We aimed to determine the efficacy of the various available oral, topical, and procedural treatment options for hair loss in individuals with androgenic alopecia. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the National Library of Medicine was performed. Overall, 141 unique studies met our inclusion criteria. We demonstrate that many over the counter (e.g. topical minoxidil, supplements, low-level light treatment), prescription (e.g. oral minoxidil, finasteride, dutasteride), and procedural (e.g. platelet-rich plasma, fractionated lasers, hair transplantation) treatments successfully promote hair growth, highlighting the superiority of a multifaceted and individualized approach to management.

OBJECTIVE: 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.
CONCLUSIONS: 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.
METHODS: 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 .

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.
OBJECTIVE: This study aimed to assess the postoperative clinical outcomes of LHF for hairline restoration.
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/cm2. 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/cm2. 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.

Hair transplantation has evolved as a practice since the 1960\'s with advances in technology and surgical technique. With various surgical techniques in existence, patients and practitioners have an abundance of options to curate the best results for the patient. However, with many options come various benefits and consequences that must be examined on a patient-by-patient basis. This review article sought to examine the various surgical modalities of hair transplantation, to outline the pros and cons of various techniques, and to help outline considerations when choosing a given surgical technique.

OBJECTIVE: Microsurgical autologous hair transplantation, when performed as follicular unit transplantation, may permanently and naturally improve advanced androgenetic alopecia in men and women and also non-active scarring alopecias.
RESULTS: Sufficient donor hair and realistic patient expectations as well as an individual surgical planning of the hair distribution are crucial prerequisites for a sustainable hair restoration. They should be determined and evaluated during a personal pre-examination and consultation with the hair surgeon. Natural results can be achieved by transplanting up to several thousands of follicular units with high densities into small micro-slits. This technique also allows for increasing the hair density without injuring surrounding original pre-existing hairs. In progressive, early or advanced androgenetic alopecia, additional medical therapy is highly recommended to stabilize the condition. Otherwise, depending on supply and demand of donor hair, only a partial hair restoration can be achieved with a satisfying density.
CONCLUSIONS: Since hair transplantation requires a precise sequence of surgical steps and careful handling of the tiny grafts, the skills and experience of the hair surgeon and his or her team are crucial. The medical risks of an assembly-line way of performing this surgery by non-licensed, non-physician staff, as reported from national clinics and medical tourism, should not be underestimated. The German Association of Hair Surgeons and the International Society of Hair Restoration Surgery offer patient information, as well as continuous medical education and guidelines for interested physicians to ensure the highest quality standard of care.
UNASSIGNED: HINTERGRUND UND ZIELE: Die mikrochirurgische autologe Haartransplantation als Follicular-Unit-Transplantation ermöglicht eine dauerhafte, natürlich aussehende Verbesserung bei androgenetischer Alopezie von Mann und Frau sowie Kopfhautnarben.
UNASSIGNED: Voraussetzungen sind ausreichend patienteneigene Spenderhaare und realistische Patientenerwartungen sowie eine individuelle und persönliche Planung der Verteilung der Transplantate für eine nachhaltige Haarwiederherstellung. Eine ärztliche Voruntersuchung und Aufklärung sind dazu unerlässlich. Durch Verpflanzung von bis zu mehreren tausend Follikeleinheiten in hoher Dichte in passgerechte Mikroschlitze sind sehr natürliche Ergebnisse erreichbar, auch eine Verdichtung ohne Verletzung bestehender Haare ist so möglich. Bei progredienter bzw. ausgeprägter androgenetischer Alopezie ist eine zusätzliche medikamentöse Stabilisierung empfehlenswert, da ansonsten – je nach Spenderhaarmenge – nur Teilrekonstruktionen in zufriedenstellender Dichte möglich sein können.
CONCLUSIONS: Da die Haartransplantation eine präzise Planung und zügige Abfolge einzelner Schritte bei schonender Handhabung der winzigen lebenden Grafts erfordert, sind die Erfahrung und Übung von Haarchirurg/in und festem Team entscheidend. Die medizinischen Risiken bei fließbandähnlicher Durchführung operativer Tätigkeiten durch nichtärztliches, unerfahrenes Personal, wovon leider im In- und Ausland zunehmend berichtet wird, sind nicht zu unterschätzen. Der Verband deutscher Haarchirurgen (VDHC) und die internationale Dachgesellschaft International Society of Hair Restoration Surgery (ISHRS) bieten seriöse Informationen für Patienten und Leitlinien sowie Fortbildungen zur Sicherung der Qualitätsstandards für interessierte Ärzte.

BACKGROUND: Scarring alopecia can significantly affect children emotionally. Follicular unit excision (FUE) and follicular unit transplantation (FUT) have been applied for scar treatment.
OBJECTIVE: This study aimed to evaluate the safety and feasibility of follicular unit hair transplantation in treating scarring alopecia in children.
METHODS: A total of nine children (seven males and two females) with cicatricial alopecia, ranging in age from 5 years, 2 months to 12 years, 10 months were included in this study. Scar formation time ranged from 7 months to 5 years. Sites were vertex (2), eyebrow (3), frontal hairline (3), and temporal regions (2).
RESULTS: Nine children in this group were followed up for 6-34 months with the following treatment options: FUE (5 cases), FUT (3 cases), and FUT combined with FUE (1 case). No significant complications were observed during the treatment. The transplanted hair grew well, the direction and shape were satisfactory, and the survival rate was >90%.
CONCLUSIONS: For children with burn trauma and cicatricial alopecia after surgery, hair transplantation can significantly improve their appearance with low surgical risk and high patient satisfaction rate.

BACKGROUND: Hair transplantation (HT) is a safe and rewarding procedure for a patient as well as the surgeon. Clonidine may be a good adjuvant in HT because of its analgesic, anxiolytic, and sedative effects.
OBJECTIVE: To study efficacy of Clonidine as a preoperative medication in HT.
METHODS: The study was a prospective trial of 46 consecutive patients who underwent HT between January and May 2017. Patients with normal vital parameters on arrival were given Tab clonidine (0.1 mg) 30 min before starting of the procedure [Clonidine group (n = 30)]; rest were included in the control group (n = 16). Vitals were monitored every 30 min during surgery until the end. Patients were assessed for pain, level of sedation during surgery and for postoperative analgesia.
RESULTS: All patients who received clonidine, except one, were comfortable and experienced no pain throughout the duration of surgery; nine went into deep sleep. Of the 16 patients in the control group, no patients reported deep sleep, 3 felt restless, and 4 had mild pain. There were no untoward effects in both groups.
CONCLUSIONS: Our study suggests that clonidine is useful as a pre-anesthetic medication in HT. However, this is a pilot study and further larger studies are needed.

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

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.
OBJECTIVE: 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.
UNASSIGNED: 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 .

Significant androgenetic hair loss occurs in men older than 50 years, and in women it occurs in many who are perimenopausal, menopausal, and postmenopausal. By age 60 years, it is estimated that 80% of women experience hair loss. Other nonandrogenetic forms of hair loss occur due to various dermatologic disorders as well as systemic disorders. Children may also experience significant hair loss, often due to genetic abnormalities and incidences of trauma. In this article the author discusses a combination approach to hair loss for men, women, and children.