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Zhang J, Zhao Y, Zhang J, Zhou Y, Yi Y, Lei R, Qu Q, Hu Z, Gao Z, Li Y, Tang Q, Miao Y. Risk Factors and Hazards of Recipient-Area Perifollicular Erythema After Hair Transplantation: A Multicenter Retrospective Cohort Study. Aesthetic Plast Surg 2024; 48:2771-2777. [PMID: 38849551 DOI: 10.1007/s00266-024-04166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Recipient-area perifollicular erythema (RPE) may delay graft growth after hair transplantation. However, there is currently a lack of observational clinical studies of RPE. OBJECTIVE To study the clinical features and risk factors associated with RPE while analyzing its correlation with graft growth. METHODS We conducted a multicenter retrospective cohort study between June 2020 and January 2023. RESULTS A total of 1090 participants were included, 178 (16.33%) showed mild RPE, 56 (5.14%) showed moderate RPE, and 10 (0.92%) showed severe RPE. Patients with RPE had severe hair shaft shedding (P < 0.001) and a lower survival rate (P < 0.001) of grafts. Logistic regression analysis showed that folliculitis is a significant risk factor for mild RPE (OR 6.061, 95% CI 3.343-10.991, P < 0.001) and moderate RPE (OR 3.397, 95% CI 1.299-8.882, P = 0.013). Besides, untimely first postoperative hair washing was associated with the development of moderate RPE (OR 0.724, 95% CI 0.553-0.947, P = 0.018) and severe RPE (OR 1.553, 95% CI 1.156-2.086, P = 0.003). CONCLUSION RPE is a postoperative complication closely related to high hair shaft shedding proportion and low graft survival rate. Both postoperative folliculitis and untimely first postoperative hair washing may induce the occurrence of RPE. 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 .
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Affiliation(s)
- Jiaxian Zhang
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yingjie Zhao
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jiarui Zhang
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yi Zhou
- Center for Plastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 314408, China
| | - Yanhua Yi
- Department of Burn, Would Repair Surgery and Plastic Surgery, Department of Aesthetic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, China
| | - Rui Lei
- Department of Plastic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Qian Qu
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zhiqi Hu
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zhiyong Gao
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yufei Li
- Department of Plastic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China.
| | - Qiang Tang
- Surgery Department of Burn Plastics and Wound Repair, Affiliated Hospital of Youjang Medical University for Nationalities, Baise City, 533000, Guangxi, China.
| | - Yong Miao
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Le D, Gan Y, Mao X, Qu Q, Fan Z, Liu B, Sun P, Zhang J, Hu Z, Miao Y. Hair follicle extraction combined with an expanded scalp flap for facial organ reconstruction. J Plast Reconstr Aesthet Surg 2023; 87:295-302. [PMID: 37925918 DOI: 10.1016/j.bjps.2023.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/23/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Abstract
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.
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Affiliation(s)
- Demengjie Le
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China
| | - Yuyang Gan
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China
| | - Xiaoyan Mao
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China
| | - Qian Qu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China
| | - Zhexiang Fan
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China
| | - Bingcheng Liu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China
| | - Pingping Sun
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China
| | - Jiaxian Zhang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China
| | - Zhiqi Hu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China.
| | - Yong Miao
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People's Republic of China.
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Othman S, Glat P. Surgical Management for Hair Restoration: A Review of Contemporary Techniques. Aesthetic Plast Surg 2023; 47:2415-2424. [PMID: 37193885 DOI: 10.1007/s00266-023-03391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
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 .
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Affiliation(s)
- Sammy Othman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New York, NY, USA
| | - Paul Glat
- Section of Plastic Surgery, Department of Surgery, St. Christopher's Hospital for Children, Philadelphia, PA, 19134, USA.
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Li K, Sun P, Liu F, Hu Z, Miao Y. Frontal-Temporal Triangle Area Hair for Eyebrow Restoration in Asians: A Comparative Study With Periauricular and Occipital Hair. Dermatol Surg 2022; 48:731-736. [PMID: 35583985 DOI: 10.1097/dss.0000000000003469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The frontal-temporal triangle area (FTTA) hair has a slow growth rate and thin caliber, which are similar to those of eyebrow hair. However, a comparison of cosmetic outcomes between FTTA and other scalp hair grafts in eyebrow transplantation has not been performed. OBJECTIVE To compare the cosmetic outcomes of FTTA hair and periauricular and occipital area (POA) hair in eyebrow restoration. METHODS A retrospective analysis of 155 patients with FTTA or POA hair transplants was performed. Comparative variables included patient characteristics, hair density, diameter, percentage of one-hair follicular units (FUs), number of transplanted FUs, harvesting time, transection rate, hair survival rate, frequency of eyebrow trimming, and patient satisfaction. RESULTS There was a significant difference in hair density, diameter, percentage of one-hair FUs, and harvesting time between the FTTA and POA hair transplants. The FTTA hair grew significantly slower than the POA hair did. The patients in the FTTA group trimmed their postoperative eyebrows at a significantly longer interval than those in the POA group. The percentage of patients who were very satisfied with the surgery results was higher in the FTTA group. CONCLUSION The FTTA hair grafts can provide aesthetically pleasing cosmetic results in eyebrow restoration.
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Affiliation(s)
- Kaitao Li
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Pingping Sun
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Fang Liu
- Medical Cosmetic and Plastic Surgery Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiqi Hu
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yong Miao
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
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Dai DM, Qu Q, Fan ZX, Hu ZQ, Miao Y. Relieving postoperative pain using tumescent solution with ropivacaine in follicular unit excision. J Cosmet Dermatol 2022; 21:4697-4702. [PMID: 35441795 DOI: 10.1111/jocd.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Local tumescent anesthesia relieves postoperative pain. OBJECTIVE To compare the effect of injecting a tumescent solution with/without ropivacaine on postoperative pain. METHODS A randomized, double-blind control study was conducted in 314 patients who underwent first follicular unit excision after obtaining informed consent and ethics committee approval. The patients were randomly divided into three groups: intra-groups (group 1, injected with tumescent solution with ropivacaine; group 2, without ropivacaine) and inter-group (group 3, right-head/left-head side with/without ropivacaine). Postoperative pain was recorded using the 5-point Wong-Baker Faces Pain Scale. No preoperative analgesic was administered to any patient. The survival rate of hair follicles was measured using dermoscopy during follow-up. Data were statistically analyzed. RESULTS Of the 314 patients included in the study, 166 were men and 148 were women with a mean age of 32.15±4.58 (range, 25-45) years. Postoperative pain with ropivacaine was significantly more relieved compared to that without ropivacaine in both groups (P<0.05). There was no significant difference between sex and survival rate of hair follicles in the intra- or inter-group. CONCLUSION A tumescent solution with ropivacaine has proven to relieve postoperative pain and is a safe and valuable form of local anesthesia in follicular unit excision.
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Affiliation(s)
- Da-Mao Dai
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Qu
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
| | - Zhe-Xiang Fan
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Qi Hu
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Miao
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
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True RH. Using Nonscalp Hair in Scalp Hair Restoration-Theory and Execution. Indian J Plast Surg 2022; 54:463-470. [PMID: 34984086 PMCID: PMC8719961 DOI: 10.1055/s-0041-1739242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
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.
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Affiliation(s)
- Robert H True
- True and Dorin Medical Group, New York, New York, United States
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Gupta B, Banerjee P, Priyadarshini Y, Rathi P. BEARD-A Potential Donor Site in Grade 6 and Grade 7 Alopecia: A Case Series. J Maxillofac Oral Surg 2021; 20:545-550. [PMID: 34776682 DOI: 10.1007/s12663-021-01535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Autologous hair transplantation has been the convention in cases of androgenic alopecia. Routinely, the occipital area serves as an ideal donor site. The advent of follicular unit extraction (FUE) has made body and beard hair harvest a possibility. Beard hair, in particular, has been far more sought after than other parts of the body. Materials and Methods A case series of 20 patients have been documented wherein cases with Grade 6 and 7 androgenic alopecia have been treated with beard hair as an adjunct donor site. The local anatomy, procedural technicalities and method of harvesting have been emphasized. The pre, intra and postoperative records have been maintained. Discussion The advent of FUE paved way for minimal downtime, better cosmesis and less scarring facilitating the possibility of using non-scalp hair in hair restoration, thus increasing the overall donor graft availability. Beard hair has its characteristic differences when compared to the scalp hair. Alongside there exists an array of advantages and disadvantages. Conclusion Minimal complications and potential advantages have encouraged the usage of beard graft in the recent past. In hindsight, beard to scalp transplantation is a worthwhile alternative in cases demanding an expanded source of donor hair which demands further literary contribution.
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Fan ZX, Liu F, Li KT, Hu ZQ, Miao Y. Effect of De-epithelialization on Graft Survival Rate After Follicular Unit Extraction. Dermatol Surg 2021; 47:1083-1086. [PMID: 34397543 DOI: 10.1097/dss.0000000000003145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To achieve a natural postoperative appearance, hair grafts are often de-epithelialized from the epidermis during follicular unit extraction (FUE). However, the effect of de-epithelialization on the survival rate of transplanted hair follicles (HFs) has not been investigated. OBJECTIVE To investigate the effect of de-epithelialization on the survival rate of transplanted HFs. METHODS A total of 64 male patients with androgenetic alopecia were included in this study. They were randomly divided into de-epithelialization and control groups. Organ culture was performed to assess the elongation of hair shaft and the percentage of anagen HFs in both groups. Patients were followed up postoperatively to evaluate complications, postoperative shedding, survival rates, and satisfaction. RESULTS No significant difference in hair shaft elongation and percentage of anagen HFs was observed between both groups. The immediate postoperative satisfaction in the control group was much lower than that in the de-epithelialization group (71.25% and 100%, respectively). No significant differences in shedding rate, graft survival rate, and complications were noticed between both groups. CONCLUSION Follicular de-epithelialization does not affect the survival rate of graft in FUE. Based on these data, de-epithelialization may improve immediate postoperative appearance and lead to a more pleasing cosmetic outcome.
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Affiliation(s)
- Zhe-Xiang Fan
- All authors are affiliated with the Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
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