Adjuvant measures and genetic evaluations to improve results of hair transplantation

Follicular unit extraction (FUE) has evolved dramatically as the most recent advancement in surgical hair restoration as it leaves a tiny scar and creates natural and pleasing results. This study aims to show the effectiveness of adjuvant measures and genetic evaluations in improving outcomes. Prospective analysis of 271 male patients with androgenic alopecia who underwent hair transplantation with FUE technique between August 2015 and February 2020 at our center was conducted. The mean age was 35.93 ±4.40 years. At one year postoperatively, patients were asked to fill up a questionnaire which included their satisfaction level, need for 2nd session, and complications. Informed written consent was obtained from all patients. Also, blood samples were provided from patients before the operation. RNA extraction and cDNA synthesis were performed using the RNX-Plus kit (Cinnagen, Iran) and Vivantis kit (Malaysia). Amplification of SRD5A2 and GAPDH genes (as internal standard) for measuring gene expression was performed by real-time PCR. Data were analyzed using the statistical package for social science SPSS V. 23. In the last 156 cases, the addition of 40 mg of Triamcinolone to the LA solution led to a dramatic reduction of the incidence of postoperative oedema, from 40% to 9%. Adding three sessions of PRP at 2nd, 4th and 6th months postoperatively resulted in an increased patient satisfaction rate with better hair density and thickness where the rate of highly satisfied patients increased from 64.5% to 83.7%. The addition of 40 mg Triamcinolone to the LA solution was highly effective in reducing postoperative oedema. Three sessions of PRP at 2nd, 4th and 6th months postoperatively were recommended. The results of SRD5A2 gene expression showed that the expression of this gene in satisfied (P = 0.049) and dissatisfied (P = 0.028) patients were significantly higher than highly satisfied patients, which means that the SRD5A2 gene expression had an essential role in the successfulness of hair transplantation. The increased expression of this gene could reduce the response to hair transplantation.

Overview of Follicular Extraction

Follicular unit extraction (FUE), now named as follicular unit excision, is one of the methods of harvesting hair follicles from the donor area for implanting in the recipient area. The occipital scalp area is the most common donor area, but nonscalp donor areas like beard, chest, and other hairy body parts can be used as donor hair follicle area. The extraction of the hair follicle leaves a tiny circular scar over the donor area. Over the past 20 years, various devices for FUE have been developed, starting from manual, simple motorized to highly advanced motors with rotation, oscillation, and vibration. Similarly, different types of punch are used: dull, sharp, ultrasharp, serrated, hybrid and specially designed punch blade for long hair follicles harvesting in various diameters from 0.7 mm to 1.1 mm. The follicles can be harvested either by manual method or by motorized method.

Comparison of a Novel Silicone Gel Wound Dressing versus Bacitracin after Follicular Unit Extraction Hair Transplantation

Background Follicular unit extraction (FUE) hair transplantation subjects are excellent candidates to assess wound dressings. The wound surface area is large and adequately delineated to allow randomization, while in-patient split scalp designs allow patients to serve as their own controls. Objectives This randomized, single-blinded, split-scalp comparison trial compares a novel, film-forming silicone gel-- Stratamed (Stratpharma AG, Basel, Switzerland) -- to Bacitracin (McKesson Medical-Surgical Inc., Richmond, VA) in subjects undergoing FUE. Methods Twenty subjects were randomized to receive Stratamed and Bacitracin on alternating sides of the scalp. Primary outcome measures included blinded clinician assessments of edema, erythema, crusting, healing response and outcome preference. Secondary measures included subject-reported assessments of pain and pruritis as well as FaceQ scores taken at post-FUE days two through six. Results Twenty subjects were enrolled. Nineteen completed the trial. All subjects were non-smokers, and none had medical comorbidities expected to impact wound healing. An average of 1778 follicles per subject were harvested. No adverse events were reported, and all subjects healed by day 7. Healing response and outcome preference were significantly higher at day 1 in the Stratamed group and by day 7, both groups were similar. There were no significant differences between groups for edema, erythema, or crusting. There were no significant differences between groups for subject-reported outcomes of pain, pruritis, or FACE-Q scores. When asked which product they preferred using, 44% of subjects preferred using Stratamed versus 22% who preferred Bacitracin. Conclusions The Stratamed wound dressing was well-tolerated in patients undergoing FUE. Stratamed may speed the healing response in the early phase of wound healing.

Hair transplantation in cicatricial alopecia

Follicular unit extraction method of hair transplantation for androgenetic alopecia is quite common, but as far as cicatricial alopecia is concerned there still exists a lacuna. In this article, we have presented various factors that surgically determine the treatment outcome in cicatricial alopecia. Thus, in advanced end-stage cicatricial alopecia, it is now possible to give good results to the patient with hair transplantation.

Evolution of Hair Transplant Surgery in India: A Plastic Surgeon's Perspective

This article is mainly aimed to delve into the history of hair transplant and its evolution in India. As a plastic surgeon in practice for the past 35 years, I have seen hair transplant surgery undergoing various transformations starting with initial use of plugs and flaps. Scalp reduction surgery also played an important role. Plugs slowly gave way to mini- and micrografts. With the incorporation of the microscope and popularizing of strip surgery and improved slivering techniques, mega sessions came to the fore thereby covering large areas. Follicular unit extraction and use of body hair have also been discussed.