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Reconstruction of the chin region represents a technical challenge due to its three-dimensional configuration and its location close to the mouth. It requires both a functional approach by restoring mobility and an aesthetic approach by restoring the perioral furrows. For men who want to wear a beard, it becomes more difficult to choose the donor site for hairy skin. In that case, strategies of full thickness skin graft or pre-expanded loco-regional flaps are unusable. We propose here a functional, aesthetic and hairy reconstruction by performing a pre-expanded temporal free flap which allowed to resolve the problem of adjacent cervical contractures and to restore an integrated the bearded chin subunit., (Copyright © 2024. Published by Elsevier Masson SAS.)

The hair-bearing superficial temporal artery flap is one of the traditional options for total eyebrow reconstruction. The anatomical variation of the superficial temporal artery has been well discussed; however, the anatomy of the superficial temporal vein is highly diverse. The authors report the use of preoperative computed tomography (CT) angiography in a 27-year-old man with a total eyebrow defect caused by thermal burn injury. The authors harvested a 6×1.5-cm pedicled hair-bearing superficial temporal artery flap from the area where the parietal branches of the superficial temporal artery and vein were running in close proximity, according to the CT angiography findings. Postoperatively, the flap survived completely without any vascular compromise. The authors believe that preoperative visualization of the superficial temporal vessels with CT angiography is highly beneficial in performing safe eyebrow reconstruction with a hair-bearing superficial temporal artery flap., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Background: Scalp micropigmentation (SMP) is becoming increasingly popular. Accordingly, complications of the procedure are on the rise. However, the results of improperly performed SMP are exceedingly challenging to rectify and ultimately lead to severe mental stress and feelings of inferiority in patients., Aims: This retrospective study aimed to explore various aspects of unsatisfactory SMP outcomes and examine corrective measures available after the procedure., Materials and Methods: A total of 120 patients who underwent corrective surgery or procedures due to unsatisfactory outcomes after SMP were enrolled in the study. Their photographs and medical charts were reviewed retrospectively., Results: Out of 120 participants, 76 were women and 43 men. In total, 107 patients (89.2%) had been treated at a tattooing or cosmetic facility at a beauty salon performing permanent makeup, 12 (10.0%) at another clinic, and one (0.8%) at an oriental medicine clinic. Of 120 patients, hair transplant surgery was performed on 74 patients (61.7%). Twenty-five (20.8%) underwent both hair transplant surgery and complementary SMP. Sixteen (13.3%) patients received laser tattoo removal and underwent SMP anew. Five patients (4.2%) had a previous tattoo removed without additional treatment. Patients' subjective satisfaction scores averaged 4.5/5. The physician's objective satisfaction score was 4.6/5., Conclusion: In cases where SMP is inadequately performed, satisfactory results can be achieved through appropriate revisions, such as tattoo removal, repeated SMP, or hair transplant surgery to conceal the tattoo by highly experienced medical professionals., Level of Evidence: IV., (© 2024 the International Society of Dermatology.)

Background: The robotic hair transplant technology, ARTAS, has a series of fine mechanical structure and an intelligent recognition system that allows it to independently select hair follicular units (FUs) and effectively harvest hair. After entering China in 2016, ARTAS has attracted the attention of hair transplant surgeons and hair loss patients given its advantages in a short learning curve and simple operation., Objective: To compare the efficacy and safety between the ARTAS system and follicular unit excision (FUE) in the treatment of male androgenetic alopecia (AGA) and to further promote the improvement and upgrading of ARTAS technology concerning hair transplantation., Methods: Thirteen Chinese male patients with Norwood-Hamilton II-IV AGA aged 25-35 years were enrolled in this study. The donor site of each patient was randomly divided into left and right regions, receiving ARTAS on one side and FUE on the other. Yield, transection, and discard rates of hair FUs from both sides were compared. Safety of the procedures in whole, as well as follow-up results were investigated and evaluated., Results: The total yield rate on the ARTAS side was lower than on the FUE side (82.05% vs. 90.03%, p > 0.05); the total discard rate on the ARTAS side was higher than on the FUE side (10.71% vs. 5.46%, p < 0.05); the total transection rate on the ARTAS side was lower than on the FUE side (13.17% vs. 13.96%, p > 0.05). No significant difference was found in patient satisfaction (efficacy), and no side effects or complications were detected during or after all surgeries., Conclusion: The current iteration of Robotic hair transplant technology is effective and safe, and can be recommended for AGA hair transplantation surgery., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Introduction: Although DIEP (deep inferior epigastric perforator) is the gold standard for breast reconstruction, long-term results with a view to postoperative hairiness and flap skin colouration have rarely been described in the literature., Methods: Patients who underwent DIEP flap breast reconstruction followed by NAC reconstruction between 2010 and 2019 were invited to our clinic for a survey and a clinical examination. A total of 781 patients were invited. The survey included the BREAST-Q and a study-specific questionnaire. The clinical examination contained specific measurements regarding postoperative hairiness and skin colouration., Results: A total of 179 patients were examined, with 203 breasts having been reconstructed. Only breasts with a visible flap skin island were taken into further evaluation. A total of 109 DIEP flap and 77 NAC reconstructions were evaluated. In the patient-reported survey, 27.5% (30 of 109) reported additional flap hairiness and 62.4% (68 of 109) reported differences in flap skin colouration compared with the surrounding skin. The clinical examination revealed a significant difference between the skin colouration of the flap compared with the surrounding skin and the skin colouration of the reconstructed NAC compared with the existing original NAC. In both cases, the reconstructions appeared significantly "lighter" (p<0.05). No significant difference was found between patients with and without hair in terms of overall satisfaction evaluated by using the BREAST-Q. Neither did the colour difference have a significant influence on patients' satisfaction., Conclusion: Additional breast hairiness and different skin colouration is relevant and should be communicated preoperatively., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonfliktbesteht., (Thieme. All rights reserved.)

Background: Achieving successful outcomes in hair transplant surgery involves various critical factors, including donor area harvesting, graft survival, and minimizing post-operative complications. This study investigates the differences in grafts obtained using the rotary and oscillatory punch methods during follicular unit extraction (FUE) surgery., Methods: The study involved 15 patients undergoing FUE. Four 4 × 6 cm 2 areas in two rows were selected for each patient, with each row utilizing a different punch method (rotary or oscillatory). The grafts were extracted and examined under a microscope, classified into single, double single, double, and triple categories. The total yield rate and average number of hairs per graft were measured and compared., Results: The average number of hair follicles per graft was 2.029 for the rotary method and 2.084 for the oscillatory method, indicating no statistically significant difference. However, the total yield rate was 88.3% for the rotary group and 90.5% for the oscillatory group, with the difference being statistically significant. In selected cases with soft scalps or deeper punch requirements, the oscillatory method showed significantly better results, with an average of 2.078 hairs per graft compared to 1.836 for the rotary method. The total yield rate in these cases was 91% for oscillatory and 86% for rotary., Conclusion: While the overall differences between rotary and oscillatory punches are minimal, the oscillatory punch is significantly more effective in cases with soft scalps or deeper punch requirements. Adhering to a structured guideline before extraction can help reduce the transection rate and increase the number of hairs per graft., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Postoperative folliculitis is a common complication of hair transplantation (HT) requiring effective preventive interventions. This study characterized postoperative folliculitis and determined risk factors in patients undergoing HT., Methods: The authors retrospectively reviewed 1317 patients who underwent HT and completed 9-month follow-up between January of 2018 and June of 2021 at 4 medical centers. The incidence of postoperative folliculitis and demographic characteristics were assessed. Logistic regression analysis was used to identify risk factors, and the characteristics of different types of folliculitis were compared., Results: The overall incidence of postoperative folliculitis was 12.11%, and clinical characteristics varied among the different types of folliculitis. Surgery in summer (OR, 1.772 [95% CI, 1.05 to 2.992]), number of transplant grafts 4000 or greater (OR, 4.818 [95% CI, 1.45 to 16.014]), transplant density greater than 45 grafts/cm 2 (OR, 2.152 [95% CI, 1.376 to 3.367]), and first nursing time greater than 3 days (OR, 1.555 [95% CI, 1.088 to 2.223]) were the main risk factors for postoperative folliculitis., Conclusions: Postoperative folliculitis after HT presents different characteristics. Surgical factors and postoperative nursing care were demonstrated to be related to folliculitis. The authors propose a preventive folliculitis model based on preoperative, intraoperative, and postoperative factors., Clinical Question/level of Evidence: Risk, III., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Dissecting cellulitis (DC) of the scalp is a chronic inflammatory condition marked by neutrophilic cicatricial alopecia, often linked to staphylococcal antigens. This case report details a 34-year-old male with scarring acne who developed DC following follicular unit extraction (FUE) approximately four months prior. Trichoscopic examination revealed brown pigmented dots, erythema, and melicerous crusts. Abscess drainage yielded negative bacterial cultures, leading to a diagnosis of DC. The patient was treated with isotretinoin (20 mg/day), dutasteride (0.5 mg/day), intralesional steroid injections, and salicylic acid-based shampoo. After four months, the patient exhibited significant improvement, with trichoscopic findings showing regrowing hairs and no abnormal hair loss. DC, though commonly associated with other follicular occlusion disorders, has not been previously reported following FUE, indicating a need for awareness of this potential complication. The efficacy of isotretinoin and the emerging role of dutasteride in managing DC highlight the importance of early diagnosis and personalized treatment. Trichoscopy is crucial for diagnosis and monitoring, emphasizing the need for prompt intervention to prevent scarring alopecia. Caution is advised when considering FUE in patients with severe inflammatory acne due to the risk of developing DC., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Guerrero-González et al.)

Background: The incidence of androgenetic alopecia in males is on the rise annually, with hair transplantation using follicular unit extraction (FUE) gaining increasing acceptance as an appropriate treatment for these individuals., Methods: A retrospective study was undertaken, involving 158 male patients diagnosed with androgenetic alopecia, who underwent treatment between January 2016 and December 2020 at the Medical Cosmetology Department of the First Affiliated Hospital of Xi'an Medical University. Demographic data and treatment characteristics were documented and analyzed. Clinical efficacy, operation-related complications, patient satisfaction rates, and quality of life scores were assessed and analyzed., Results: Following FUE hair transplantation, over 90% of the hair follicles survived in 158 patients, with more than 85% of patients achieving a hair follicle survival rate exceeding 95% at 12 months post-operation. Patient satisfaction rates exceeded 98%, while the complication rate was below 6%., Conclusion: Our findings demonstrate that FUE is a minimally invasive hair transplant technique associated with a high hair follicle survival rate and optimal hair density. This approach proves effective in treating male androgenetic alopecia and merits further clinical application., Competing Interests: Declarations Ethics approval and consent to participate The Ethics Committees of the First Affiliated Hospital of Xi’an Medical University approved this study. Patients provided informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Eyebrow transplant surgeries have become increasingly popular in recent years. Periauricular hair, with its slow growth rate and fine caliber similar to eyebrow hair, has been strategically used in eyebrow transplants to achieve enhanced and authentically natural aesthetic results., Objectives: This study aimed to assess the postoperative clinical outcomes of using periauricular hair for eyebrow transplantation., Methods: Data from 81 patients (72 women and 9 men) who underwent eyebrow transplantation with periauricular hair between October 2020 and September 2022 were analyzed. They were followed up for 15 months' post-surgery to evaluate recovery and complications. Patient satisfaction and quality of postoperative life were assessed using a 5-point Likert scale., Results: For female patients, the average total number of transplanted hair grafts and surgery duration were 402.33 ± 158.48 FU (follicular unit) and 193.86 ± 66.69 min, respectively. Contrastingly, male patients exhibited slightly higher values, with an average of 481.78 ± 126.43 FU and 229.00 ± 96.80 min, respectively. No significant complications were reported during the postoperative follow-up. Patients expressed general satisfaction with immediate and 15-month postoperative outcomes, reflected in a mean overall satisfaction score of 4.90. The overall satisfaction of the subjects at 15 months postoperative was significantly higher than the preoperative satisfaction (Z = -8.483, p < 0.001). The eyebrow/forehead surgery did not have a significant impact on postoperative satisfaction (H = 5.355, p = 0.374 > 0.05); however, patients without tattoos tended to report higher levels of postoperative satisfaction (Z = 8.056, p = 0.004 < 0.05). Patient satisfaction ratings for physical function, psychological function, social function, and quality of life post-operation were 5, 4.95, and 4.94, respectively., Conclusions: Eyebrow transplant using periauricular hair can improve cosmetic outcomes and is a viable option in clinical practice., Competing Interests: Declaration of competing interest None., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Conventional epilation methods commonly encounter challenges in achieving permanent removal of unwanted facial terminal hair (uFTH), particularly when it is interspersed among normal hairs., Objective: To assess the safety and effectiveness of follicular unit excision (FUE) for permanent removal of uFTH., Methods: The retrospective analysis included 231 patients who underwent FUE hair removal at three medical centers. uFTH in five facial areas was excised and assessed for follicular integrity. Surgical details, complications, in situ hair regrowth, and patient satisfaction were recorded and analyzed., Results: Scattered uFTH was excised using a fine punch (inner diameter, 0.6~0.7 mm) at a rate of 18.0~23.6 units per minute in five facial areas. The procedure yielded a low transection rate of only 6.2% (median), minimizing in situ hair regeneration and facilitating the intact harvesting of hair follicles for transplantation. Most sites exhibited optimal wound healing without visible scarring. The overall complication rate is 26.3%, with folliculitis accounting for 3%. Overall satisfaction was significantly high, reaching 96.6%., Conclusion: FUE technique is a precise and effective potential approach for uFTH permanent removal in facial areas., 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Aim: To integrate and summarize the best evidence on perioperative management practices for hair transplantation patients, providing an evidence-based reference for clinical., Methods: An exhaustive literature search was conducted to identify the best evidence for managing patients undergoing hair transplantation during the perioperative period. The databases searched included Up To Date, BMJ Best Practice, UK National Institute for Health and Care Excellence, National Guideline Clearing House, Scottish Intercollegiate Guidelines Network, Guidelines International Network, Cochrane Library, JBI Database of Systematic Reviews and Implementation Reports, PubMed, Web of Science, European Dermatology Forum, China National Knowledge Infrastructure, Wanfang Data, Medlive Guideline Network, and Sinomed. The search spanned publications from February 2013 to February 2024, focusing on clinical decisions, evidence summaries, guidelines, and expert consensus., Results: We finally identified 22 articles with high-quality results (consisting of 9 clinical decisions, 6 guidelines, 7 expert consensuses), providing 41 pieces of evidence across seven categories: assessment of transplantation conditions, transplant planning and preoperative preparation, anesthetic preparations, surgical methods and operation skills, postoperative wound management, medication-related guidance, optimization of nursing and treatment strategies. Special emphasis has been placed on the sections covering anesthesia preparation, surgical methods, and operational techniques, with detailed explanations provided., Conclusion: The summarized best evidence on perioperative management practices for hair transplantation patients can serve as evidence-based guidelines for clinical. It is recommended that clinical staff adopt evidence-based recommendations to improve and optimize patient outcomes and promote postoperative recovery. As these evidences came from different countries, factors such as the clinical environment should be evaluated before application., Level of Evidence V: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Follicular vitiligo is a distinct subtype of vitiligo characterized by the selective destruction of the follicular melanocytic reservoir. Treatment of follicular vitiligo-associated leukotrichia has always been a clinical challenge., Methods: Twenty participants (mean age, 29 years) with stable follicular vitiligo were recruited between 2020 and 2021 for 2-stage surgery. In stage 1, an incision around the vitiligo lesion was performed to subcutaneously dissect and scrape the leukotrichia. In stage 2, healthy follicles obtained from the occipital donor site were transplanted into the vitiligo area. Follow-up examinations were conducted for 1 year postoperatively using a camera and dermatoscope to observe the growth rate, color, and surviving number of the transplanted hairs. Patient satisfaction was recorded to evaluate the potential surgical improvement., Results: The transplanted hair grew with natural texture, as expected. The average survival rate of the transplanted hair follicles was 93.8%. No recurrence of leukotrichia was observed in the recipient area. No complications were observed, and the postoperative scars in the recipient area were entirely covered by black hair. All patients were satisfied with their resulting appearance., Conclusion: Minimally invasive removal of leukotrichia combined with hair transplantation might be an appropriate surgical option for stable follicular vitiligo to create natural and stable pigmented hair., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons.)

Background: Hair transplant (HT) is the standard treatment for female pattern hair loss (FPHL), but scalp micropigmentation (SMP) is an alternative. Currently, there are no criteria to help choose between HT and SMP., Methods: Forty female patients with FPHL who had successfully undergone HT and SMP, were reviewed to identify factors that might help decide between treatments. Hair density (HD) and hair caliber were measured at the part line and mid-occipital region by a Folliscope. The sensitivity and specificity of HT and SMP were determined by area under the curve (AUC) and receiver operating characteristic curve., Results: Patients were divided into HT (n = 23) and SMP (n = 17) groups. The follicular unit density (FUD) (HT: 62.06 ± 4.8551/cm 2 ; SMP: 66.59 ± 3.4971/cm 2 ) and HD (HT: 96.16 ± 16.6954/cm 2 ; SMP: 116.08 ± 17.0520/cm 2 ) were significantly different (p < 0.01) between groups. The AUC for FUD was 77.6% with a cutoff value of 66.83 and 87.0% (1-0.412) sensitivity. The AUC for HD was 82.4% with a cutoff value of 96.17 and 69.6% (1-0.118) sensitivity., Conclusions: HD was the most important factor when deciding between HT surgery and SMP. SMP is recommended when the HD is ≥104.6 hairs/cm 2 and HT surgery is strongly recommended when the HD is ≤96.17 hairs/cm 2 ., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Hair transplantation is a widely performed cosmetic procedure for hair restoration. While generally safe, it carries the risk of complications, including recipient site necrosis (RSN). RSN is a rare but serious complication. This study aims to conduct a detailed analysis of 18 patients who had necrosis in the recipient area after hair transplantation., Methods: A retrospective review of medical records was conducted on 18 consulted patients who developed RSN following hair transplantation between 2017 and 2023. Data collected included patient demographics, medical history, surgical details, treatment modalities, and outcomes. Treatment involved surgical intervention (debridement), and conservative measures (wound care) in all cases., Results: The mean age of patients was 36.06 years (range: 22-48). The most common risk factors identified were smoking 66.7% (n = 10), hypertension 20% (n = 3), and diabetes mellitus 13.3% (n = 2). All patients (n = 18) underwent single-session hair transplantation using the follicular unit excision technique, and an average of 3899.44 ± 93.76 follicular units were transplanted. Outcomes such as scarring and graft failure occurred in all patients., Conclusion: The presented study is the largest complication series in the literature. RSN is a rare but significant complication of hair transplantation. Identifying and managing risk factors, such as smoking, diabetes and hypertension, is crucial for prevention. Early recognition and prompt treatment are essential for optimal outcomes. While conservative management is often successful, surgical intervention may be necessary in severe cases., Level of Evidence Iv: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Telemedicine has rapidly advanced in plastic and aesthetic surgery, but obtaining high-quality images during online hair transplantation consultations remains challenging, impeding doctors' visual evaluation., Objective: To investigate patients' attitude and satisfaction with online hair transplantation consultations, and to develop a standardized photo guideline to help patients capture high-quality images., Methods: We surveyed patients' attitudes and satisfaction with online hair transplantation consultations from November 23, 2023 to May 3, 2024. Meanwhile, five surgeons developed a standardized photo guideline and assessed its effectiveness by comparing image quality between two patient groups: those using the photo guideline and those not using it., Results: We collected 570 responses to the attitude questionnaire, with 76.66% of participants expressing a willingness to undergo online hair transplantation consultations. The patient satisfaction survey yielded an overall satisfaction score of 4.44 ± 0.72 out of 5 for online hair transplantation consultations. Furthermore, all five surgeons rated photographs taken by patients following the photo guideline as higher quality compared to those taken by patients who did not use it., Conclusion: Patients show high satisfaction with online hair transplantation consultations. The standardized photo guideline proves effective in helping patients take high-quality photographs for online consultations., Level of Evidence Iv: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Hair transplantation, particularly through follicular unit extraction (FUE), can lead to postoperative complications, such as numbness, itching, and pain in donor areas, primarily because of delayed wound healing. Efficient management of donor-site healing is crucial to mitigate these complications and improve overall patient outcomes., Objective: This study aimed to assess the efficacy of hair follicular-derived microtissue (HFMT) in promoting wound healing and alleviating postoperative complications in donor areas after FUE hair transplantation., Methods: Perifollicular tissue obtained during the trimming phase of hair transplantation was processed into HFMT and analyzed for its properties using histological and molecular techniques. In a single-blind, split-scalp study involving 98 participants, Group A received HFMT or mupirocin, whereas Group B received HFMT or no treatment. Dermatoscopic images were captured postoperatively, and visual analog scale scores were used to evaluate pain, itching, and numbness., Results: HFMT-treated donor sites in Group A demonstrated a significantly higher wound closure ratio on postoperative day 3 than mupirocin-treated sites. Pain scores for HFMT-treated sites were consistently lower on postoperative days 3, 5, and 7. Similar trends were observed for itching scores. Group B exhibited outcomes comparable with Group A., Conclusion: The application of HFMT homogenates effectively accelerated wound healing and alleviated donor-site complications after FUE hair transplantation., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: There are 2 extraction techniques for follicular units (FUs) in hair transplantation: strip harvesting follicular unit transplantation (FUT) and follicular unit excision (FUE). Currently, no extant studies have demonstrated that one technique is superior in extraction and donor area optimization for a dense result., Objective: This study compares the FUT and FUE techniques by evaluating the percentage of FUs with 3 or more hairs and the hairs-to-follicular-unit ratio in patients who underwent both procedures at different times., Materials and Methods: The medical records of patients who underwent at least 1 FUT procedure and at least 1 FUE procedure (with this being the second surgical procedure) were reviewed. The surgeries were performed in the same clinic with the same surgeon and surgical team., Results: There was a higher percentage of FUs with 3 or more hairs and a higher hairs-to-follicular-unit ratio with the FUE technique than with the FUT technique., Conclusion: In FUE, surgeons tend to choose better-looking FUs with thick, plentiful hairs. Even with these results, it is impossible to declare one procedure superior because the correct indication considers multiple factors., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To investigate the results of two grafting methods to manage CLs in the FHL of women., Background: The present study was performed to investigate the results of two grafting methods to manage cowlicks (CLs) in the frontal hairline of women., Methods: Patients were categorized into two groups based on the grafting method: the matching with the original hair direction (MOD) group and the matching with the CL hair direction (MCD) group. Satisfaction ratings were compared between the two groups., Results: Among 80 patients, 77 had a single CL and 3 had a double CL. In the MOD group, 7 of 12 (58.3%) patients underwent a touch-up procedure for density enhancement with an average of 123 follicular units; the average patient and physician satisfaction ratings were 4.84 and 4.60, respectively. In the MCD group, 7 of 68 (10.3%) patients underwent a touch-up procedure for density enhancement around the CL; the average patient and physician satisfaction ratings were 4.64 and 4.50, respectively., Conclusion: In female hairline correction surgery, the surgeon must choose between MOD and MCD by considering the location, shape, and pattern of the CL; the facial shape; and the patient's preference. Delicate graft placement is required to obtain natural-looking results., Level of Evidence Iv: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: The success of hair transplantation surgeries for androgenetic alopecia is evaluated by postoperative long-term outcomes. Patients' self-management during the long recovery period affects this outcome., Objective: This study aimed to explore patients' self-management status, facilitators, and impediments in the postoperative period and to provide a reference for developing a postoperative self-management intervention program., Methods: Patients who underwent hair transplantation for androgenetic alopecia were selected using purposive sampling. They were interviewed using one-to-one semi-structured interviews at a general tertiary hospital in Hangzhou from March to April 2022. Qualitative research analysis software Nvivo 12.0 was used to analyze the collected data., Results: The self-management of postoperative patients with androgenetic alopecia during the recovery period encompasses six areas: more problems with postoperative medication (e.g., not being able to take medication on time) and wound care (e.g., not daring to shampoo, etc.), not being able to review their postoperative condition on time (due to busy schedules at work and at home), more hindrances to the establishment of good living habits (affected by overtime work, socialising, and bad habits of the people around them), and seeking positive ways of relieving bad emotions (stress, anxiety, depression, etc.), worrying about one's image during recovery and taking the initiative to obtain and use resources to promote recovery (through the Internet, books, etc.)., Conclusions: Various factors impact the postoperative self-management abilities of patients, including medication, shampooing, and emotions. It is essential to design support programs to enhance these abilities and improve long-term hair transplantation outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: Follicular unit hair transplantation has greatly elevated the results of eyebrow restoration. However, unnatural and unbeautiful-looking results are still often seen after the surgery., Objectives: This study focused on poor eyebrow transplantation, discussed its possible reasons, and offered refined proposals., Methods: A retrospective analysis was performed on 100 patients who were dissatisfied with the results of eyebrow grafting and came to our department from 2011 to 2021. Demographic characteristics, primary disease, and clinical data were objectively summarized and analyzed for these patients., Results: The patients' medical charts and photographs were analyzed and summarized into the following outcomes: Thirty-six patients (36%) had sparse eyebrows. Forty-one patients (41%) had eyebrows with inhomogeneous density and disordered growth direction. Eleven patients (11%) did not have single-hair grafting. Seven reconstructed eyebrows (7%) had a poor connection with the remaining eyebrows. Five new eyebrows (5%) had inconsistent hair characteristics with the original eyebrows. Lower hair survival rates, insufficient understanding of naturally beautiful eyebrows, and inadequate communication with patients were the main reasons for poor outcomes., Conclusions: Good reconstructed eyebrows should have a high hair survival rate, and hair growth direction and characteristics should also be consistent with the natural eyebrow to achieve ideal surgical effects., Level of Evidence Iv: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Introduction: Hair transplantation surgery requires the efficient completion of hair follicles and thus appropriate hair implantation needles. The objectives of this study were to evaluate the effectiveness and feasibility of self-made hair implantation needles using injection needles and evaluate the speed of different hair implantation methods., Methods: Four patients were randomly assigned to four groups. A gem knife pre-punching planting method was used for the patient in Group A, while Group B received immediate implantation after punching with ordinary injection needles, Group C was treated with synchronized punching and planting using hair implanters, and Group D was treated with a self-made hair implantation needle. The speed of the different implantation methods for single and double hair follicles and the differences between the planting of single and double hair follicles were assessed., Results: Group D was found to have the fastest hair planting speed for both single and double hair follicles, followed by Groups C and A, with the slowest speed observed in Group B. Groups A and B were associated with significantly lower speeds of double hair planting than single hair planting, There was no significant difference between Groups C and D., Conclusions: The self-made hair implantation needle is a novel and efficient tool for synchronized punching and planting. It has a faster planting speed and does not require assistance., Level of Evidence Ii: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Restoration of the beard region has become an important component of hair restoration surgery due to increased awareness of its natural-appearing results. In the author's experience performing more than 700 primary beard hair transplants and tens of reparative procedures, key aesthetic steps include proper graft dissection so that one- and two-hair grafts contain a minimal cuff of surrounding skin, acute angulation and appropriate direction of recipient sites using the smallest possible recipient-site blades, and aesthetic design., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Context: Laser hair removal treatment for hairlines with an unsatisfactory appearance often leads to an unnatural appearance; however, few studies have reported treatment outcomes., Objective: To explore the satisfaction rate of laser hair removal involving the hairline., Design: Retrospective analysis., Setting: Data from 5 clinical institutions., Patients: Patients (915; 630 female and 285 male) who underwent laser hair removal., Interventions: Issues associated with hair removal were classified, and their proportions were calculated. Hair transplantation was performed to improve the appearance of different hairline issues., Main Outcome Measures: Relevant indicators of hair transplantation and postoperative effects., Results: Overall, 82 patients were unsatisfied with their hairline appearance; of these patients, 58 underwent hair transplantation to improve the hairline. Additionally, demographic statistics showed that 68% and 32% of patients were in the 20 to 30 and 30 to 40 years age groups, respectively; there were no patients in the 40 to 50 years age group. Among female patients who underwent hair transplantation, 25% had a poor hairline position, 64% had a stiff hairline appearance, and 11% experienced both issues. Among male patients, 50% had a stiff hairline appearance, 28% had temporal absence, and 22% experienced both issues. Surgical treatment included moving the hairline forward and rebuilding the frontal curves. All patients were satisfied with hair transplantation outcomes., Conclusions: Laser hair removal can result in diverse types of unnatural hairlines. Hair transplantation has been proven to effectively improve the aesthetic appearance of the hairline., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Chronic ulcers significantly affect the quality of life of patients and impose a high cost on the healthcare system. The therapeutic management should be comprehensive, taking into consideration the etiological diagnosis of the wound and the characteristics of the wound bed when deciding on a therapeutic proposal appropriate to the healing phase, correcting factors that delay healing. During the epithelialization phase, repair techniques with grafts are recommended to shorten re-epithelialization time, improve the quality of scar tissue, and achieve adequate pain management. Currently, due to the reported benefits of skin appendages, the technique of follicular unit auto-grafting obtained with a scalp punch is among the chosen strategies for wound repair. This is a minimally invasive, outpatient practice, whose technique has advantages over the donor site, patients recovery and well-being., (Copyright © 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Postburn scarring alopecia on hair-bearing aesthetic subunits causes cosmetic disfiguring and psychological problems. Follicular unit extraction (FUE) hair transplantation is an effective technique for camouflaging postburn scarring alopecia. However, poorly vascularized and fibrotic scar tissue limits the viability of grafts. The mechanical and vascular characteristics of scar tissue can be improved by nanofat grafting. This study aimed to present the results of postburn scarring alopecia treatment using nanofat-assisted FUE hair transplantation., Methods: Eighteen patients who had postburn scarring alopecia in and around the beard were enrolled. Patients underwent single-session nanofat grafting and FUE hair transplantation at 6-month intervals. Twelve months after hair transplantation, the survival rate of transplanted follicular graft, scar improvement, and patient satisfaction were assessed by counting each transplanted follicle individually, using the Patient and Observer Scar Assessment Scale, and using a 5-point Likert satisfaction scale, respectively., Results: Nanofat grafting and hair transplantation were successfully performed without complication. All scars significantly improved in mature characteristics ( P < 0.00001 for patients; P < 0.00001 for observers). The survival and density rates of transplanted follicular units ranged from 77.4% to 87.9% (mean, 83.2% ± 2.5%) and 10.7% to 19.6% (mean, 15.2% ± 2.46%), respectively. All patients reported significantly satisfying cosmetic results ( P < 0.00001)., Conclusions: Scarring alopecia is an inevitable and challenging late complication of deep burned hair-bearing units. Combining nanofat injection and FUE hair transplantation is among the most innovative and effective treatments for postburn scarring alopecia., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Follicular unit hair extraction (FUE) is effective for hair restoration but is less successful on scarred tissue due to reduced vascularity and altered tissue architecture. Stem cell therapy can enhance tissue regeneration, possibly improving FUE outcomes on scarred tissue. This study investigated the impact of stem cell therapy prior to FUE on scarred tissue. Sixty patients with scalp scars from trauma or previous surgeries were divided into two groups. Group A ( n = 30) received autologous stem cell therapy followed by FUE, while Group B ( n = 30) underwent FUE without prior stem cell treatment. Autologous stem cells were harvested from patients' adipose tissue and injected into the scarred area four weeks before FUE. Outcomes were assessed at 3-, 6-, and 12-months post-transplantation, focusing on hair density, graft survival rate, and patient satisfaction. Histological examinations evaluated tissue regeneration. Group A showed significantly higher hair density (mean increase of 45%) and graft survival rates (87%) compared to Group B (mean increase of 25%, graft survival rate of 60%) at all follow-up points ( P < 0.05). Histological analysis revealed enhanced neovascularization and reduced fibrosis in the stem cell-treated group, with 70% more new blood vessels and 50% less fibrotic tissue compared to the control group. Patient satisfaction scores were higher in Group A (average score of 8.5 out of 10) versus Group B (6.0), indicating better aesthetic outcomes and reduced scar visibility. Pre-treatment with autologous stem cell therapy significantly improved FUE effectiveness on scarred tissue, enhancing graft survival, hair density, and patient satisfaction. Further research is recommended to optimize this therapeutic strategy., Competing Interests: The authors declare no conflict of interest., (© 2024 by the authors.)

Frontal fibrosing alopecia (FFA) represents a distinctive form of primary lymphocytic scarring alopecia characterized by fronto-temporal hair recession and eyebrow hair loss. While predominantly affecting postmenopausal women, FFA also occurs in women of reproductive age and men, with variations observed across different ethnic groups. Genetic predisposition, environmental factors and inflammatory pathways contribute to its pathogenesis, with evolving diagnostic criteria enhancing accuracy. FFA treatment lacks standardization, encompassing topical, systemic and physical therapies, while hair transplantation remains a temporary solution. This article reviews the current understanding of FFA, aiming to provide clinicians with updated insights for its management., (© 2024. The Author(s).)

Background and Rationale: Cicatricial alopecia not only affects patients' appearance but also has negative effects on their physical and mental well-being, as well as their daily lives. Therefore, it is essential to provide proactive treatment to patients., Objective: To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of secondary scarring alopecia caused by burn, and to evaluate its effectiveness., Methods: A retrospective observational study has been conducted, which included 41 patients with secondary scarring alopecia caused by burn. 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: Satisfaction assessments were conducted for all 41 patients. Out of the total, 31 individuals expressed being very satisfied, 7 individuals reported being satisfied, and 3 individuals indicated being not very satisfied. Among the patients, 3 experienced complications, including herpes in the donor area for one patient, temporary hair loss for another patient, and thick scab for the third patient., Conclusion: FUE hair transplantation yields positive results for secondary scarring alopecia caused by burn. It offers natural hair growth patterns, minimal trauma, quick recovery, high patient satisfaction, and few complications., (© 2024 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Alopecia is defined as partial or complete hair loss. The most common form is androgenetic alopecia, which occurs in both men and women. Despite the nonsurgical options available for treatment, the only permanent solution is hair transplantation. Hair loss has been shown to have significant psychological consequences associated with loss of self-confidence, poor self-image and difficulties in social functioning. We aim to examine the effect of hair transplantation on quality of life and psychosocial functioning., Methods: Forty-eight patients with androgenetic alopecia were enrolled in this two-center prospective study and underwent hair transplantation by the Follicular Unit Extraction method. Different questionnaires were used to assess their quality of life and other psychosocial parameters before and after hair transplantation., Results: According to SF-36 Physical and Mental Health Score patients showed significant improvement in life quality after hair transplantation. Diener's Life Satisfaction Scale (DASS-21) revealed increased life satisfaction after the procedure. Stress and anxiety DASS-21 subscales showed significantly reduced results; while, the DASS-21 depression scale and MSPSS were not significantly changed., Conclusion: Taken together, quality of life and psychosocial functioning increased after hair transplantation. Structured abstract is required. Please provide.I insert name of paragraphs within abstract as follows: background, methods, results, conclusion Level of Evidence II: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Platelet-rich plasma (PRP) and its combined therapeutic modalities have catalyzed new possibilities in dermatology; however, limitations in evidence and lack of consensus remain among clinicians regarding optimal composition, protocol, technique, and application., Objective: To provide an update and analysis of the evidence for PRP in hair restoration and skin rejuvenation through review of recent available data, highlighting controversies and expert insights to guide future studies, and stimulate discourse and innovations benefitting patients., Methods: A structured review and expert analysis of PubMed publications before October 2023, with a focus on recent literature from January 2020 through October 2023., Results and Conclusion: Growing literature supports the utility and benefits of PRP and related autologous products for applications for skin and hair, with strongest evidence for androgenetic alopecia and skin rejuvenation. However, this is limited by lack of consensus regarding best practices and protocols. Randomized, controlled trials with uniform metrics comparing outcomes of various compositions of autologous blood products, preparation methods, dosimetry, and frequency of treatments are still required. This will allow the medical discourse to grow beyond the realm of expert opinion into consensus, standardization, and more wide spread adoption of best practices that will benefit patients., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To describe a case of endogenous endophthalmitis as a complication from hair transplantation., Methods: Case report of a 53-year-old man with a history of recent hair transplantation., Results: The patient presented with a febrile illness and blurry vision 1 week after hair transplantation. Infectious workup included blood cultures positive for methicillin-resistant Staphylococcus aureus, and he was treated with IV antibiotics. Initial ocular examination demonstrated 20/30 and hand motions in the right and left eyes, respectively, with significant vitritis. He underwent vitreous tap and injections of vancomycin and dexamethasone in both eyes and removal of purulent staple from the site of recently transplanted hair. His ocular and systemic symptoms improved. Approximately 3 months after initial clearing of the initial infection he had recurrence of bacteremia that prompted repeat intravitreal and systemic antibiotics. His vision returned to baseline with mild residual optic nerve pallor and atrophic retinal changes in the left eye., Conclusion: Hair transplantation is associated with minimal systemic complications, but in rare cases, sepsis is possible and can result in intraocular seeding causing endophthalmitis. MRSA endogenous endophthalmitis frequently results in negative vitreous taps and treatment outcomes in the literature have been shown to vary widely including a return to baseline vision as in the described case.

Follicular unit excision (FUE) graft dissection has become the dominant method of donor harvesting globally, however, only a percentage of donor hair can be excised inside the safe donor area before visible donor thinning occurs. Compared to linear strip excision (LSE) where all follicular units inside the harvested ellipse of hair are used, FUE poses substantial limitations for lifetime graft yield and, therefore, cosmetic coverage in patients with advanced pattern hair loss. This paper reviews how combining the donor harvesting methods of FUE and LSE has been shown to optimize graft yield while minimizing the risk of donor depletion from overharvesting. It then describes a surgical technique called FUE-Linear Ellipse (FUE-LE) where FUE dissection of grafts inside a demarcated linear ellipse eliminates the need for a large dissection team which has posed a barrier for many new practices that offer both the donor harvesting methods. For practices that currently offer only FUE, the addition of the LSE method by the modified FUE-LE technique is possible without specialized staff training or associated equipment costs. In this paper, surgery practices that have adopted this technique will report on their experiences. Hair restoration surgeons are encouraged to provide both methods of donor harvesting (FUE and LSE using FUE-LE) in order to optimize graft yield for patients and avoid long-term donor depletion. Based on limited experience, it appears the technique of FUE-LE will help achieve this goal., Competing Interests: None declared., (Thieme. All rights reserved.)

Follicular unit excision (FUE) is a very effective and valuable modality for obtaining donor hair follicles using manual, motorized, or robotic devices to harvest individual donor follicular units in situ without a linear donor scar or visible scarring making it ideal for patients who wish to wear their hair short and hide signs of surgery. Over the past two decades, FUE has become increasingly popular, and the rising demand for FUE has driven the worldwide market size of hair restoration surgery (HRS) to an unprecedented height.FUE has revolutionized the HRS industry and offers excellent cosmesis and high patient satisfaction. Unfortunately, a large part of the favorable appeal of FUE is due to false claims that it is "minimally invasive," "scarless," or "not even surgery." Most patients opt-in for FUE due to these misconceptions, which are advertised by "black-market" clinics offering low-cost FUE surgery performed by amateur, nonprofessional technicians on unsuspected patients. The technique appears deceptively simple, and many neophyte surgeons falsely believe that the learning curve of FUE is short because the barrier of entry is low and no previous surgical skill is required. Nevertheless, injuries on grafts are extremely easy to occur since FUE is a blind technique and can be minimized only with excellent technique, which takes years to master.FUE actually presents unique challenges for the surgeon and carries potential long-term permanent side effects if not performed properly. The surgeon must have a thorough understanding of the nuances of the FUE surgical technique to ensure consistent graft quality and favorable cosmesis of both donor and recipient areas. Efficient FUE requires dexterity, training, dedication, devotion, enthusiasm, cognitive clarity, scientific knowledge, experience, and an extended learning curve.FUE is an invaluable addition to the armamentarium of a hair restoration surgeon but has to be judiciously performed., Competing Interests: None declared., (Thieme. All rights reserved.)

Follicular unit grafts can be harvested using two methods: strip follicular unit transplantation and follicular unit excision. Each method can generate outstanding results, but both are uniquely different with respect to the advantages and disadvantages they offer. Devising a sound surgical plan is instrumental to assure that a patient's short-term and long-term goals can be met, but creating the best plan possible for the graft harvest process is not straightforward. This paper will review the various advantages and disadvantages of each graft harvest method, along with their short-term and long-term ramifications, so as to provide insight into the process by which a sound surgical plan can be developed for any patient seeking surgical hair restoration., Competing Interests: None declared., (Thieme. All rights reserved.)

Follicular unit excision (FUE) has emerged as the preferred method for hair transplants. Standardized terms and definitions established by members of the International Society of Hair Restoration Surgery and prominent hair restoration surgeons have become the standard, enabling effective knowledge sharing. This chapter provides an overview of the terminology relating to the field.The historical evolution of FUE and its pivotal role in modern hair transplantation is summarized. Anatomical terminology and graft-related definitions follow, providing insights into the scalp's complex structures and graft characteristics. The subsequent sections detail the terminology associated with graft excision and extraction, shedding light on the precise techniques and procedures employed. An exploration of various FUE techniques and the evolving landscape of FUE devices underscores the continual refinement of hair restoration practices. The chapter proceeds to discuss the "safe'" scalp donor zones, donor assessment terminology, and elements in identifying the optimal donor area for a successful FUE procedure. Additionally, punch dynamics and technique characteristics are examined, emphasizing their pivotal role in achieving superior FUE outcomes. The chapter concludes by discussing the classification of punches and graft evaluation terms, offering insights into the tools, and criteria used to assess graft quality and viability., Competing Interests: None declared., (Thieme. All rights reserved.)

Nonscalp donor hair harvesting or body hair transplantation offers patients an additional source of donor hair in cases when the scalp does not have an adequate supply for the intended recipient area. The most common applications for nonscalp donor hair are for patients with advanced hair loss or to camouflage scarring from prior hair restoration procedures. For patients with available body hair, the beard is probably the best source followed by the chest and abdomen. Combined, these sources may be able to provide thousands of additional grafts for transplantation. Nonscalp hair donor harvesting is technically challenging and should be performed by those with extensive experience in follicular unit excision surgical techniques., Competing Interests: None declared., (Thieme. All rights reserved.)

For decades, the placement of follicular units (FUs) into incisions in the recipient area was exclusively carried out using forceps. In 1992, Dr. Choi introduced an instrument known as the "implanter," which had the advantage of simultaneously creating incisions and placing FUs without damaging sensitive parts. Its initial popularity was greater in the East, primarily due to the characteristics of Asian hair. Asian hair is typically straight and thick, with FUs mostly consisting of just one or two hair.With the description of the follicular unit excision (FUE) technique in 2002 and its widespread adoption nearly a decade later, the advantages of using the implanter also gained popularity in the West. The uniformity in the size of FUs provided by the FUE technique and the possibility of delegating the placement were key attractions in the use of this placement tool. In addition to the traditional Korean implanter with a sharp needle, other implanters and inserters have been described.The choice of implantation technique depends on individual adaptation and the advantages and disadvantages offered by each instrument. Although forceps allow for safe placement in the hands of well-trained teams, the increased fragility of FUs obtained with the FUE technique has led to the growing acceptance of techniques that employ implanters and inserters., Competing Interests: None declared., (Thieme. All rights reserved.)

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/cm 2 . 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/cm 2 . 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., (© 2024 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Post-combustion alopecia presents a complex medical challenge with implications spanning dermatological and psychiatric disorders. The use of hair transplantation has proven to be a significant improvement for this condition. However, the current management involves various techniques, each with advantages and disadvantages. Progressive skin expansions, surgical scar reduction, and skin grafts containing hair follicles yield unsatisfactory aesthetic outcomes and have limited applicability as a first-line treatment for fire victims. So far, follicular unit extraction (FUE) has proven to be one of the most versatile procedures in such cases, having the potential to restore a natural anatomical profile closely resembling the pre-traumatic appearance that led to the traumatic alopecia. Additionally, it contributes to the improvement of associated psychiatric comorbidities, facilitating proper social reintegration and enhancing overall quality of life. This report focuses on a case of post-combustion alopecia and severe facial distortion due to third-degree burns resulting in severe psychiatric comorbidities, which benefited from a proper social reintegration and improvement of the quality of life after three consecutive sessions of FUE for scalp and eyebrow hair., Competing Interests: The authors declare no conflict of interest., (© 2024 by the authors.)

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., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Hair loss, in particular androgenetic alopecia, has troubled humans since the dawn of history. Treatment options for hair restoration have undergone massive transformation from punch grafting to follicular unit transplantation. Current surgical treatment options in hair restoration fall broadly under two categories, follicular unit transplantation most commonly known as strip method and follicular unit extraction (FUE). The strip method though widely used initially is not so common now due to its fair share of disadvantages ranging from linear donor scar, scar widening to strip overharvesting and wastage of grafts. Follicular unit excision (FUE) was introduced as an alternative method for extraction of grafts to combat the donor linear scar produced by strip method but the disadvantages of FUE include the number of grafts harvested in a single session, moth eaten appearance of donor area caused by over extraction of grafts and harvesting from outside the safe zone. Newer developments like extraction of axillary hair, body hair and pubic hair have been sought to overcome the limitations of number of grafts harvested in a single session of FUE. With more patients now affected by alopecia in their early 20s, there is an ever-increasing demand from the patients for the youthful hairline and hence the focus has shifted towards mega and giga sessions of hair transplantation which pose danger of over extraction of grafts leading to depletion of available donor sites. This article elaborates the combined sequential strip and FUE method along with an intraoperative calculation model to overcome the limitations of over extraction and wastage of grafts. (1) Combination of techniques Strip method with FUE. (2) An intraoperative calculation model that aids in limiting over extraction and wastage of grafts. (3) It is a real time model which can be applied in practice with ease.Level of Evidence IV 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 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

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., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Competing Interests: Conflicts of interest None disclosed.

There are many instruments to prick the comedone before its extraction and scalp during hair transplantation. These instruments are not well guarded, and it can cause deep injury and fear in the patients. Here we described how to guard these needle for safety during procedure., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Cutaneous and Aesthetic Surgery.)