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Background: Recipient area scalp necrosis is considered a potential complication of hair transplantation, but has rarely been reported. A small number of patients have developed scalp necrosis after hair transplantation with the widely used Follicular unit excision (FUE) technique. There are no guidelines to prevent and manage this complication. The aim of this study was to provide an insight into the pathogenesis, prevention, and management of scalp necrosis following hair transplantation. Methods: From 2012 to 2021, among more than 10 000 patients who underwent hair transplantation, only three developed scalp necrosis in our clinical experience, besides, one patient transferred to our hospital because of scalp necrosis after undergoing hair transplantation. According to the disease etiology and patients' symptom, a combination of wound management and antimicrobial therapy was employed. This study was approved by the institutional ethics committee of Nanfang Hospital. Results: Of the four patients, three received timely treatment and had a good prognosis. Necrosis became confined and healed within 2–3 weeks. Grafts in the lesion area partially survived. In case 4, due to improper treatment at the early stage, the lesion developed extensively and deeply, which not only delayed wound healing, but also resulted in complete loss of grafts. Conclusion: Preoperative prophylaxis, timely diagnosis, and immediate treatment of scalp necrosis can prevent serious complications and reduce morbidity after hair transplantation. [ABSTRACT FROM AUTHOR]

Androgenetic alopecia (AGA) is the most common pattern of hair loss resulting from the effects of androgen on hair follicles. MicroRNAs (miRs) serve imperative roles in the regulation of many biological processes of hair follicles. However, the exact molecular mechanism of AGA remains to be elucidated. In the present study, we found miR‐122, which is mainly recognized as a tumor suppressor, was highly overexpressed in the bulb of balding hair follicles in comparison with nonbalding ones in AGA. Moreover, miR‐122 induces apoptosis of human dermal papilla cells (hDPCs) with miR‐122 mimics in vitro, and the expression of insulin‐like growth factor 1 receptor (IGF1R) in hDPCs was reduced following upregulation of miR‐122. Mechanistically, dual‐luciferase reporter assay confirmed that miR‐122 directly targeted the 3′‐untranslated region of IGF1R. These findings suggested that upregulation of miR‐122 induces apoptosis, potentially via the repression of IGF1R in hDPCs of AGA, providing a novel insight into the potential pathological mechanism of miR‐122 in AGA DPCs. [ABSTRACT FROM AUTHOR]

Androgenetic alopecia is the most common form of hair loss disorder. The features of this process are shortening of the anagen phase in hair cycling and progressive miniaturization of the hair follicle. However, the mechanisms in androgenetic alopecia are still unclear, and the treatment methods are also limited. Therefore, further study on the pathogenesis and new therapies for androgenetic alopecia are urgently needed. In this study, we found that endogenous autophagy was severely impaired, accompanied by increased apoptosis in early catagen‐like miniaturized hair follicles from the balding scalps of androgenetic alopecia patients. Moreover, inhibition of autophagy using 3‐methyladenine could induce apoptosis, premature hair follicle regression and slow down the hair growth in organ‐cultured hair follicles. Taken together, these results suggest that impairment of autophagy could be a potential mechanism in androgenetic alopecia. [ABSTRACT FROM AUTHOR]

Background: Hair transplantation is the gold standard method for the treatment of alopecia. Recently, demand for the surgery has increased rapidly. However, high demands also require more professional training for the surgeons. With the maturing of hairline design skills, parietal whorl design has become the next challenge and no appropriate training models have yet been reported. Aims: To present an innovative, simple, and appropriate training model for designing the scalp parietal whorl. Methods: Outward divergent arc curves were drawn from the navel of an orange. Recipient sites were created with 23G needles or 1.0‐mm knives or 1.0‐mm blades according to the outward divergent arc curves, then hair shafts were transplanted using forceps. Results: Different densities of hair shafts were transplanted. Transplantation of 10‐20 follicular units (FU)/cm2 was too sparse, 30 FU/cm2 achieved a good appearance, but 40‐50 FU/cm2 was better. Through practicing on the model, excellent results of parietal whorl transplantation on patients can be achieved. Conclusions: This new model can perfectly suit the lines and direction of the parietal whorl and also present different density transplantation practicing. We provide a training method for new surgeons as well as a rehearsal opportunity for previously trained doctors. [ABSTRACT FROM AUTHOR]

Background: Androgenic alopecia (AGA) is characterized by progressive hair follicle miniaturization. Novel treatments are needed to intervene in the miniaturization process. The authors aimed to evaluate the efficacy, safety, effectiveness, and effective population of autologous hair follicle mesenchymal stem cell therapy for the treatment of advanced AGA in Chinese individuals., Methods: Fifty patients ranging in age from 25 to 45 years (average, 32 ± 1.24 years) were included. None of them had ever used minoxidil, finasteride, or other drugs to promote hair growth. Healthy hair follicles were extracted from the occipital area and treated to obtain hair follicle mesenchymal stem cell suspensions. The recipient sites were divided into 2 groups. Nine points were injected in a 1-cm 2 area, and 100 µL of solution containing either 1 × 10 5 cells or normal saline was injected at each point. The follow-up duration was 9 months. Observers were blinded to patient groupings and measurements., Results: An increased proportion of terminal hair and hair shaft diameter was observed in the experimental group at 1 month. The effect lasted for 3 months. The hair-thickening effect of advanced miniaturized hair follicles with hair shaft diameter less than 60 µm was more notable than that for above 60 µm. No patient experienced any obvious side effects., Conclusions: Hair follicle mesenchymal stem cells were effective in the treatment of advanced AGA in Chinese individuals. A hair shaft diameter of 60 µm can be used as a key index to predict the effectiveness of the therapy., Clinical Question/level of Evidence: Therapeutic, II., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons.)

Introduction: Regenerative medicine is a promising approach for hair loss; however, its primary challenge is the inductivity of human dermal papilla cells (DPCs), which rapidly lose hair growth-inducing properties in 2D culture. Despite extensive research efforts to construct DPCs, current 3D microenvironments fabricated to restore hair inductivity remain insufficient., Objectives: Here, we aimed to fabricate ECM-enriched controllable vascularized dermal papilla (DP) spheroids that highly mimic in vivo DPCs microenvironments to restore their hair inductivity., Methods: We employed layer-by-layer (LbL) self-assembly using gelatin and alginate to construct nanoscale biomimetic ECM for DPCs, with Ca 2+ as a cross-linking agent to create controllable DP spheroids. DPCs were also co-cultured with human umbilical vein endothelial cells to construct vascularized DP spheroids. Immunofluorescence staining and angiography was used to detect angiogenesis in vitro and in vivo. RNA sequencing and in vivo implantation were employed to investigate DPCs signature., Results: LbL technology enabled DPCs to aggregate into controllable DP spheroids of size and cell numbers similar to those of primary DP. Vascularization prevented hypoxia-induced necrosis and functioned in association with host vessels post-transplantation. Compared with traditional 3D culture, nanoscale ECM and vascularization were found to restore the transcriptional signature of DPCs and triple hair induction efficiency following engraftment., Conclusion: Our novel biomimetic developmental tissue engineering strategy is a crucial step toward the recovery of human DPC hair inductivity, which would enable the rapid clinical application of large-scale hair regeneration platforms., 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., (© 2022 The Authors. Published by Elsevier B.V. on behalf of Cairo University.)