted procedure was performed only on one side, and the plain random implant contralaterally for comparison. A marked downregulation of the sebum concentration was observed in the dermaroller treated area 1, 3, and 6 months later in respect to the control side. CONCLUSION: The dermaroller assisted procedure is safe and effective in reducing the foreign body reaction by the sebaceous glands and the vascular axis injured by the implanting needle; a longer standing success of the implanted hair can thus be achieved reducing the burden of inflammatory reaction.

Paradigm Shift from Linear Strip to Follicular Unit Excision in Hair Restoration Surgery.

Follicular unit excision (FUE) is a very effective and valuable modality for obtaining donor hair follicles using manual, motorized, or robotic devices to harvest individual donor follicular units in situ without a linear donor scar or visible scarring making it ideal for patients who wish to wear their hair short and hide signs of surgery. Over the past two decades, FUE has become increasingly popular, and the rising demand for FUE has driven the worldwide market size of hair restoration surgery (HRS) to an unprecedented height.FUE has revolutionized the HRS industry and offers excellent cosmesis and high patient satisfaction. Unfortunately, a large part of the favorable appeal of FUE is due to false claims that it is "minimally invasive," "scarless," or "not even surgery." Most patients opt-in for FUE due to these misconceptions, which are advertised by "black-market" clinics offering low-cost FUE surgery performed by amateur, nonprofessional technicians on unsuspected patients. The technique appears deceptively simple, and many neophyte surgeons falsely believe that the learning curve of FUE is short because the barrier of entry is low and no previous surgical skill is required. Nevertheless, injuries on grafts are extremely easy to occur since FUE is a blind technique and can be minimized only with excellent technique, which takes years to master.FUE actually presents unique challenges for the surgeon and carries potential long-term permanent side effects if not performed properly. The surgeon must have a thorough understanding of the nuances of the FUE surgical technique to ensure consistent graft quality and favorable cosmesis of both donor and recipient areas. Efficient FUE requires dexterity, training, dedication, devotion, enthusiasm, cognitive clarity, scientific knowledge, experience, and an extended learning curve.FUE is an invaluable addition to the armamentarium of a hair restoration surgeon but has to be judiciously performed.

Follicular Unit Excision Donor Area Management and Considerations of the Scalp.

Over the last several years, follicular unit excision (FUE) donor harvesting has become the predominant donor harvest method, surpassing the traditional method of linear strip excision donor harvesting. While this may offer advantages in specific clinical settings, the reality of ongoing losses with the natural evolution of male patterned hair loss places a premium on obtaining as much lifetime donor hair as possible to address this clinical reality. This lifetime demand requirement must be weighed against the possibility of a detrimental cosmetic appearance of the donor area with serial donor harvests utilizing FUE. This chapter will examine the important technical and artistic considerations critical for hair restoration surgeons to appreciate in order to maintain cosmetically high-quality donor area outcomes in patients choosing to undergo FUE harvesting for hair transplantation surgery.

Clinical effects of autologous follicular unit extraction transplantation in the treatment of secondary cicatricial alopecia after infections.

OBJECTIVE: To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of secondary scarring alopecia caused by infections, and to evaluate its effectiveness. METHODS: A retrospective observational study has been conducted, which included nine patients with secondary scarring alopecia caused by infections. All patients underwent initial autologous FUE hair transplantation surgery, and the occurrence of postoperative complications was monitored. Patient satisfaction was evaluated after 12 months post-surgery. RESULTS: At the follow-up, postoperative satisfaction was 88.9% in nine patients, with only one case of postoperative infection and no incidence of skin necrosis, significant bruising and swelling, unnatural appearance or temporary hair loss. CONCLUSIONS: Autologous FUE hair transplantation is an effective method for treating secondary scarring alopecia caused by infections. This procedure is minimally invasive, resulting in high patient satisfaction and minimal complications postoperatively.

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.

Instrumentation and Devices Specific to Follicular Unit Excision.

The volume of hair transplantation procedures done via the follicular unit excision (FUE) harvesting technique has increased tremendously over the last few years. With this growth, new advances in technology have come along. The wide variety of instrumentation and devices can be overwhelming, especially for a novice surgeon. This chapter aims to discuss the relevant aspects of FUE and its relationship to the devices that are used to harvest grafts. The development and overview of all the major types of instrumentation will be reviewed.

Concepts, Terminology, and Innovations in Follicular Unit Excision Hair Restoration Surgery.

Follicular unit excision (FUE) has emerged as the preferred method for hair transplants. Standardized terms and definitions established by members of the International Society of Hair Restoration Surgery and prominent hair restoration surgeons have become the standard, enabling effective knowledge sharing. This chapter provides an overview of the terminology relating to the field.The historical evolution of FUE and its pivotal role in modern hair transplantation is summarized. Anatomical terminology and graft-related definitions follow, providing insights into the scalp's complex structures and graft characteristics. The subsequent sections detail the terminology associated with graft excision and extraction, shedding light on the precise techniques and procedures employed. An exploration of various FUE techniques and the evolving landscape of FUE devices underscores the continual refinement of hair restoration practices. The chapter proceeds to discuss the "safe'" scalp donor zones, donor assessment terminology, and elements in identifying the optimal donor area for a successful FUE procedure. Additionally, punch dynamics and technique characteristics are examined, emphasizing their pivotal role in achieving superior FUE outcomes. The chapter concludes by discussing the classification of punches and graft evaluation terms, offering insights into the tools, and criteria used to assess graft quality and viability.

Follicular Unit Excision-Linear Ellipse Donor Harvesting Technique: Combining Standard Follicular Unit Excision with Follicular Unit Excision inside a Linear Strip (Modified Linear Strip Excision) to Optimize Graft Yield.

Follicular unit excision (FUE) graft dissection has become the dominant method of donor harvesting globally, however, only a percentage of donor hair can be excised inside the safe donor area before visible donor thinning occurs. Compared to linear strip excision (LSE) where all follicular units inside the harvested ellipse of hair are used, FUE poses substantial limitations for lifetime graft yield and, therefore, cosmetic coverage in patients with advanced pattern hair loss. This paper reviews how combining the donor harvesting methods of FUE and LSE has been shown to optimize graft yield while minimizing the risk of donor depletion from overharvesting. It then describes a surgical technique called FUE-Linear Ellipse (FUE-LE) where FUE dissection of grafts inside a demarcated linear ellipse eliminates the need for a large dissection team which has posed a barrier for many new practices that offer both the donor harvesting methods. For practices that currently offer only FUE, the addition of the LSE method by the modified FUE-LE technique is possible without specialized staff training or associated equipment costs. In this paper, surgery practices that have adopted this technique will report on their experiences. Hair restoration surgeons are encouraged to provide both methods of donor harvesting (FUE and LSE using FUE-LE) in order to optimize graft yield for patients and avoid long-term donor depletion. Based on limited experience, it appears the technique of FUE-LE will help achieve this goal.

Utility of Follicular Unit Excision Using Nonscalp Donor Hair.

Nonscalp donor hair harvesting or body hair transplantation 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 nonscalp 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. Nonscalp hair donor harvesting is technically challenging and should be performed by those with extensive experience in follicular unit excision surgical techniques.

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.

Impact of Hair Transplantation on Quality of Life.

BACKGROUND: Alopecia is defined as partial or complete hair loss. The most common form is androgenetic alopecia, which occurs in both men and women. Despite the nonsurgical options available for treatment, the only permanent solution is hair transplantation. Hair loss has been shown to have significant psychological consequences associated with loss of self-confidence, poor self-image and difficulties in social functioning. We aim to examine the effect of hair transplantation on quality of life and psychosocial functioning. METHODS: Forty-eight patients with androgenetic alopecia were enrolled in this two-center prospective study and underwent hair transplantation by the Follicular Unit Extraction method. Different questionnaires were used to assess their quality of life and other psychosocial parameters before and after hair transplantation. RESULTS: According to SF-36 Physical and Mental Health Score patients showed significant improvement in life quality after hair transplantation. Diener's Life Satisfaction Scale (DASS-21) revealed increased life satisfaction after the procedure. Stress and anxiety DASS-21 subscales showed significantly reduced results; while, the DASS-21 depression scale and MSPSS were not significantly changed. CONCLUSION: Taken together, quality of life and psychosocial functioning increased after hair transplantation. Structured abstract is required. Please provide.I insert name of paragraphs within abstract as follows: background, methods, results, conclusion Level of Evidence II: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .