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.

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.

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.

Use of fractionated laser therapy for the treatment of androgenetic alopecia: a systematic review and meta-analysis.

Procedural management, including fractionated laser therapy, has been increasingly investigated for the management of androgenetic alopecia (AGA). However, no comprehensive resources exist detailing the efficacy of fractionated laser therapies used for the treatment of AGA. A systematic review investigating fractionated laser use for AGA was performed, separated into each distinct fractionated laser modality. A meta-analysis was performed to examine improvement in hair counts and hair shaft diameter. Fourteen studies were included for systematic review, which identified the use of erbium-glass, thulium, erbium-ytrrium:aluminum garnet (YAG), and carbon dioxide (CO2) fractionated laser for the treatment of AGA. In the meta-analysis, fractionated laser combination therapy showed significant improvement in hair shaft diameter (2.51, 95% CI 2.37-2.65, I2 = 90.54). Fractionated laser monotherapy alone significantly improved hair shaft diameter (2.28 95% CI 2.03-2.52, I2 = 91.20%). This effect was durable on subgroup analysis for both erbium-glass (2.36 95% CI 2.01-2.71, I2 = 92.05%) and thulium (1.61 95% CI 1.08-2.15, I2 = < 0.00%). There was no improvement in hair shaft count for any laser modality. Erbium-glass laser is an effective modality as either monotherapy or combination with topical/injectable therapies to improve hair shaft diameter in AGA.

Frontotemporal craniotomy with skin incision along the superior temporal line outside the hairline in bald male patients with temporal gliomas.

A head skin incision is inevitable in neurosurgical procedures and is usually concealed within the hairline. Androgenetic alopecia (AGA) is a progressive hair loss disorder or baldness highly prevalent in men. Therefore, if bald male patients require neurosurgical procedures, skin incisions cannot be concealed, but this subject is yet to be discussed in the literature. This study presents a frontotemporal craniotomy using a skin incision along the superior temporal line, ignoring the hairline in bald male patients. Thirty-three patients with temporal gliomas underwent surgical removal between 2015 and 2022. They were divided into three groups: bald male patients with skin incisions not concealed in the hairline (minimum group, n = 13), bald and non-bald male patients with skin incisions concealed in the hairline (male group, n = 11), and female patients with skin incisions concealed in the hairline (female group, n = 9). In the minimum group, patients had no complaints regarding the incision scar. Cosmetic outcome was excellent, and no cases showed surgical site infection or peripheral facial nerve palsy. Compared with the male and female groups, the minimum group had the shortest skin incision length; however, the craniotomy size and extent of resection were similar. Skin incision for frontotemporal craniotomy cannot be hidden in bald male patients, and the preferred location for the incision is unknown. The skin incision along the superior temporal line is a cosmetically favorable, feasible, and safe procedure.

[Clinical effects of scalp flaps pedicled with superficial temporal artery parietal branch in repairing facial destructive burn wounds].

Objective: To explore the clinical effects of scalp flaps pedicled with superficial temporal artery parietal branch in repairing facial destructive burn wounds. Methods: A retrospective observational study was conducted. From January 2016 to December 2021, 15 patients with facial destructive burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 11 males and 4 females, aged 22 to 79 years. Two patients were complicated with unilateral eyeball destructive burns, two patients were complicated with unilateral auricle defects, eight patients were complicated with lip and cheek defects, and three patients were complicated with lip, cheek, and unilateral nasal alar defects. The burn wound areas ranged from 9 cm×6 cm to 13 cm×10 cm. The scalp flaps pedicled with superficial temporal artery parietal branch, with the area of 10 cm×7 cm to 15 cm×11 cm, were designed, excised, and transferred for repairing burn wounds. The secondary wounds at the donor sites were repaired with medium-thickness scalp grafts. According to patient's needs, the hairs grew at the facial transplanted flap were removed by laser at 2 weeks after the flap was completely viable, or the expanded scalp flap was used to treat the secondary alopecia in the flap donor area of the head at 3 months after the primary wound repair. The survival of the flap/skin graft and the wound healing of the donor and recipient areas after the primary wound repair were recorded. During the follow-up, the appearance of the flap, the scar hyperplasia at the suture site, the repair effect of facial functional parts, the treatment effects of laser hair removal and secondary alopecia treatment at the flap donor site were observed; the patient's satisfaction with the overall repair effect was inquired. Results: After the primary wound repair, all the flaps transplanted to the burn wounds and the skin grafts transplanted to the secondary wounds of the flap donor sites survived well, and the wounds at the donor and recipient sites of flap healed well. The color, texture, and thickness of flap were basically the same as those of normal facial skin, and the scar at the suture site was slight during 3 to 18 months of follow-up period after the primary wound repair. In 11 patients complicated with lip defects, the oral integrity, and the opening and closing functions of mouth were restored with the mouth opening being 2.0-2.5 cm and no microstomia; all the patients could carry out basic language communication, 8 of them could take regular food, and 3 of them could take soft food. The wounds in two patients with unilateral eyeball destructive burns were repaired. In 2 patients complicated with auricle defects, the wounds were repaired, and the external auditory canals were normal. In 3 patients complicated with unilateral nasal alar defects, their noses had poor appearance with reduced nostrils. No hair growth was observed in the facial flap sites after treatment of laser hair removal in 8 patients. Five patients were successfully treated with expanded scalp flaps for secondary alopecia in the flap donor area of the head. The patients were all satisfied with the overall repair effect. Conclusions: The scalp flap pedicled with superficial temporal artery parietal branch has abundant blood supply and is suitable for repairing the wounds in facial destructive burns. It is easy to transfer and can better restore the appearance and function of the recipient area with minimal damage to the flap donor area, which is worthy of clinical promotion.

Efficacy of autologous dermal sheath cup cell transplantation in male and female pattern hair loss: A Single-Arm, Multi-Center, phase III equivalent clinical study.

A previous, proof-of-concept clinical study suggested that dermal sheath cup cell injections into the affected areas of male/female pattern hair loss (PHL) may have some amelioratory effects, the clinical efficacy of which needs further examination. A phase III equivalent clinical study was conducted to further probe the therapeutic potential of this novel approach and verify its safety and efficacy in improving the appearance of PHL. Thirty-six participants with PHL were injected with dermal sheath cup cell harvested from non-affected occipital hair follicles twice in quarterly intervals. Global photographic assessment and phototrichogram were performed in a blinded manner. Patient-reported outcomes were assessed for 12 months. On global photographic assessment, 30% of the participants showed improvement. The analysis of phototricogram data detected the increases in the cumulative hair diameter, hair cross-sectional area, and mean hair diameter of 107.6 ± 152.6 µm/cm2 , 13069.1 ± 10960.7 µm2 /cm2 , and 0.9 ± 0.9 µm (ratios vs. baseline: +1.4%, +3.4%, and +2.2%), respectively. The female and high terminal hair ratio groups achieved better improvement. Of the total participants, 62.9% noted some degree of improvement. No serious adverse events were detected. This novel approach exhibited visible effects while ensuring safety and patient satisfaction. Therefore, it holds promise as a possible therapeutic option for treating PHL, especially in women.

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.

[Effect study of Sonic hedgehog overexpressed hair follicle stem cells in hair follicle regeneration].

Objective: To determine the expression level of Sonic hedgehog (Shh) in the passage of hair follicle stem cells (HFSCs), analyze the effect of Shh overexpression on the proliferation activity of HFSCs, and explore the survival of HFSCs after Shh overexpression and its effect on hair follicle regeneration. Methods: Hair follicles from the normal area (H1 group) and alopecia area (H2 group) of the scalp donated by 20 female alopecia patients aged 40-50 years old were taken, and the middle part of the hair follicle was cut under the microscope to culture, and the primary HFSCs were obtained and passaged; the positive markers (CD29, CD71) and negative marker (CD34) on the surface of the fourth generation HFSCs were identified by flow cytometry. The two groups of HFSCs were transfected with Shh-overexpressed lentivirus. Flow cytometry and cell counting kit 8 assay were used to detect the cell cycle changes and cell proliferation of HFSCs before and after transfection, respectively. Then the HFSCs transfected with Shh lentivirus were transplanted subcutaneously into the back of nude mice as the experimental group, and the same amount of saline was injected as the control group. At 5 weeks after cell transplantation, the expression of Shh protein in the back skin tissue of nude mice was detected by Western blot. HE staining and immunofluorescence staining were used to compare the number of hair follicles and the survival of HFSCs between groups. Results: The isolated and cultured cells were fusiform and firmly attached to the wall; flow cytometry showed that CD29 and CD71 were highly expressed on the surface of the cells, while CD34 was lowly expressed, suggesting that the cultured cells were HFSCs. The results of real-time fluorescence quantitative PCR and Western blot showed that the expression levels of Shh protein and gene in the 4th, 7th, and 10th passages of cells in H1 and H2 groups decreased gradually with the prolongation of culture time in vitro. After overexpression of Shh, the proliferation activity of HFSCs in the two groups was significantly higher than that in the blank group (not transfected with lentivirus) and the negative control group (transfected with negative control lentivirus), and the proliferation activity of HFSCs in H1 group was significantly higher than that in H2 group before and after transfection, showing significant differences ( P<0.05). At 5 weeks after cell transplantation, Shh protein was stably expressed in the dorsal skin of each experimental group; the number of hair follicles and the expression levels of HFSCs markers (CD71, cytokeratin 15) in each experimental group were significantly higher than those in the control group, and the number of hair follicles and the expression levels of HFSCs markers in H1 group were significantly higher than those in H2 group, and the differences were significant ( P<0.05). Conclusion: Lentivirus-mediated Shh can be successfully transfected into HFSCs, the proliferation activity of HFSCs significantly increase after overexpression of Shh, which can secrete and express Shh continuously and stably, and promote hair follicle regeneration by combining the advantages of stem cells and Shh.

Hair Restoration Techniques.

Hair restoration is an essential topic in the current management of facial plastic surgery concerns and queries. Advances in hair restoration include oral and topical medications and compounded preparations, injections including platelet-rich plasma, light therapy, and follicular unit extraction methods. This article provides a review of current techniques.

Application of Autologous Hair Transplantation Technique in Children with Cicatricial Alopecia.

INTRODUCTION: Cicatricial alopecia not only affects the appearance of children's heads and faces but also their mental health in the long term. This study aims to explore the therapeutic characteristics and clinical effects of autologous hair transplantation technology in children with cicatricial alopecia. METHODS: Children in our department who received autologous hair transplantation technology for cicatricial baldness of the scalp from February 2019 to October 2022 were collected. Their basic information was analyzed, and postoperative follow-up was conducted, including calculation of hair follicle survival rate, hair growth, complications, and an efficacy satisfaction survey given to the children's family members. RESULTS: Thirteen children were included in this study (10 males and 3 females), aged from 4 years 1 month to 12 years 10 months, with an average age of 7 years 5 months. Two hundred to 2500 hair follicular units were extracted, with an average recipient area of 22.7 cm2, an average hair follicle unit density of 55.3 ± 9.1 per cm2, and an average hair/follicular unit (hair/FU) ratio of 1.75 ± 0.07. Thirteen children in this group were followed up for 6-12 months with the following treatment options: FUE (follicular unit extraction, 9 cases), FUT (follicular unit transplantation, 3 cases), and FUT combined with FUE (1 case). The average hair survival rate was 85.3%. Except for one child with temporary folliculitis, there were no complications. The GAIS score is divided into five levels: complete improvement (2 cases), obvious improvement (10 cases), partial improvement (1 case), no improvement (0 cases), and deterioration (0 cases). The patient satisfaction results included very satisfied (2 cases), mostly satisfied (10 cases), and dissatisfied (1 case). CONCLUSION: Autologous hair transplantation technology is a safe and effective method for children with cicatricial alopecia.

An international expert consensus statement focusing on pre and post hair transplantation care.

AIM: To achieve international expert consensus and give recommendations on best practices in hair transplantation surgery, focusing on pre- and post-transplantation care. METHODS: A modified Delphi method was used to reach consensus. An international scientific committee developed an 81-statement questionnaire. A panel of 38 experts in hair transplantation from 17 countries across 4 continents assessed the questionnaire. RESULTS: Two consensus rounds were carried out, with 59 out of 81 statements (73%) reaching consensus. Expert recommendations emphasize the correct selection of candidates for hair transplantation and the need for patients to have received adequate medical treatment for alopecia before transplant. Comorbidities should be assessed and considered while planning surgery, and an individualized plan for perioperative care should be drawn up before transplant. Certain medications associated with increased risk of bleeding should be withdrawn before surgery. Specific recommendations for post-transplantation care are given. After transplantation, patients should gradually resume their normal haircare regimen. Close follow-up should be carried out during the first year after transplant. CONCLUSIONS: This study presents numerous consensus-based recommendations on general aspects of hair transplantation, including candidate selection, medical therapy prior to transplantation, anesthesia, and resuming haircare after transplantation.

Comparison of 2 Incisional Methods in Hair Transplantation.

Hair transplantation has been an effective technique for facial contour modification. Hair follicular units (FU) harvested from scalp strip is the gold-standard method for hair transplantation. The difference in obtaining FU from different shapes of scalp strips is not clear yet. Follicular units of 127 patients were harvested from scalp strip through parallelogram incision or fusiform incision from October 2017 to January 2020. The number of FU in 1 cm 2 scalp strip were calculated and paired t test were used to compare the difference in hair follicle acquirement rate between 2 incisions. The number and acquisition rate of FU by parallelogram incision were significantly higher than that by fusiform incision. Therefore, parallelogram incision might be more suitable to harvest FU for hair transplantation surgery.

Rare Congenital Frontal Hairline Deformity with Temporo-Parieto-Occipital Multiple Folds of Scalp.

Two cases of congenital hairline deformity are reported. Both cases exhibited multiple wrinkled areas in the lower occipital region, with hair that punctured and irritated the adjacent skin as it grew, creating ulcerated lesions. Both patients had a unilateral folded and raised wrinkled and twisted region stretching from the temporal area to the parietal and occipital areas. There was also a defect in the frontotemporal hairline of the affected side that was not present on the contralateral side. The skin of the forehead was also thinner on the affected side. Both patients were in good physical health and had no other congenital abnormalities or pertinent family history. There were no other skin, neurological, or physical abnormalities. In each case, the excessive skin was excised from the temporo-occipital region and microscopically dissected into follicular units, which were transplanted into the temporal area and the frontal hairline. Histologic examination did not reveal any specific abnormal findings. The transplanted hairs were well engrafted and showed natural results. Congenital anomalies of the hairline or hair-bearing scalp tissue are rare. Cutis verticis gyrata is a rare disease that causes multiple furrows and folds of the scalp. However, the cases reported here exhibited a somewhat different appearance from that of cutis verticis gyrata, as multiple folds were present in the scalp in each case, along with an alopecic lesion. This author has successfully treated 2 cases of this rare form of congenital hair loss that has not yet been reported to our knowledge.

Follicular unit extraction megasession treatment of high-grade androgenetic alopecia in Asians: Introducing novel principles for surgical design.

BACKGROUND: Male androgenetic alopecia (MAGA) has been one of the most common reasons for hair consultation, which affects more than half of men under the age of 50. Recently, follicular unit extraction (FUE) megasession has been an attractive treatment option for patients with severe AGA. However, compared with hair transplant surgery by traditional FUE or follicular unit transplantation (FUT), a megasession lacks a suitable surgical design solution for Asian high-grade AGA patients. Therefore, we introduced novel principles for surgical design into FUE megasession for Asians. OBJECTIVE: The goal was to investigate the naturalness of hair, patient and doctor satisfaction level, and safety assessment of FUE megasession with the specific surgical design, to explore a novel technique for an efficient, satisfactory, and safe FUE megasession procedure. METHODS: Thirty-six Asian male patients with AGA in Hamilton Grade V-VI were enrolled in the research. All participants underwent FUE megasession treatment with the specific surgical design. The investigators observed the patients' general conditions, surgical information, naturalness of hair, and patient and doctor satisfaction level and adverse reactions. RESULTS: Before surgery, the average age of patients was 36.8 ± 9.6 years, and average duration of disease was 8.3 ± 3.8 years. During surgery, we harvested an average of 3705 ± 383 grafts. Recipient density ranged from 30 FUs/cm2 to 50 FUs/cm2 , and the total operation time was 10.6 ± 0.9 h. After surgery, patient-rated Likert score for naturalness of hair was as high as 4.72, and the doctor rated 4.61. Patient satisfaction score was up to 4.64, and the doctor scored 4.75. No serious side effects occurred in the study. CONCLUSION: FUE megasession with the introduced surgical design is a satisfactory treatment option for patients with high-grade AGA in Asians, with few side effects. The application of the novel design method can effectively lead to relatively natural density and appearance in one operation. Due to its remarkable effect, high satisfaction level, and few postoperative complications, FUE megasession with the introduced surgical design has great potential for Asian high-grade AGA patients.

Surgical Management for Hair Restoration: A Review of Contemporary Techniques.

BACKGROUND: Hair loss can cause psychological distress for patients, regardless of the etiology or extent of the defect. Many conservative and pharmacological approaches are successful in management, but refractory or severe cases often mandate surgical treatment. Surgical techniques have been refined over the course of a century, and we aim to review the most contemporary strategies. METHODS: A review of the literature was performed using the databases PubMed, Web of Science, and Embase, in May 2020. Articles were included if they discussed techniques used within the past 10 years, in search of more contemporary strategies and the most widely used approaches. RESULTS: The use of local flaps, scalp reduction surgery, and hair transplantation techniques are all used for various indications. Modern hair transplantation can be further divided into follicular unit excision and follicular unit transplantation, each with its own advantages. Local flaps are most often used for post-traumatic and reconstructive indication, while hair transplantation can be used for smaller cosmetic lesions or in combination with a variety of other reconstructive techniques. CONCLUSION: Hair loss continues to be a challenging pathology for both patients and physicians, regardless of etiology. When conservative treatment is inadequate, there exist multiple surgical techniques that can feasibly restore hair, though the exact degree of success may vary between patients. The proper technique is dependent upon etiology, patient specific factors, as well as surgeon experience and comfort. LEVEL OF EVIDENCE III: 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 .

Efluvio en línea de aparición inmediata asociado a trasplante capilar de alta densidad: descripción de 28 casos / Immediate-Onset Linear Effluvium Associated With High-Density Hair Transplantation: A Series of 28 Cases

Describimos 28 pacientes que desarrollaron una forma de efluvio postrasplante capilar con características no descritas en la literatura: a) morfología lineal; b) aparición inmediata (1-3 días); c) asociación con ‘dense packing’ en entradas (‘signo de Mickey Mouse’); d) progresión del diámetro de la línea (patrón ‘wave-like’); e) posible adición posterior de efluvio lineal concéntrico a vértex (‘signo del Donut’), y f) además de otros efluvios tampoco publicados por su inmediatez de aparición. La morfología lineal podría ser el resultado de la alta densidad colocada en nuestros pacientes, provocando hipoxia perilesional y efluvio de las unidades foliculares miniaturizadas que rodean la zona receptora. Debido a que la línea alopécica provoca inseguridad a los pacientes sobre una posible no colocación de injertos, recomendamos iconografía postoperatoria inmediata demostrando unión de áreas trasplantada y no trasplantada, así como la explicación previa al paciente de este fenómeno transitorio y completamente reversible en 3 meses (AU)

We describe 28 patients who experienced effluvium with previously unreported features shortly after hair transplant surgery. Notable features were as follows: a) a linear morphology; b) immediate onset (1-3 days); c) association with dense-pack grafting in areas of receding hairline at the temples (Mickey Mouse pattern); d) a progressive increase in the diameter of the hair loss line (wave-like pattern); e) in some cases, subsequent concentric linear effluvium on the crown (donut pattern); and f) other forms of previously unreported immediate-onset effluvium. The linear morphology could be the result of dense packing, which can cause perilesional hypoxia and loss of miniaturized hairs around the recipient area. Since linear hair loss can cause patient concern about graft failure, we recommend taking images of transplanted and nontransplanted areas immediately after surgery and warning patients in advance about these transient effects, which are fully reversed in 3 months (AU)

[Translated article] Immediate-Onset Linear Effluvium Associated With High-Density Hair Transplantation: A Series of 28 Case / Efluvio en línea de aparición inmediata asociado a trasplante capilar de alta densidad: descripción de 28 casos

We describe 28 patients who experienced effluvium with previously unreported features shortly after hair transplant surgery. Notable features were as follows: a) a linear morphology; b) immediate onset (1-3 days); c) association with dense-pack grafting in areas of receding hairline at the temples (Mickey Mouse pattern); d) a progressive increase in the diameter of the hair loss line (wave-like pattern); e) in some cases, subsequent concentric linear effluvium on the crown (donut pattern); and f) other forms of previously unreported immediate-onset effluvium. The linear morphology could be the result of dense packing, which can cause perilesional hypoxia and loss of miniaturized hairs around the recipient area. Since linear hair loss can cause patient concern about graft failure, we recommend taking images of transplanted and nontransplanted areas immediately after surgery and warning patients in advance about these transient effects, which are fully reversed in 3 months (AU)

Describimos 28 pacientes que desarrollaron una forma de efluvio postrasplante capilar con características no descritas en la literatura: a) morfología lineal; b) aparición inmediata (1-3 días); c) asociación con ‘dense packing’ en entradas (‘signo de Mickey Mouse’); d) progresión del diámetro de la línea (patrón ‘wave-like’); e) posible adición posterior de efluvio lineal concéntrico a vértex (‘signo del Donut’), y f) además de otros efluvios tampoco publicados por su inmediatez de aparición. La morfología lineal podría ser el resultado de la alta densidad colocada en nuestros pacientes, provocando hipoxia perilesional y efluvio de las unidades foliculares miniaturizadas que rodean la zona receptora. Debido a que la línea alopécica provoca inseguridad a los pacientes sobre una posible no colocación de injertos, recomendamos iconografía postoperatoria inmediata demostrando unión de áreas trasplantada y no trasplantada, así como la explicación previa al paciente de este fenómeno transitorio y completamente reversible en 3 meses (AU)