BACKGROUND: Hair restoration surgery (HRS) is a commonly performed elective procedure but to date lacks a review of the full scope of complications.
OBJECTIVE: To provide a comprehensive overview of observed complications associated with follicular unit extraction (FUE) and follicular unit transplantation (FUT).
METHODS: Randomized control trials, cohort studies, case series, and case reports published in 1985 or later on adults (age>18). Nontraumatic or autoimmune etiologies of alopecia were excluded as procedure indications.
METHODS: PubMed, EMBASE, Cochrane databases (last search December 31, 2022).
METHODS: Data-charting and extraction were independently performed with two reviewers using Covidence.
RESULTS: Forty-three publications were included. Two large series reported the overall complication rate to be 1.2 and 4.7%. Common complications included bleeding requiring intervention (up to 8%), persistent numbness (up to 11%), infection (up to 11% with two reports of Kaposi varicelliform eruptions and one of mucormycosis), effluvium at donor and recipient sites (up to 4.1% and 6.5%, respectively). The most common donor-site complication was hypertrophic scarring/keloid formation after FUT (up to 15.1%). Complications at the recipient site, including crusting (up to 54.8%), frontal edema (up to 50%), and sterile folliculitis (up to 53.3%), tended to be poorly defined with a broad range of incidences.
CONCLUSIONS: Serious complications associated with HRS are rare in the hands of experienced providers. However, comprehensive discussions of risk must be had with prospective patients as any complication in the context of an elective procedure may be significant and psychologically devastating for the individual patient.
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 .

UNASSIGNED: Current no-shave long hair-follicular unit excision (LH-FUE) techniques employ recesses (slots, notches, or grooves) in punch tips to reduce the long-hair shaft break rate (SBR) and graft transection rate (GTR). However, these methods demand advanced skills and extended procedure time.
UNASSIGNED: We aimed to evaluate a skin-responsive FUE technique without the use of recess-tipped punches, accommodating diverse hair and skin types in LH-FUE procedures.
UNASSIGNED: We retrospectively analyzed patients who underwent this technique using a UGraft Zeus device at five multinational clinics (Mexico, Colombia, India, United States, and Türkiye) from August 9, 2021, to April 11, 2023. Donor zones were pre-operatively graded for expected difficulty using the Sanusi FUE Scoring (SFS) Scale, ranging from class I (low difficulty) to V (high difficulty).
UNASSIGNED: Among 152 patients (mean age, 46 years; 146 straight-wavy, 6 curly-coiled hair), most (n=107) were class I donors. The GTR ranged 2.2%-4.3%, and was highest in class IV donors and those with thick-firm scalps. The SBR was 12.2%, and the average graft excision rate (GER; speed) was 440 grafts/h. Only 19G and 18G punches were used. All patients were satisfied with the procedure, with 57.4% reporting that they were \"very happy\". Surgeon willingness to perform no-shave LH-FUE significantly increased from 1.25 to 4.20 (on a scale of 1-5) after adopting this device. SFS class, skin thickness, and firmness, more than hair curliness, influenced the GTR, SBR, torque, and punch movement duration.
UNASSIGNED: Our findings reveal consistent success in conducting no-shave LH-FUE using this skin-responsive device across diverse patients. Notably, success was achieved without recess-tipped punches, resulting in low GTR and SBR, along with a high GER and increased patient satisfaction. These outcomes suggest enhanced procedure speed and ease of use, contributing to a greater willingness among surgeons to adopt this technique.

BACKGROUND: Temporary hair loss at the recipient site after hair restoration surgery is called shock loss (SL). This study analyzed the risk factors for SL among patients who received follicular unit excision.
METHODS: This study included 621 patients (554 males and 67 females). Twenty-three patients had SL (9 males and 14 females with a mean age of 40.8 years). The prevalence of SL was analyzed in relation to sex, age, graft follicular units, cause of alopecia, diabetes mellitus, smoking, drinking alcohol, and local anesthesia agent.
RESULTS: Sex was identified as a risk factor for SL (odds ratio [OR]: 30.18; 95% confidence interval [CI] 9.43-96.55; p<0.001). Among female patients, age was identified as a risk factor for SL (OR:1.07; 95% CI 1.00-1.15; p=0.039). Over 40 years, the female pattern hair loss group had a significantly higher risk for SL than a female cosmetic group younger than 39 years.
CONCLUSIONS: Sex was the only risk factor found for SL in this study. In addition, age was identified as a risk factor for SL among female patients. We believe our results provide information and risk factors for SL, not only for hair transplant surgeons, but also patients who will receive follicular unit excision.
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 .

暂无摘要。

UNASSIGNED: Trichoscopy is a noninvasive diagnostic method for hair and scalp diseases. Data on trichoscopy post hair restoration surgery are limited, and some authors show no relevant changes.
UNASSIGNED: Trichoscopic findings in 45 patients are described, after being followed for 12 months after hair restoration surgery. They evolved without any hair disease.
UNASSIGNED: Trichoscopy showed some hair shaft abnormalities previously described in alopecia areata and chemotherapy-induced alopecia.

暂无摘要。

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.

Patterned hair loss which includes both male pattern hair loss (MPHL) or androgenic alopecia (AGA) and female pattern hair loss (FPHL) is the most common indication for hair transplant surgery. However, not all such patients are candidates for hair transplants. There are eight conditions that cause patients to not be appropriate candidates. These are: diffuse unpatterned alopecia (DUPA), cicatricial alopecia (CA), patients with unstable hair loss, patients with insufficient hair loss, very young patients, patients with unrealistic expectations, patients with psychologic disorders such as body dysmorphic disorder (BDD) and trichotillomania, and patients who are medically unfit. In addition, there are patients who are poor candidates and who should undergo hair transplantation only if they understand and accept limited results. The key to identifying these patients involves performing careful and detailed history and examination at the time of consultation.

Hair transplantation, or hair restoration surgery (HRS) remains the only method to consistently restore hair in those experiencing pattern hair loss as well as hair loss from most other causes. HRS has been significantly improved with the development of follicular unit extraction, later renamed follicular unit excision, or FUE. This allows the surgeon to harvest grafts from the donor area without leaving a scar. FUE can also be used to harvest grafts from other areas of the body. When performed properly using the most technically advanced devices, the transection of the grafts with FUE remains under 4%.

BACKGROUND: Hair transplant procedure is a surgical procedure which affects the sensitivity of the scalp.
OBJECTIVE: To compare scalp two-point discrimination (2PD) values in healthy controls and patients who had hair transplant surgery.
METHODS: The comparative study was conducted in 25 healthy individuals and 25 patient who underwent hair transplant surgery (either strip surgery or FUE). An area was marked o scalp about 10 cm from the nasion. A caliper with 15 g weight was used. Both the prongs were ensured to be placed perpendicular to the skin. The contact time was only 2.0 seconds. An interval of 10 seconds was given before increasing the 2PD distance. In each measurement, the distance was increased by 1 mm. All the data were recorded and analyzed statistically using ANOVA test.
RESULTS: The mean age of the control group was 29.72 and 31.7 years in patients\' group. The average 2PD score in controls was 12.76 and 17.80 mm in patients. The average 2PD score was found to be 17.7 in patients who had surgery less than 18 months ago as compared to the score of 17.6 in patients who had surgery more than 18 months ago (P > .05). The smokers had less sensitivity as compared to the nonsmokers (P < .05).
CONCLUSIONS: The scalp sensitivity was found to be less than 39% in patients after hair transplant surgery.