Comparison of postoperative pain according to the harvesting method used in hair restorative surgery

A Scoping Review on Complications in Modern Hair Transplantation: More than Just Splitting Hairs

BACKGROUND

Hair restoration surgery (HRS) is a commonly performed elective procedure but to date lacks a review of the full scope of complications.

OBJECTIVES

To provide a comprehensive overview of observed complications associated with follicular unit extraction (FUE) and follicular unit transplantation (FUT).

ELIGIBILITY CRITERIA

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.

SOURCES OF EVIDENCE

PubMed, EMBASE, Cochrane databases (last search December 31, 2022).

CHARTING 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.

CONCLUSION

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.

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 .

Beyond skin deep: Revealing the essence of iPS cell-generated skin organoids in regeneration

Various methods have been used for in vivo and in vitro skin regeneration, including stem cell therapy, tissue engineering, 3D printing, and platelet-rich plasma (PRP) injection therapy. However, these approaches are rooted in the existing knowledge of skin structures, which overlook the normal physiological processes of skin development and fall short of replicating the skin's regenerative processes outside the body. This comprehensive review primarily focuses on skin organoids derived from human pluripotent stem cells, which have the capacity to regenerate human skin tissue by restoring the embryonic skin structure, thus offering a novel avenue for producing in vitro skin substitutes. Furthermore, they contribute to the repair of damaged skin lesions in patients with systemic sclerosis or severe burns. Particular emphasis will be placed on the origins, generations, and applications of skin organoids, especially in dermatology, and the challenges that must be addressed before clinical implementation.

Paradigm Shift from Linear Strip to Follicular Unit Excision in Hair Restoration Surgery

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.

An Analysis of Risk Factors of Recipient Site Temporary Effluvium After Follicular Unit Excision: A Single-Center Retrospective Study

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.

MATERIALS AND 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.

CONCLUSION

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.

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 .

Novel Follicular Unit Excision Device That Reduces Graft Injury and Improves Ergonomics in Hair Transplantation Surgery

PURPOSE

Follicular unit excision (FUE) surgery is becoming increasingly popular and the number of grafts transplanted in a single session is increasing. Furthermore, complicated surgeries and those requiring a longer surgical time such as non-shaven FUE and long hair FUE are more actively being performed worldwide. The main aim in FUE surgery is to obtain the best quality grafts while minimizing follicular damage during donor harvest. This article describes a novel FUE device that achieves these goals.

PATIENTS AND METHODS

We describe a novel FUE device with Bluetooth function, fingertip touch sensor, multiphasic movement, automated operation by setting the interval time between punching motions, ergonomic design, various innovative functions, and an easily upgradable application used to operate the handpiece. We also report the concept of design, mechanism of action, methods of use, and effect of each innovative function.

RESULTS

The various state-of-the-art features of the device minimize the risk of follicular injury when working with a wide variety of scalp and hair follicle types and conditions. In addition, it enables successful donor harvesting by reducing the surgeon's workload and improving ergonomics.

CONCLUSION

We introduce an innovative and new device for use in FUE surgery. This novel device has the potential to increase the convenience, scalability, and safety of FUE surgery.

Multi-Wave Punch for Follicular Unit Excision Hair Transplantation Surgery

Follicular unit excision is widely used for hair transplantation because it lacks a donor scar and is associated with less postoperative pain. Obtaining high-quality grafts and minimizing hair follicle damage during graft harvesting are key. This review elaborates on the types and dynamics of punches used in follicular unit extraction. We also describe the utility and advantages of a new "Multi-Wave Punch," a new type of punch designed to optimize graft extraction and reduce follicular injury. This multi-wave punch is composed of three different parts. The cutting edge at the end is blunt-angled. Adjacent is the leading edge, which is characterized by several horizontally oriented multi-wave shapes. Most proximal is the main body, which is decagonal in shape. Because of the multi-wave and decagonal structure, the punch easily enters the outer layers of the scalp. The wave energy is transmitted to the surrounding tissue, separating hair follicles from adjacent tissue, facilitating extraction, reducing follicular damage, and ensuring higher quality grafts.

Relieving postoperative pain using tumescent solution with ropivacaine in follicular unit excision

BACKGROUND

Local tumescent anesthesia relieves postoperative pain.

OBJECTIVE

To compare the effect of injecting a tumescent solution with/without ropivacaine on postoperative pain.

METHODS

A randomized, double-blind control study was conducted in 314 patients who underwent first follicular unit excision after obtaining informed consent and ethics committee approval. The patients were randomly divided into three groups: intra-groups (group 1, injected with tumescent solution with ropivacaine; group 2, without ropivacaine) and inter-group (group 3, right-head/left-head side with/without ropivacaine). Postoperative pain was recorded using the 5-point Wong-Baker Faces Pain Scale. No preoperative analgesic was administered to any patient. The survival rate of hair follicles was measured using dermoscopy during follow-up. Data were statistically analyzed.

RESULTS

Of the 314 patients included in the study, 166 were men and 148 were women with a mean age of 32.15±4.58 (range, 25-45) years. Postoperative pain with ropivacaine was significantly more relieved compared to that without ropivacaine in both groups (P<0.05). There was no significant difference between sex and survival rate of hair follicles in the intra- or inter-group.

CONCLUSION

A tumescent solution with ropivacaine has proven to relieve postoperative pain and is a safe and valuable form of local anesthesia in follicular unit excision.

Eyebrow Transplantation Using Long Hair Follicular Unit Excision Technique

Long hair follicular unit excision (LHF) allows surgeons to fully visualize hair curliness, which is crucial in eyebrow transplantation where matching curliness is a matter of utmost importance. In this study, we aimed to evaluate the clinical importance of LHF in eyebrow transplantation.

Long hair follicular unit excision: personal experience

BACKGROUND

Long hair follicular unit excision (FUE) is the most state-of-the-art surgical technique in the field of hair transplantation surgery. Long hair FUE reduces the signs of surgery by camouflaging the recipient area with long hair, and allows hair curl identification when placing grafts. In addition, donor area shaving can be omitted.

METHODS

This article presents the surgical approach and methods of long hair FUE. Patients were categorized by sex, age, recipient site, purpose of the surgery, and history of previous hair transplantation. Medical charts and photographs were reviewed to obtain the transection rate and calculated density for each patient.

RESULTS

Long hair FUE was applied to 134 patients (112 women and 22 men). Thirty-four patients received eyebrow hair transplantation, 73 underwent female hairline correction surgery, nine patients underwent sideburn reconstruction, two were treated for female pattern hair loss, and 19 were treated for male pattern baldness (MPB). Four of the patients with MPB also underwent eyebrow transplant surgery. Of the patients with MPB, 17 (89%) had Norwood type III baldness, and two (11%) had type IV hair loss. The mean number of grafts required was 292 for eyebrow transplantation, 1,214 for female hairline correction, 251 for sideburn reconstruction, 1,344 for female pattern hair loss, and 1,567 for MPB. The mean follicle transection rate was 9.2%, and the mean calculated number of follicles per graft achieved was 2.23.

CONCLUSION

This long hair FUE method introduced by the authors is an excellent surgical method when performed by surgeons with sufficient skill and expertise.