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.

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

BACKGROUND: 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. OBJECTIVE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

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.

Preparation of Platelet-Rich Plasma: National IADVL PRP Taskforce Recommendations.

The goal of these recommendations is to provide a framework to practitioners for implementing useful, evidence-based recommendations for the preparation of platelet-rich plasma (PRP) in various dermatological indications. The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these recommendations to its task force on PRP. A comprehensive literature search was done in the English language on the preparation of PRP across multiple databases. The grade of evidence and strength of recommendation was evaluated on the GRADE framework (Grading of Recommendation, Assessment, Development and Evaluation). A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared. A total of 45 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], and case series) were critically evaluated and the evidence thus gathered was used in the preparation of these recommendations. This expert group recommends the use of double-spin manual method for the preparation of PRP. The recommended parameters for centrifuge are 100-300 g for 5-10 min for the first spin and 400-700 g for 10-17 min for the second spin. The recommended platelet concentration in PRP for the treatment of various dermatological conditions is 1-1.5 million platelets/µL. The activation of PRP is not required when it is injected into soft tissues.

Platelet-Rich Plasma in Androgenetic Alopecia.

The goal of these recommendations is to provide a framework to practitioners for implementing useful, evidence-based recommendations for the preparation of platelet-rich plasma (PRP) and its use in androgenetic alopecia (AGA). The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these recommendations to its taskforce on PRP. A comprehensive literature search was done in the English language on the PRP across multiple databases. The grade of evidence and strength of recommendation were evaluated on the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) framework. A draft of clinical recommendations was developed on the best available evidence, which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, the final consensus statement was prepared. A total of 30 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], and case series) were critically evaluated, and the evidence thus gathered was used in the preparation of these recommendations. This expert group recommends use of manual double-spin method for the preparation of PRP for AGA. Minimum three to five sessions of PRP are recommended for AGA with a gap of 1 month between the two sessions. Patients with Grade II to V Norwood Hamilton classification of AGA are the ideal subset for PRP. A total of 5 to 7 mL of PRP and 0.05 to 0.1 mL/cm2 is the recommended dose of PRP for AGA. Activation of PRP is not required when it is used for AGA. About 1 to 1.5 million platelets/µL of platelets in PRP is the recommended platelet concentration in PRP for the treatment of AGA. I-PRF (injectable platelet-rich fibrin) has also been found to be useful in AGA, although further studies are required to establish its role. PRP can also have an adjunctive role in hair transplantation procedures.

Platelet-Rich Fibrin, Preparation and Use in Dermatology.

The goal of these recommendations is to provide a framework to practitioners for implementing useful, evidence-based recommendations for the preparation of platelet-rich fibrin (PRF) and its use in various dermatological indications. The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these recommendations to its taskforce on platelet-rich plasma. A comprehensive literature search was done in the English language on the PRF across multiple databases. The grade of evidence and strength of recommendation was evaluated on the GRADE framework (Grading of Recommendation, Assessment, Development and Evaluation). A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared. A total of 40 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books] and case series) were critically evaluated and the evidence thus gathered was used in the preparation of these recommendations. This expert group recommends use of A-PRF+ protocol, that is (200 g for 8 min) for preparation of solid PRF and C-PRF protocol (700 g for 8 min) for liquid PRF. Swing out bucket model of centrifuge or the horizontal centrifuge is recommended for preparation of both PRF, and liquid PRF. Centrifugation must begin within 90-120 s of drawing of blood. PRF can be used in various indications for skin rejuvenation and nonhealing ulcers as either monotherapy or in combination with other therapies.

A Comparative Study on the Rate of Anagen Effluvium and Survival Rates of Scalp, Beard, and Chest Hair in Hair Restoration Procedure of Scalp.

BACKGROUND: The use of non-scalp donor hair is considered in situations of a relative or absolute lack of head donor hair supply. Till now, very few published works are present on body hair transplant. None of them have compared scalp and non-scalp hair in terms of survival as well as characteristics. OBJECTIVE: To compare the characteristics such as rate of anagen effluvium and survival rates of scalp, beard, and chest hair in hair restoration procedure of scalp. MATERIALS AND METHODS: Three blocks of 1cm2 were marked on a non-frontal area. Thirty slits with a 0.9mm blade were made in each block. Single follicular unit was taken from scalp, beard, and chest area and was implanted simultaneously in each block, respectively. The areas were evaluated for any graft loss, anagen effluvium, and survival rate. RESULTS: During initial period of 2 months, anagen effluvium in scalp (40%) and beard (30%) were significantly less than body (53.3%) hair with excellent survival rate of beard (95%), followed by scalp (89%) and then followed by chest hair (76%) at 1 year. CONCLUSION: Non-scalp hair can become an excellent source of donor area for hair restoration procedure.

Assessment of Safe Donor Zone of Scalp and Beard for Follicular Unit Extraction in Indian Men: A Study of 580 Cases.

CONTEXT: Hair restoration surgery for androgenetic alopecia (AGA) essentially involves various forms of hair transplantation. There is paucity of studies assessing donor area in Indian men and also no simplified guidelines are available for the safe donor area for follicular unit extraction (FUE). Our study is an attempt to study the donor area in Indian men. AIMS: To assess the density of follicular units (FUs) in the donor area, that is, both scalp and beard in Indian men, and to propose simplified guidelines for FUE. MATERIALS AND METHODS: The study design was cross-sectional and was carried out for 2 years. All the consenting male patients with male pattern hair loss Hamilton Norwood grading III or more who consulted for a hair restoration surgery were recruited. FU density was assessed in the donor area of scalp by drawing a rectangle with its lower border being a straight line joining two points, which are 27-28mm from the line drawn perpendicular to tragus, passing through external occipital protuberance. Three squares of area 1cm2 were drawn within the rectangle. Average of the FUs and follicles in the three squares was calculated to obtain mean density in the donor area of the scalp. Total number of FU was assessed, considering 25% extraction, total average number of extractable follicles was assessed. Total donor area was divided into three areas (areas 1, 2, and 3) and average number of extractable FU was assessed in each. Donor area in the beard, below the jawline, was divided into a triangle and rectangle. Average number of FU, total number of extractable FU was calculated similarly. RESULTS: A total of 580 male patients were recruited in the study. Mean FU density in the scalp and beard was 78.2/cm2 and 49.7/cm2, respectively. The total available number of FUs for extraction in the areas 1, 2, and 3 and beard considering 25% extraction was 2064, 3097, 3612, and 824, respectively. We propose three types of donor areas in the scalp, namely, limited, standard, and extended donor area.

Mini-Punch Skin Excision: A Newer Novel Approach for Tattoo Removal.

Q-switched Nd:YAG laser remains the gold standard for tattoo removal, but still some tattoos are not completely removed in a specified period as desired by the patient. Herein, we present a case report of 23-year-old patient who came to the outpatient department for tattoo removal. The tattoo measured around 20cm × 18cm and was located on the back. Nine to 12 sessions of 1064-nm Q-switched Nd:YAG laser were planned at 4- to 6-week interval. After the completion of nine sessions, all the shades of the tattoo disappeared, but the lines persisted. A trial of increased laser energy and multiple-pass R20 treatment was performed, which rather increased the scarring and no improvement in tattoo clearance was noticed. We tried mini-punch skin excision for clearing the remnant tattoo lines. The tattoo was cleared successfully without significant scarring. Mini-punch skin excision is a very promising technique, similar to the follicular unit extraction technique of hair transplant, for tattoo removal of the patients who want immediate results as compared to lasers that take almost a year, provided the patient accepts the risk of scarring.

Approach to Hair Transplantation in Advanced Grade Baldness by Follicular Unit Extraction: A Retrospective Analysis of 820 Cases.

BACKGROUND: In advanced grade baldness (Norwood 5-7), hair restoration has been considered difficult due to the donor recipient area mismatch. In this article, we have given a comprehensive methodical approach to manage these cases. OBJECTIVE: To assess the outcome and challenges faced with follicular unit extraction (FUE) and to plan a successful management in advanced grade baldness in 820 cases of androgenic alopecia. MATERIALS AND METHODS: A retrospective analysis of 820 male patients with advanced grade of baldness (grade 5-7) treated by FUE. The patients were divided into five groups based on the extent of scalp coverage, for example, frontal coverage, frontal + mid-front coverage, vertex, full coverage, and frontal forelock only. The results were analyzed at 6, 9, 12, and 24 months. RESULTS: At 12 months, 94% patients were satisfied with the results, whereas 62% wanted another sitting for increasing the coverage area/density. CONCLUSION: Hair transplantation can give natural and aesthetic results even in advanced baldness. Beard and body hairs can be used to augment results in cases with limited donor supply. A mature hairline with an adequate density in a gradient, from front to back helps in achieving a satisfactory response even in extensive cases of advanced baldness.

An Innovative Training Model for Practicing Hairline Designing.

Hair transplantation has undergone a massive transformation in todays world. Besides advancement in technique there has also been a great increase in the demand for hair transplant. This rise in demand for hair transplant has further led to an increase in the requirement of professionally trained hair transplant surgeons. In this article we have described a new, versatile and simple technique for hair transplant surgeons to effectively practice hair line designing. This innovative technique proves vital in perfecting the art of the recipient area designing for the hairline, eyebrow, beard etc. for a surgeon who is undergoing training as well as for previously trained surgeons to rehearse an old skill to gain further confidence. Besides helping us practice the art of hairline designing this technique also teaches us the correct angle, direction, depth and density of slits which are ideal and thus helps us to be better prepared for the real life scenario.

The Science and Art of Eyebrow Transplantation by Follicular Unit Extraction.

Eyebrows constitute a very important and prominent feature of the face. With growing information, eyebrow transplant has become a popular procedure. However, though it is a small area it requires a lot of precision and knowledge regarding anatomy, designing of brows, extraction and implantation technique. This article gives a comprehensive view regarding eyebrow transplant with special emphasis on follicular unit extraction technique, which has become the most popular technique.

Intralesional immunotherapy with killed Mycobacterium indicus pranii vaccine for the treatment of extensive cutaneous warts.

BACKGROUND: Multiple cutaneous warts in adults are often symptomatic, cosmetically disabling, and difficult to treat. Killed Mycobacterium indicus pranii (previously known as Mycobacterium w, popularly known as Mw) vaccine has earlier been investigated in genital warts with encouraging results. OBJECTIVE: To evaluate the efficacy and safety profile of intralesional injected killed Mw vaccine for the treatment of extensive extragenital cutaneous warts. METHODS: In this study, a retrospective analysis of medical records was performed in patients with cutaneous warts treated with intralesional Mw vaccine. Only patients with more than 5 extra-genital warts, involving at least two body sites and which had not shown any signs of spontaneous regression over 6 months were treated with the vaccine. RESULTS: Forty four patients were treated with intralesional Mw vaccine. The mean number of warts was 41.5±25.7 with a disease duration of 3.1±2.5 years. Complete clearance was achieved in 24 (54.5%) patients with a mean of 3.4±1.1 intralesional injections. Cosmetically acceptable response to therapy (>75% clearance) was achieved in 37 (84.1%) patients. Wart response at distant sites was seen in 38 (86.3%) patients. Thirty-six patients (81.8%) experienced mild therapy-related side effects. Eighteen patients with complete response were followed up for 5.27±1.7 months and none had recurrence of lesions. CONCLUSIONS: Killed Mw vaccine is safe and effective in the treatment of extensive cutaneous warts. Larger, preferably randomized controlled trials are needed to assess its efficacy vis a vis standard therapies for warts.

Body hair transplantation in vitiligo.

Hair transplantation has been used to repigment a stable vitiligo patch. Body hair transplant was done for a 28-year-old male with stable vitiligo with scarring. Peri-folllicular repigmentation was noted at 4 weeks and complete repigmentation of vitiligo patch was achieved at 12 weeks. No recurrence was noted at the end of 3-month follow-up with a good colour match with surrounding skin. To the best of our knowledge, this is the first case report highlighting the effectiveness of body hair transplantation by FUE in focal vitiligo patch with leukotrichia.