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Background: The linear scar and misalignment of hair follicles are disadvantages of the follicular unit transplantation (FUT) or strip technique. The most common misalignment is at the end of the strip. Although most surgeons try to match hair direction to achieve optimal hair alignment, their attempts are often unsuccessful., Objectives: We aimed to assess strip designs to improve hair alignment during hair transplantation., Methods: We conducted a retrospective study of 157 patients who underwent hair transplantation with either the commonly used elliptical incision or our novel triangular flag-shaped designed incision on the donor strip tip. Two blind evaluators assessed the outcome of hair alignment using a 5-point visual analog scale., Results: In total, 303 wounds on 157 patients were assessed. Overall, our triangular flag-shaped design (TFD) achieved better hair alignment than the common elliptical design (CED) (p=0.01). Patients with hair direction straight on the upper wound edge and hair direction inward on the lower wound edge showed improved outcomes with TFD, whereas patients with hair direction inward on both upper and lower wound edges showed better outcomes with CED., Conclusions: The TFD tip of donor strips achieved proper hair alignment for most hair transplant patients., 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 ., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Female hairline restoration has increasingly been in demand for the past decade. However, no reports address the correlation between characteristics of hair at the hairline and at the donor area., Objective: To assess follicular characteristics at the hairline and at the donor area including hair density, diameter, and their correlation., Materials and Methods: One hundred one randomly selected Southeast Asian female volunteers were assessed for hairline and donor area characteristics. Data from the donor sites, including the temporal, parietal, occipital, and neck region were compared with that of the hairline., Results: Hairline density was 135.2 hair/cm with a diameter of 80.07 μm in midline, 112.95 hair/cm with 73.96 μm at the frontotemporal area, 69.82 hair/cm with 72.09 μm at temple peak, and 74.26 hair/cm with 72.35 μm at sideburns. The donor hair density was 98.89 to 152.19 hairs/cm and hair diameter was 76.80 to 81.11 μm. Aging was shown to affect hair density and diameter at the donor area., Conclusion: All donor sites are suitable for hairline restoration of the midfrontal region except in the neck region. The suitable donor area for the frontotemporal area, temple peak, and sideburns is the nape. Hair density and diameter declined with age at some donor sites.

Background: Hair density, together with hair diameter has a tremendous impact on the cosmetic outcome of hair transplantation surgery., Objective: This retrospective study aims to assess the average number of follicular unit (FU) grafts in the donor area of Asian men with androgenetic alopecia., Methods: Seventy patients (ages 24-65 years old) with virgin scalp who had their first hair transplantation were included. During the harvesting procedure, a 2- to 3-cm-wide area of the donor site was shaved from ear to ear with 5 specific areas assigned as reference points for the study namely the central occipital area, left and right parietal and temporal areas. A video microscope was used to capture the field of each reference point. Follicular units in each area were counted and the number of 1-hair, 2-hair, and 3-hair follicular groupings was recorded., Results: East and Southeast Asians had an average of 61.1 FU/cm (111.2 hairs/cm); West Asians had an average density of 63.6 FU/cm (126.8 hairs/cm); South Asians were noted to have an average density of 63.5 FU/cm (126.8 hairs/cm)., Conclusion: Asian hair density has slight variations in the number of FU grafts in each donor area.

Background: Scalp laxity is a major factor in achieving the maximum number of grafts in donor harvesting during hair restoration surgery. Proper assessment is important for each individual but especially so in patients presenting tight scalp., Objective: To validate cross beam laser (CBL) for scalp laxity assessment in comparison with Mayer elasticity scale (MES)., Materials and Methods: In a retrospective study of 165 patients, both CBL and MES were used to evaluate scalp laxity in vertical plane at the center and lateral area before surgery. The real width (RW) of donor strip during surgery was considered the gold standard., Results: Spearman correlation coefficient revealed that the CBL width was significantly correlated with the MES width in the following subgroups: (1) subjects undergoing their first session, (2) subsequent session patients, and (3) patients who required maximum number of grafts. Although the CBL width was statistically significant when compared with the RW in certain areas, whereas the MES width was statistically significant in all areas, the differences between the CBL width and the RW were minimal and clinically insignificant., Conclusion: The accuracy of scalp laxity measurements using the CBL procedure establishes CBL as a reliable tool for hair restoration surgery.

Hair restoration has emerged as a subspecialty of aesthetic plastic surgery practiced by a wide range of doctors including plastic surgeons, general surgeons, dermatologists, and even general practitioners. As a current trend, most doctors practice "Ultrarefined follicular unit hair transplantation" in which the entire procedure is done precisely with minimal donor scar. In selected cases, Mega or even Giga sessions are now done with natural appearance and almost undetectable scar, in a single session with good density. This article is an attempt to review the history of hair restoration surgery, describe a novel technique currently practiced in our center, and summarize possible future innovations.

Background: Postoperative recipient-area folliculitis may be a cause of less or delayed growth of transplanted hair and an obvious cause of distress to the patient. No study has been done to elaborate on its clinical features and assess possible factors that may correlate with its occurrence., Objective: To study the clinical features and possible factors that may be associated with the development of recipient-area folliculitis after follicular-unit transplantation (FUT)., Methods: Retrospective analysis of 27 patients who developed folliculitis after FUT and 28 patients without such complication., Results: Lesion onset ranged from 2 days to 6 months after FUT (mean 1.44 months). Lesions were mostly pustules that resolved without sequela. Statistical analysis showed that, in terms of patient characteristics (e.g., hair features, scalp condition) and the number of grafts transplanted, there was no statistically significant difference in assessed parameters between those with and without folliculitis (p<.05)., Conclusion: Main clinical features of postoperative folliculitis consist mostly of few to moderate self-limited pustules. In this study, regardless of management, lesions healed without scarring and without affecting graft growth. Neither patient characteristics nor number of grafts transplanted was associated with this complication.

Background: Androgenetic alopecia remains the most common cause of male pattern baldness (MPB) in all races. The prevalence of MPB in Caucasians is well documented. The prevalence of MPB in Asians is believed to be very low, only one-fourth to one-third on average compared to Caucasians. However, according to my previous study, there is a clear trend indicating that it is approaching that of Caucasians., Objective: To assess the prevalence of MPB in the Asian population in Bangkok, Thailand; to compare this prevalence to previous studies conducted on Asians; and to compare the results to previous studies conducted on Caucasian., Methods: This study was conducted by two physicians and assisted by two registered nurses. The questionnaire included age, sex, Norwood classification, diet, family history of baldness, income, and education. The physicians examined the scalp of each interviewee upon completion of each questionnaire. The ethnic focus group in this study was Thai and Chinese who reside in Bangkok, Thailand. The interviews were conducted in hospitals, nursing homes, classroom, medical meetings, temples, parks, and villages., Results: A total of 1124 men were randomized in this study. The prevalence of cosmetically significant MPB (Norwood III-VII) was 38.52% and steadily increasing with age, approaching that of Caucasians. Variant MPB was found to be 0.67% and other types of androgenetic alopecia was 0.6%. From an ethnic point of view, the majority of the groups were of mixed blood and mostly of Chinese origin, thus we were unable to distinguish between Chinese and Thai., Conclusion: This study shows that the prevalence of MPB in Asians is not as low as previously thought. The cause of this increasing prevalence is uncertain. There are no past studies in Thailand for comparison, however, it can be extrapolated that the socioeconomic environment and westernized diet may contribute to this prevalence.

Background: There are several methods for harvesting donor hairs, including punch excision, single-bladed knife excision, and multibladed knife excision. All of these procedures are blind and thus result in transection of hair follicles. Transection of hair follicles during harvesting results in fewer follicles being available for transplantation, detrimentally affecting the final cosmetic result., Objective: To explore a new method of donor hair harvesting called "donor dissecting." This new procedure is an open technique because hair follicles are directly visualized during the harvesting process., Methods: The technique of donor dissecting utilizes a #15 scalpel blade to excise the donor hair ellipse from the occiput while maintaining meticulous hemostasis. This enables individual hair follicles to be visualized and protected from transection during the harvesting process. Once the donor ellipse is harvested, it is then further divided into individual mini- and micrografts using direct visualization of individual follicles to again prevent transection., Results: The technique of donor dissecting was utilized in 50 consecutive hair transplant patients. Utilizing this new technique, only 1.9% of hair follicles in the donor ellipse were transected during the harvesting process. The dissection of the donor ellipse 1.2% follicles being transected in the graft cutting process. Combining the donor dissection technique with dissection of the individual grafts, we were able to transect 1.59% of hair follicles harvested for transplantation., Conclusion: The technique of donor dissection minimizes the transection of hair follicles in the donor hair harvesting phase of hair transplantation. This technique is superior to the blind methods of donor harvesting which have been plagued by the problem of hair follicle transection.