Stem cell therapy prior to follicular unit hair transplantation on scarred tissue: a novel approach to a successful procedure.

Follicular unit hair extraction (FUE) is effective for hair restoration but is less successful on scarred tissue due to reduced vascularity and altered tissue architecture. Stem cell therapy can enhance tissue regeneration, possibly improving FUE outcomes on scarred tissue. This study investigated the impact of stem cell therapy prior to FUE on scarred tissue. Sixty patients with scalp scars from trauma or previous surgeries were divided into two groups. Group A (n = 30) received autologous stem cell therapy followed by FUE, while Group B (n = 30) underwent FUE without prior stem cell treatment. Autologous stem cells were harvested from patients' adipose tissue and injected into the scarred area four weeks before FUE. Outcomes were assessed at 3-, 6-, and 12-months post-transplantation, focusing on hair density, graft survival rate, and patient satisfaction. Histological examinations evaluated tissue regeneration. Group A showed significantly higher hair density (mean increase of 45%) and graft survival rates (87%) compared to Group B (mean increase of 25%, graft survival rate of 60%) at all follow-up points (P < 0.05). Histological analysis revealed enhanced neovascularization and reduced fibrosis in the stem cell-treated group, with 70% more new blood vessels and 50% less fibrotic tissue compared to the control group. Patient satisfaction scores were higher in Group A (average score of 8.5 out of 10) versus Group B (6.0), indicating better aesthetic outcomes and reduced scar visibility. Pre-treatment with autologous stem cell therapy significantly improved FUE effectiveness on scarred tissue, enhancing graft survival, hair density, and patient satisfaction. Further research is recommended to optimize this therapeutic strategy.

A Comparative Study on the Application of Robotic Hair Restoration Technology Versus Traditional Follicular Unit Excision in Male Androgenetic Alopecia.

BACKGROUND: The robotic hair transplant technology, ARTAS, has a series of fine mechanical structure and an intelligent recognition system that allows it to independently select hair follicular units (FUs) and effectively harvest hair. After entering China in 2016, ARTAS has attracted the attention of hair transplant surgeons and hair loss patients given its advantages in a short learning curve and simple operation. OBJECTIVE: To compare the efficacy and safety between the ARTAS system and follicular unit excision (FUE) in the treatment of male androgenetic alopecia (AGA) and to further promote the improvement and upgrading of ARTAS technology concerning hair transplantation. METHODS: Thirteen Chinese male patients with Norwood-Hamilton II-IV AGA aged 25-35 years were enrolled in this study. The donor site of each patient was randomly divided into left and right regions, receiving ARTAS on one side and FUE on the other. Yield, transection, and discard rates of hair FUs from both sides were compared. Safety of the procedures in whole, as well as follow-up results were investigated and evaluated. RESULTS: The total yield rate on the ARTAS side was lower than on the FUE side (82.05% vs. 90.03%, p > 0.05); the total discard rate on the ARTAS side was higher than on the FUE side (10.71% vs. 5.46%, p < 0.05); the total transection rate on the ARTAS side was lower than on the FUE side (13.17% vs. 13.96%, p > 0.05). No significant difference was found in patient satisfaction (efficacy), and no side effects or complications were detected during or after all surgeries. CONCLUSION: The current iteration of Robotic hair transplant technology is effective and safe, and can be recommended for AGA hair transplantation surgery.

Recipient Site Necrosis After Follicular Unit Excision Technique For Hair Transplantation: Evaluation of 18 Patients.

BACKGROUND: Hair transplantation is a widely performed cosmetic procedure for hair restoration. While generally safe, it carries the risk of complications, including recipient site necrosis (RSN). RSN is a rare but serious complication. This study aims to conduct a detailed analysis of 18 patients who had necrosis in the recipient area after hair transplantation. METHODS: A retrospective review of medical records was conducted on 18 consulted patients who developed RSN following hair transplantation between 2017 and 2023. Data collected included patient demographics, medical history, surgical details, treatment modalities, and outcomes. Treatment involved surgical intervention (debridement), and conservative measures (wound care) in all cases. RESULTS: The mean age of patients was 36.06 years (range: 22-48). The most common risk factors identified were smoking 66.7% (n = 10), hypertension 20% (n = 3), and diabetes mellitus 13.3% (n = 2). All patients (n = 18) underwent single-session hair transplantation using the follicular unit excision technique, and an average of 3899.44 ± 93.76 follicular units were transplanted. Outcomes such as scarring and graft failure occurred in all patients. CONCLUSION: The presented study is the largest complication series in the literature. RSN is a rare but significant complication of hair transplantation. Identifying and managing risk factors, such as smoking, diabetes and hypertension, is crucial for prevention. Early recognition and prompt treatment are essential for optimal outcomes. While conservative management is often successful, surgical intervention may be necessary in severe cases. 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 .

Facial Hair in Hair Restoration Surgery: Beard Transplantation and Beard-To-Scalp Hair Restoration.

Restoration of the beard region has become an important component of hair restoration surgery due to increased awareness of its natural-appearing results. In the author's experience performing more than 700 primary beard hair transplants and tens of reparative procedures, key aesthetic steps include proper graft dissection so that one- and two-hair grafts contain a minimal cuff of surrounding skin, acute angulation and appropriate direction of recipient sites using the smallest possible recipient-site blades, and aesthetic design.

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.

Evolución de la técnica follicular unit extraction (FUE) / Evolution of the follicular unit extraction (FUE) technique

El microtrasplante capilar, método FUE, es la cirugía para la recuperación capilar que consta en la extracción de unidades foliculares con punches de distintos diámetros y longitudes, desde una zona llamada dadora, generalmente occipital y/o temporal aunque pueden utilizarse otras partes del cuerpo como barba, tórax, abdomen y pubis, para luego de seleccionarse y conservarse en forma adecuada ser implantadas en la llamada zona receptora. Tanto los avances en la técnica como en el uso de instrumental de última generación generan resultados mejores y más naturales, con una recuperación más rápida y menor daño de sus zonas dadoras.

Hair transplant, FUE method, is surgery for hair recovery that consists of the extraction of follicular units with punches of different diameters and lengths, from an area called the donor; usually occipital and/or temporal; although they can be used on other parts of the body such as beard, thorax, abdomen and pubes. After being appropriately selected and preserved, they are implanted in the so-called receiving area. Both advances in technique and in the use of cutting-edge instruments generate better and more natural results, with faster recovery and less damage to the donor areas

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Preoperative prophylaxis, timely diagnosis, and immediate treatment of scalp necrosis can prevent serious complications and reduce morbidity after hair transplantation.

No-Shave Long Hair Follicular Unit Excision Using an All-Purpose Skin-Responsive Device.

Background: Current no-shave long hair-follicular unit excision (LH-FUE) techniques employ recesses (slots, notches, or grooves) in punch tips to reduce the long-hair shaft break rate (SBR) and graft transection rate (GTR). However, these methods demand advanced skills and extended procedure time. Objective: We aimed to evaluate a skin-responsive FUE technique without the use of recess-tipped punches, accommodating diverse hair and skin types in LH-FUE procedures. Methods and Materials: We retrospectively analyzed patients who underwent this technique using a UGraft Zeus device at five multinational clinics (Mexico, Colombia, India, United States, and Türkiye) from August 9, 2021, to April 11, 2023. Donor zones were pre-operatively graded for expected difficulty using the Sanusi FUE Scoring (SFS) Scale, ranging from class I (low difficulty) to V (high difficulty). Results: Among 152 patients (mean age, 46 years; 146 straight-wavy, 6 curly-coiled hair), most (n=107) were class I donors. The GTR ranged 2.2%-4.3%, and was highest in class IV donors and those with thick-firm scalps. The SBR was 12.2%, and the average graft excision rate (GER; speed) was 440 grafts/h. Only 19G and 18G punches were used. All patients were satisfied with the procedure, with 57.4% reporting that they were "very happy". Surgeon willingness to perform no-shave LH-FUE significantly increased from 1.25 to 4.20 (on a scale of 1-5) after adopting this device. SFS class, skin thickness, and firmness, more than hair curliness, influenced the GTR, SBR, torque, and punch movement duration. Conclusion: Our findings reveal consistent success in conducting no-shave LH-FUE using this skin-responsive device across diverse patients. Notably, success was achieved without recess-tipped punches, resulting in low GTR and SBR, along with a high GER and increased patient satisfaction. These outcomes suggest enhanced procedure speed and ease of use, contributing to a greater willingness among surgeons to adopt this technique.

Hair follicle extraction combined with an expanded scalp flap for facial organ reconstruction.

BACKGROUND: Use of scalp skin for facial organ reconstruction represents a mainstream procedure for organ reconstruction. In most cases, adequate amounts of skin can be obtained by using tissue expanders, but harvesting sufficient scalp tissue in patients with low hairlines is challenging. Hair follicular unit extraction (FUE) is one approach to resolve this problem. With FUE, hair follicles are removed from the scalp skin, which can then be prepared as a donor site to obtain sufficient amounts of hairless skin. OBJECTIVES: To evaluate the safety and efficacy of FUE when combined with an expanded scalp flap for facial organ reconstruction. MATERIAL AND METHODS: Patients with low hairlines requiring facial organ reconstruction were selected for this study. The area of skin extension and hair removal were determined prior to surgery, a process which was performed in three stages. Stage I consisted of hair follicle removal using the FUE technique at the donor site. Stage II involved expander implantation using water injections. In Stage III facial organ reconstruction was completed. RESULTS: With the use of the FUE technique, hair follicles from the donor scalp were thoroughly removed and the donor scalp tissue was successfully expanded. Postoperatively, no evident scar formation at the reconstruction site or contracture of the expanded flap was observed. All patients were satisfied with the outcome of their reconstruction procedure. CONCLUSION: FUE provides a means for hair follicle removal from the donor site and can be employed to achieve a safe and effective procedure for facial reconstruction in patients with low hairlines.

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

Purpose: 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. Patients and Methods: 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. Results: 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. Conclusion: 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.

Toxicokinetic analyses of naphthalene, fluorene, phenanthrene, and pyrene in humans after single oral administration.

Polycyclic aromatic hydrocarbons (PAHs) are generated by incomplete combustion of organic matter. They have health effects in multiple organs and can cause lung, skin, and bladder cancers in humans. Although data regarding their toxicity is available, information on the absorption, distribution, metabolism, and excretion of PAHs in humans is very limited. In the present study, deuterium-labeled naphthalene (Nap), fluorene (Flu), phenanthrene (Phe), and pyrene (Pyr) were orally administered as a single dose (0.02-0.04 mg/kg) to eight healthy adults. Both serum and urine samples were monitored for 72 h after the exposure. Parent compounds and PAH metabolites (monohydroxy-PAHs; OH-PAHs) were measured by headspace-solid phase microextraction coupled with gas chromatography-mass spectrometry and high-performance liquid chromatography-tandem mass spectrometry, respectively. Based on the time-concentration profiles in serum and urine, non-compartmental analysis was performed, and two-compartment models were constructed and validated for each PAH. Subsequently, all of the parent compounds were rapidly absorbed (Tmax: 0.25 to 1.50 h) after oral administration and excreted in urine with a biological half-life (T1/2) of 1.01 to 2.99 h. The fractional urinary excretion (Fue) of OH-PAHs ranged from 0.07 % to 11.3 %; their T1/2 values ranged from 3.4 to 11.0 h. The two-compartment models successfully described the toxicokinetic characteristics of each PAH and its metabolites. Fue and the two-compartment models could be useful tools for exposure simulation or dose-reconstruction of PAHs. The results of this study will provide useful information for interpreting biomonitoring data of PAHs.

Maxillofacial Surgery and Hair Transplantation: Ethics with Expertise.

Background: The hair transplantation has become widely popular aesthetic procedure. Hair transplantation being a relatively new field in maxillofacial surgery, several aspects raise issues and controversies. Follicular unit transplantation (FUT) and follicular unit extraction (FUE) are two commonly used and accepted techniques. Further, hair transplantation has been successfully used in correction of alopecia, cleft lip scars, post-burn or surgical scars, vitiligo and as an adjuvant to other maxillofacial procedures. Several maxillofacial surgeons have incorporated hair transplantation procedure into their aesthetic practice successfully. Sound knowledge of surgical technique, armamentarium and proper surgical planning are important for good results. A lot of debate has been there on minimum qualification for performing hair transplantation. Purpose: The aim of this review is to highlight that an oral and maxillofacial surgeon can perform hair transplant surgery with perfection and can manage all associated complications with expertise.

An Economical Innovative Use of a Dental Burr to Sharpen and Reuse Follicular Unit Extraction (FUE) Punches for Hair Transplantation.

A simple technique of using a dental burr to sharpen a follicular unit extraction (FUE) punch for hair transplant surgery is used. During the process of extraction in FUE, the sharpness of a punch plays a vital role in reducing transection rates and thus increasing the yield of harvested grafts. Every time a sharp punch loses its sharpness, its expensive to replace it, hence we have described an ingenious technique to reuse a punch innumerable times, thus reducing the financial burden for the surgeon and the patient.

Effects of Fertilization Approaches on Plant Development and Fertilizer Use of Citrus.

Fertilization is an important part of citrus crop management. However, limited details are available about the fertilization approach on citrus plant development. A pot experiment for the fertilization approaches and fertigation levels were conducted in this study. Four fertilization approaches, namely, drip fertigation (DF), broadcast fertilization (CK+), hole fertilization (HF) and pour fertilization (PF) were tested. The fertigation level treatment included 100% (DF-337.5), 80% (DF-270), 60% (DF-202.5) and 40% (DF-135) fertilizer supply with DF, and the 100% fertilizer supply with broadcast fertilization were served as control (CK). The results showed that DF not only increased the absorptions of nitrogen (N), phosphorus (P) and potassium (K) but also promoted citrus plant height, stem diameter and dry weight. In fruit quality, DF had the highest fruit total soluble solid (TSS) and titratable acidity (TA) contents. For fertilizer loss, DF had the lowest N and K leaching losses of 9.26% and 4.05%, respectively, and the lowest N and K runoff losses among the approaches. Isotopic tracing with 15N indicated that DF had the highest fertilizer use efficiency. Based on the analysis of fertigation levels, DF approach with 60% fertilizer reduction could improve citrus plant development. Therefore, DF promoted citrus plant growth and fruit quality by accelerating fertilizer utilization and impairing fertilizer loss. The fertilizer amount in citrus production could be reduced significantly using DF.

The pros and cons of follicular unit extraction (FUE) versus elliptical donor harvesting (FUT).

Hair transplantation has evolved as a practice since the 1960's with advances in technology and surgical technique. With various surgical techniques in existence, patients and practitioners have an abundance of options to curate the best results for the patient. However, with many options come various benefits and consequences that must be examined on a patient-by-patient basis. This review article sought to examine the various surgical modalities of hair transplantation, to outline the pros and cons of various techniques, and to help outline considerations when choosing a given surgical technique.

Restoration of appearance for women after aesthetic eyelash transplantation using a novel eyelash resection technique.

BACKGROUND: Hair transplantation based on the follicular unit extraction provides a new opportunity to improve the appearance of patients with congenital sparse eyelashes. However, disparity between transplanted grafts and original eyelashes and the physiological characteristics of upper eyelid skin cause difficulties with this technique and result in low satisfaction. Removal of unsatisfactory eyelashes is indispensable for restoration of appearance and a second transplantation. Unfortunately, existing methods for hair removal have variable success rates, and hairs frequently regrow. OBJECTIVE: This article introduces an effective method to remove unsatisfactory eyelashes in patients with congenital sparse eyelashes who have undergone eyelash transplantation. METHODS: We used a new technique, which involves resection of eyelashes with a composite strip, to remove unsatisfactory eyelashes in patients who underwent eyelash transplantation. The demographic and clinical characteristics of patients were recorded. Outcomes evaluated included patient satisfaction, hair regrowth, and long-term complications. RESULTS: From 2017 to 2021, 10 patients (20 sides) underwent eyelash removal. All patients were highly satisfied with the outcomes. Unsatisfactory eyelashes were thoroughly removed, and none regrew during 1 year of follow-up. No complications were observed. CONCLUSION: Strip composite eyelash excision is a safe and effective method for patients who have undergone unsatisfactory eyelash transplantation.

Cicatricial eyebrow restoration using the follicular unit extraction technique.

INTRODUCTION: Cicatricial eyebrow loss that occurs after trauma or burns considerably reduces a person's self-confidence. Several methods, either surgical or nonsurgical, have been defined to reconstruct eyebrows. This study focused on eyebrow restoration using the atraumatic follicular unit extraction (FUE) technique in patients and emphasized certain details that should be considered during the treatment process. In this study, we discussed the management of 18 cases using this technique and their outcomes with respect to published literature. METHODS: This study examined eyebrow restoration performed using a modified FUE technique in 18 patients who had cicatricial eyebrow loss due to trauma, excised congenital giant nevus, or burns. Moreover, special methods, including platelet-rich plasma, microneedling, steroid injections, and fat grafting, were used in each patient to increase the odds of graft survival. RESULTS: Aesthetically and functionally satisfactory outcomes were observed along with the appropriate orientation and symmetry of the eyebrows in all patients' follow-ups. Moreover, patients exhibited increased self-confidence, and the quality of skin, particularly in the transplantation area, was improved. There was no complication either in the recipient or in the donor site. CONCLUSION: Eyebrow restoration using the atraumatic FUE technique should be considered as the first treatment option in cases with cicatricial eyebrow loss as long as an appropriate evaluation and treatment method is followed for each patient.