Role of Hair Transplantation in Scarring Alopecia—To Do or Not to Do

Alopecia in the scalp region leads to psychosocial embarrassment for an individual. Alopecia could be due to several reasons, including genetic, hormonal, traumatic and infections. Cicatricial alopecias (CAs) are considered as trichological emergency, since their progression is rapid and always results in permanent hair loss. The pathogenesis, disease progression and prognosis of CA are poorly understood, and the treatment process is still evolving. An early diagnosis must be established, and aggressive treatment protocol should be followed in the management of scarring alopecia. This article presents various aspects of CA and determines whether hair transplant (HT) should be done in this condition.

Beware of the Impostors—Scalp Pathology Primer for the Hair Transplant Surgeon

Histopathological features are important for the practicing hair transplant surgeon to ensure proper case selection, diagnosis, choice of proper treatment, and successful outcome. While the primary focus of the hair transplant surgeon is androgenetic alopecia (AGA), it is important to be aware of other conditions that can mimic AGA, whose treatment may be different. This article outlines some of these conditions such as scarring alopecias, alopecia areata, etc., and how to distinguish them. Proper identification will ensure proper treatment and avoid potential missteps in management.

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.

Patient Counselling and Medicolegal Aspects of Hair Transplant Surgery

Hair transplantation being an elective aesthetic surgery, the importance of informed consent cannot be overstated. Explaining the condition of hair loss, the causes, progress, prognosis, and all available treatment options is a part of this process. Providing conflict-free information, ensuring that the patient comprehends this information, and allowing him/her to make the decision to authorize the surgeon to perform the procedure is the moral obligation of the hair transplant surgeon. The benefits of this approach are noticeable and one of the most effective ways to have a satisfied patient and reduce the possibility of claims.

Trichoscopy for the Hair Transplant Surgeon—Assessing for Mimickers of Androgenetic Alopecia and Preoperative Evaluation of Donor Site Area

Preoperative diagnostic confidence and donor site assessment are important for all hair transplant surgery patients. While the majority of patients seek hair transplantation for male or female pattern hair loss (androgenetic alopecia [AGA]), there are mimickers that must be differentiated from patterned hair loss, as they alter the candidacy of the patient for transplantation. They are termed mimickers as they also can present with patterned hair loss. The use of trichoscopy has become increasingly popular for such use. Patterned hair loss mimickers, which include the underappreciated alopecia areata incognita (AAI) and fibrosing alopecia in patterned distribution (FAPD), can be identified clinically with key trichoscopic findings such as yellow dots and peripilar casts, respectively, that correlate with their histologic diagnosis. Donor hair density and putative hair pathology of the safe donor area can also by assessed via trichoscopy. This article discusses the use of trichoscopy, particularly for diagnosing mimickers of patterned hair loss as well as preoperative donor site assessment.

Hair Transplant for Eyebrow Restoration

Eyebrow restoration can be best done with individual single hair follicles grafts harvested by FUE. Understanding the male and female eyebrow allows us to plan an aesthetic reconstruction, requiring 70 to 120 grafts. Selection of donor hair, angle of placement, alignment and direction within the rows influences the results, as does scarring and perfusion of the skin. Details of planning, technique, anesthesia and postoperative care, as well as drawbacks of older methods, are discussed in the article.

GAN-Based ROI Image Translation Method for Predicting Image after Hair Transplant Surgery

In this paper, we propose a new deep learning-based image translation method to predict and generate images after hair transplant surgery from images before hair transplant surgery. Since existing image translation models use a naive strategy that trains the whole distribution of translation, the image translation models using the original image as the input data result in converting not only the hair transplant surgery region, which is the region of interest (ROI) for image translation, but also the other image regions, which are not the ROI. To solve this problem, we proposed a novel generative adversarial network (GAN)-based ROI image translation method, which converts only the ROI and retains the image for the non-ROI. Specifically, by performing image translation and image segmentation independently, the proposed method generates predictive images from the distribution of images after hair transplant surgery and specifies the ROI to be used for generated images. In addition, by applying the ensemble method to image segmentation, we propose a more robust method through complementing the shortages of various image segmentation models. From the experimental results using a real medical image dataset, e.g., 1394 images before hair transplantation and 896 images after hair transplantation, to train the GAN model, we show that the proposed GAN-based ROI image translation method performed better than the other GAN-based image translation methods, e.g., by 23% in SSIM (Structural Similarity Index Measure), 452% in IoU (Intersection over Union), and 42% in FID (Frechet Inception Distance), on average. Furthermore, the ensemble method that we propose not only improves ROI detection performance but also shows consistent performances in generating better predictive images from preoperative images taken from diverse angles.

Hair Transplant: Challenges, Solutions and Guideline for Beginners

The aim of this article is to summarize the challenges which might have to be faced by the beginners while setting up a hair transplantation practice. Hair transplantation is one of the most rapidly evolving procedures in aesthetic surgery that is steadily gaining attention in dermatology practice in the recent times. It is a very time‑consuming and tedious procedure to be performed even by the trained practitioner.Hair transplantation is a procedure which needs highly skilled professional and helping labor. Hand and eye co‑ordination are also utmost important to perform such delicate surgeries.Alcohol is a diuretic, meaning it will dehydrate you. This can prolong your recovery time and increase your risk of discomfort. Moreover, it can elevate your blood pressure to an unsafe level and reduce the supply of blood and crucial nutrients to your head. Avoid alcohol for the first five days after your procedure.

Complications of Hair Transplant Procedures—Causes and Management

Hair transplant surgery per se has low risk, is relatively safe, and has minimum incidence of complications. However, it is a well-accepted fact that no medical science procedure exists without any potential risk of complications. The complication may be a single complaint in the form of pain, itching, dissatisfaction related to the procedure's outcome, or surgical complication in the form of infection, wound dehiscence or skin necrosis. Inadequate counselling increases unsatisfaction. Improper examination increases the complications, and incomplete medical history and history of allergy increases the risk during surgery.The author collected data of his 2896 patients, operated over a period of 10 years, and recorded the complains and complications. The most common complications were sterile folliculitis, noted in 203 patients, vasovagal shock in seven patients of, hypertensive crisis in one patient, hiccups in six patients, facial edema after hair transplant in 18 patients, graft dislodgement in 8 patients, infection in two diabetic patients, minor necrotic patches in recipient area in three patients, keloid development in one patient, numbness in 18 cases, and hypersensitivity in recipient and/or donor area. Donor area effluvium was seen in one case and three patients showed recipient area effluvium. Twenty-six patients were not happy with the results, and five cases showed partial loss of implanted hair. The overall significant life-threatening or major complications were zero, but the total minor complications' percentage was 0.10%.The key to minimize complaints and complications are detailed counselling, taking careful medical history and history of allergy, and proper examination of patients.

Hair Transplant with Strip Harvest: Indications, Contraindications, and Technique

The evolutionary process of modern hair transplantation began with the plug era and, transitioning through a period of minigrafting and micrografting, finally led to follicular unit transplantation (FUT). Apart from the expansion of donor:recipient ratio, this technique produces an excellent esthetic result, indistinguishable from the natural hair. The merit of strip harvest lies in the maximum amount of follicular unit harvest, minimizing the amount of hair follicle transection, and producing a single scar, irrespective of number of sessions. This article summarizes the prerequisites, indications, contraindications, and technique of strip harvest.