Is Every Patient of Hair Loss a Candidate for Hair Transplant?-Deciding Surgical Candidacy in Pattern Hair Loss.

Patterned hair loss which includes both male pattern hair loss (MPHL) or androgenic alopecia (AGA) and female pattern hair loss (FPHL) is the most common indication for hair transplant surgery. However, not all such patients are candidates for hair transplants. There are eight conditions that cause patients to not be appropriate candidates. These are: diffuse unpatterned alopecia (DUPA), cicatricial alopecia (CA), patients with unstable hair loss, patients with insufficient hair loss, very young patients, patients with unrealistic expectations, patients with psychologic disorders such as body dysmorphic disorder (BDD) and trichotillomania, and patients who are medically unfit. In addition, there are patients who are poor candidates and who should undergo hair transplantation only if they understand and accept limited results. The key to identifying these patients involves performing careful and detailed history and examination at the time of consultation.

Using Nonscalp Hair in Scalp Hair Restoration-Theory and Execution.

Harvesting of beard and body hair follicles for transplantation can be an effective form of treatment for appropriate patients. These patients may have had prior scalp transplantation and require repair but do not have sufficient scalp donor follicles remaining. Other patients will have these hairs mixed with scalp hairs to produce a greater density of hair on the bald scalp. Follicular unit excision (FUE) is preferred for body and beard follicle harvesting. Not all body hair is suitable for transplantation. Only hairs that are similar in appearance and behavior to scalp hair are suitable for transplantation to the scalp. The best nonscalp sources are the beard and anterior torso. Hairs from other body sites may be used for transplantation to the eyebrows. The standard techniques of FUE harvesting and anesthesia must be modified from those used in scalp harvesting to be safe and effective. With proper patient selection and technique, a significant cosmetic benefit can be achieved from these procedures.

Follicular Unit Excision Punches and Devices.

BACKGROUND: Follicular unit excision (FUE) is used to harvest follicular units for hair transplantation using trephine punches. The characteristics of FUE punches can impact the success of this technique; thus, many innovative punch designs and devices have been developed. With many options available, it can be difficult for the hair restoration surgeon to know which punch best suits the needs of their patients. OBJECTIVE: To provide a comprehensive review of punch shapes and devices available. METHODS: Search of PubMed, reference mining of relevant publications, and hand searching trade publications. RESULTS: We examined FUE punches and devices and consolidated descriptive information for each to create textual and visual guides. No single punch shape or device may suit all cases; thus, it is important to know the best uses and limitations of each. CONCLUSION: The surgeon should have a comprehensive knowledge base of available punch shapes and devices and understand the advantages and disadvantages of each. It is also beneficial to have an in-depth knowledge of skin properties and follicular unit structure. Ultimately, understanding the dynamics behind punch excision will enhance the FUE technique.

Innovations hair restoration surgeons have made to adapt to the challenges of follicular unit excision.

BACKGROUND: Early use of follicular unit excision (FUE) as a method of hair transplantation was limited by high rates of hair follicle transection. This hurdle has been overcome by innovative methods, punch shapes, and devices. With the vast array of tools available, it can be difficult for hair transplant surgeons to choose the best option for their practices. AIMS: To provide an in-depth review and comparison of currently available FUE methods, punch designs, and motorized devices, and discuss how these tools fit the unique skin and hair characteristics of patients. METHODS: A review of the literature and available information on FUE methods, punches, and devices, as well as the authors' experience in this area, is provided. RESULTS: Innovative FUE methods, punch shapes, and motorized devices have successfully minimized the rate of hair follicle transection. Methods include the use of sharp punches with depth control, and blunt rotating punches. Punch shapes such as flared, hybrid, and edge out have successfully reduced transections by keeping the cutting edge away from the follicles under the skin. The development of motorized devices using features including rotation, roto-oscillation, oscillation, vibration, suction, and hydration has also aided in achieving more successful graft excision. CONCLUSION: Follicular unit excision is a widely used technique by hair restoration surgeons. Therefore, it is important for physicians to be aware of the array of punches and devices available and understand how these tools can be used to adapt to the unique skin and hair characteristics of individual patients to optimize successful graft harvesting.

Microprocessor-controlled local anesthesia versus the conventional syringe technique in hair transplantation.

BACKGROUND: Local anesthesia by the traditional injection technique is central to optimizing patient comfort during hair transplant procedures. However, even when carefully and properly performed, some patients still describe their treatment sessions as painful. OBJECTIVE: To determine if patients undergoing hair transplantation experience less pain and discomfort when their local anesthesia is performed with the Wand (as of spring 2001, the Wand has been renamed "CompuMed- Featuring the Wand Handpiece"), a microprocessor pump that precisely controls the infusion rate and pressure of local anesthetic solution. METHODS: We used combined retrospective studies and a prospective blinded study of men and women who received hair transplantation treatments between January 1999 and March 2001 at our private outpatient clinics in the United States. A total of 101 patients compared their experiences during their hair transplant sessions performed by us before and after we started using the Wand. Thirty-nine patients compared their experiences during treatments done by 32 other medical groups and when we used the Wand. In addition, 88 patients compared the Wand to injection while blinded to technique. The outcomes were measured with patient pain rating questionnaires using the Wong-Baker Faces Pain Rating Scale (0, no pain-5, severe pain). RESULTS: Patients in all three study groups reported that anesthesia with the Wand was less painful. Wand anesthesia was overwhelmingly (68%) described as associated with none (0) or very little (1) pain. Surprisingly, Wand anesthesia was associated with superior comfort not only during the administration of anesthesia (P =.005), but throughout the treatment session and during the first 48 postoperative hours. CONCLUSION: Microprocessor-controlled local anesthesia with the Wand is superior to traditional injection in consistently producing comfortable hair transplant treatments.