Theoretical basis and clinical practice for FUE megasession hair transplantation in the treatment of large area androgenic alopecia

Design, proof-of-concept of single robotic hair transplant mechanisms for both harvest and implant of hair grafts

The design and development of a prototype for a singular robotic hair transplant system capable of harvesting and implanting hair grafts were executed in this study. To establish a proof-of-concept for hair transplant procedures involving harvesting and implantation, a test system using a spherical phantom of the scalp was selected. The developed prototype of the robotic hair transplant system demonstrates the potential to reduce the duration that grafts remain without a blood supply, thereby minimizing hair graft damage. Additionally, the overall operation time for follicular unit extraction is comparatively shorter than that of conventional systems. Results from the robot vision tests indicate an 89.6% accuracy for hair graft detection with a 4 mm hair length phantom and 97.4% for a 2 mm hair length phantom. In the robot position control test, the root mean square error was found to be 1.268°, with a standard error of the mean of 0.203°. These outcomes suggest that the proposed system performs effectively under the conditions of a spherical phantom with a 2 mm hair length and a 5 mm distance between harvests.

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.

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.

Evaluation of a Novel Graft-Holding Solution in Hair Transplantation: A Randomized Controlled Clinical Study

BACKGROUND

Hair transplantation has become a popular choice for alopecia treatment; however, postsurgical hair shedding still annoys both patients and surgeons.

OBJECTIVE

To explore the impact of graft-holding solution on postsurgical hair shedding and testify the protective efficacy of histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine (HTK-AD).

METHODS

There were 240 patients enrolled in the study, and the follicles were placed into either HTK-AD or Ringer solution (RS). Masson staining and live/dead staining were performed to evaluate graft morphology and apoptosis levels, respectively. The between-group comparison of postsurgical graft shedding, survival rate, complications, and patient satisfaction was performed.

RESULTS

Grafts in HTK-AD maintained organized dense collagen construction and higher cell viability, but those preserved in RS became soft, which hindered implantation. Histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine significantly reduced the incidence of postsurgical hair shedding (73.81% vs 95%), delayed shedding onset, and diminished shedding amount versus RS ( p < .05) when ≥3,000 grafts were transplanted. The shedding duration was shortened, and hair regrowth started earlier in HTK-AD versus RS ( p < .05); thus, satisfaction was increased. The final survival rate showed no difference between 2 groups.

CONCLUSION

Histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine is superior to RS for hair graft preservation because it improves graft viability and alleviates postsurgical shedding.