Journal of Cosmetic and Laser Therapy, 2015; Early Online: 1–2
CASE REPORT
Hair follicles are viable after delayed FUE procedure
J Cosmet Laser Ther Downloaded from informahealthcare.com by Nyu Medical Center on 07/30/15 For personal use only.
ALIREZA MOHEBBIPOUR LARAN1, RAMIN MIRMOHAMMADI1, MOHAMMADREZA REZAEI BANA2 & SHAGHAYEGH MANOOCHEHRI1 1Department of Dermatology and Department of Mathematics, Ardebil Branch, Islamic Azad University, Ardebil, Iran and 2Department of Dermatology, Ardabil University of Medical Sciences, Ardebil, Iran
Abstract Nowadays, male pattern hair loss is usually managed with hair transplant. However, maintaining the hair follicle viability between extraction and implantation period is a great concern which restricts the hair transplantation period. However, it is possible that the hair follicles can be preserved and be viable for few days. Here, we report a case with delayed follicular unit extraction in three consecutive days with acceptable hair growth after a 5-month follow-up. Key Words: follicular unit extraction, hair transplant, outcome, viability
Introduction
Case report
In the present world, hair loss is a problem faced by individuals of all age groups and ethnicity. Hair serves an important cosmetic function in humans and either the lack or excess of hair causes significant emotional stress (1). The past decade has seen significant developments in the management of hair loss. Many methods of hair transplant have been reported. There are two main hair transplant methods: follicular unit transplantation (FUT) in which a strip is harvested and follicular unit extraction (FUE) in which individual follicular units are harvested. FUE has many advantages, including a small donor area scar, less pain, and a slender graft without extra surrounding tissue. Complications are uncommon in the literature (2,3). However, the main concern in both methods is the low viability of the extracted hair follicles and the need for rapid and immediate transplant of the follicles (3,4). In previous studies, it is reported that a hair follicle could be preserved at 4°C for the next 48 h (5). However, there is little information in this regard in clinic. Here we present a case of hair transplant with the FUE method in three consecutive days with the same extracted hair follicles at the baseline.
A 32-year-old male patient with male pattern hair loss underwent hair transplant procedure with FUE method for three consecutive days in our clinic. For this patient, 210 grafts were extracted with follicular implant technique from occipital area and 70 grafts were implanted in the frontal area immediately (Figure 1A). The remaining 140 hair grafts were preserved in normal saline at 4°C in the refrigerator. Seventy grafts were implanted during the next 24 h and the remaining 70 grafts were implanted during the next 48 h after hair grafts extraction (Figure 1B and C). The patient was followed for 5 months and the hair implant outcome was measured (Figure 2). Normal hair growth occurred in 67 (95.7%) grafts of 70 implanted hair grafts on day 1, 59 grafts (84%) implanted on day 2, and 48 grafts (68%) implanted on day 3. Discussion Hair transplantation has been a long-standing treatment of male pattern hair loss. Among different introduced techniques, FUE is a relatively minimally
Correspondence: Ramin Mirmohammadi, Department of Dermatology, Ardebil Branch, Islamic Azad University, Basij Ave., Ardebil, Iran. E-mail: ramin. [email protected] (Received 28 December 2014 ; accepted 27 March 2015) ISSN 1476-4172 print/ISSN 1476-4180 online © 2015 Informa UK, Ltd. DOI: 10.3109/14764172.2015.1039037
2
A. M. Laran et al.
J Cosmet Laser Ther Downloaded from informahealthcare.com by Nyu Medical Center on 07/30/15 For personal use only.
Figure 1. (A) First day of hair implant. (B) Second day of hair implant. (C) Third day of hair implant.
invasive option for hair restoration with minimal scar on the donor site. However, the main problem in the FUE is that the procedure takes a long time (2). The main concern in all hair transplant techniques is the viability of the hair follicles after extraction and their rapid implantation on the target site. FUE also creates much smaller grafts with less hydrating fat than those in strip surgery, which increases the risk of dehydration and graft loss (2,3). Many studies have tried to increase the grafts’ life and reduce the desiccation risk after harvest, by rapid transfer of the grafts to the saline solution as well as by cooling the saline solution with external ice packs (3,4). Although all these efforts are done to increase the life of hair follicle implants, some previous experiences on animals have reported that the hair follicle could be preserved at 4°C for almost 2 days, but the delayed transplant should be performed not later than 48 h (5,6). There is no previous report on delayed hair graft transplant in the literature in clinic situation. Here we report a case of delayed FUE in a 32-year-old male patient. The hair follicles were preserved at 4°C and the hair transplantation was performed on the same day, 24 and 48 h later. After a 5-month
follow-up, we observed normal hair growth in 95.7% of implanted hair grafts on day 1, 84% implanted on day 2, and 68% implanted on day 3. Although the viability of the hair follicles was reduced during that time, it is demonstrated that it is possible to extract hair follicles in one day and implant them after several days.
Consent Written informed consent for publication of clinical details and clinical images was obtained from the patient.
Grant information The author(s) declared that no grants were involved in supporting this work. Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References
Figure 2. Outcome of hair implant after 5 months.
1. Hunt N, McHale S. The psychological impact of alopecia. BMJ. 2005;331:951–953. 2. Bicknell LM, Kash N, Kavouspour C, Rashid RM. Follicular unit extraction hair transplant harvest: A review of current recommendations and future considerations. Dermatol Online J. 2014;20:pii: doj_21754. 3. Rashid RM, Bicknell LM. Follicular unit extraction hair transplant automation: Options in overcoming challenges of the latest technology in hair restoration with the goal of avoiding the line scar. Dermatol Online J. 2012;18:12. 4. Harris JA. Follicular unit extraction. Facial Plast Surg. 2008;24:404–413. 5. Kurata S, Ezaki T, Itami S, Terashi H, Takayusu S. Viability of isolated single hair follicles preserved at 4 degrees C. Dermatol Surg. 1999;25:26–29. 6. Jiange Q, Wenzhong L, Guocheng Z, Liangbin Y, Wei S. How long can hair follicle units be preserved at 0 and 4 degrees C for delayed transplant? Dermatol Surg. 2005;31:23–26.
CASE REPORT
Hair follicles are viable after delayed FUE procedure
J Cosmet Laser Ther Downloaded from informahealthcare.com by Nyu Medical Center on 07/30/15 For personal use only.
ALIREZA MOHEBBIPOUR LARAN1, RAMIN MIRMOHAMMADI1, MOHAMMADREZA REZAEI BANA2 & SHAGHAYEGH MANOOCHEHRI1 1Department of Dermatology and Department of Mathematics, Ardebil Branch, Islamic Azad University, Ardebil, Iran and 2Department of Dermatology, Ardabil University of Medical Sciences, Ardebil, Iran
Abstract Nowadays, male pattern hair loss is usually managed with hair transplant. However, maintaining the hair follicle viability between extraction and implantation period is a great concern which restricts the hair transplantation period. However, it is possible that the hair follicles can be preserved and be viable for few days. Here, we report a case with delayed follicular unit extraction in three consecutive days with acceptable hair growth after a 5-month follow-up. Key Words: follicular unit extraction, hair transplant, outcome, viability
Introduction
Case report
In the present world, hair loss is a problem faced by individuals of all age groups and ethnicity. Hair serves an important cosmetic function in humans and either the lack or excess of hair causes significant emotional stress (1). The past decade has seen significant developments in the management of hair loss. Many methods of hair transplant have been reported. There are two main hair transplant methods: follicular unit transplantation (FUT) in which a strip is harvested and follicular unit extraction (FUE) in which individual follicular units are harvested. FUE has many advantages, including a small donor area scar, less pain, and a slender graft without extra surrounding tissue. Complications are uncommon in the literature (2,3). However, the main concern in both methods is the low viability of the extracted hair follicles and the need for rapid and immediate transplant of the follicles (3,4). In previous studies, it is reported that a hair follicle could be preserved at 4°C for the next 48 h (5). However, there is little information in this regard in clinic. Here we present a case of hair transplant with the FUE method in three consecutive days with the same extracted hair follicles at the baseline.
A 32-year-old male patient with male pattern hair loss underwent hair transplant procedure with FUE method for three consecutive days in our clinic. For this patient, 210 grafts were extracted with follicular implant technique from occipital area and 70 grafts were implanted in the frontal area immediately (Figure 1A). The remaining 140 hair grafts were preserved in normal saline at 4°C in the refrigerator. Seventy grafts were implanted during the next 24 h and the remaining 70 grafts were implanted during the next 48 h after hair grafts extraction (Figure 1B and C). The patient was followed for 5 months and the hair implant outcome was measured (Figure 2). Normal hair growth occurred in 67 (95.7%) grafts of 70 implanted hair grafts on day 1, 59 grafts (84%) implanted on day 2, and 48 grafts (68%) implanted on day 3. Discussion Hair transplantation has been a long-standing treatment of male pattern hair loss. Among different introduced techniques, FUE is a relatively minimally
Correspondence: Ramin Mirmohammadi, Department of Dermatology, Ardebil Branch, Islamic Azad University, Basij Ave., Ardebil, Iran. E-mail: ramin. [email protected] (Received 28 December 2014 ; accepted 27 March 2015) ISSN 1476-4172 print/ISSN 1476-4180 online © 2015 Informa UK, Ltd. DOI: 10.3109/14764172.2015.1039037
2
A. M. Laran et al.
J Cosmet Laser Ther Downloaded from informahealthcare.com by Nyu Medical Center on 07/30/15 For personal use only.
Figure 1. (A) First day of hair implant. (B) Second day of hair implant. (C) Third day of hair implant.
invasive option for hair restoration with minimal scar on the donor site. However, the main problem in the FUE is that the procedure takes a long time (2). The main concern in all hair transplant techniques is the viability of the hair follicles after extraction and their rapid implantation on the target site. FUE also creates much smaller grafts with less hydrating fat than those in strip surgery, which increases the risk of dehydration and graft loss (2,3). Many studies have tried to increase the grafts’ life and reduce the desiccation risk after harvest, by rapid transfer of the grafts to the saline solution as well as by cooling the saline solution with external ice packs (3,4). Although all these efforts are done to increase the life of hair follicle implants, some previous experiences on animals have reported that the hair follicle could be preserved at 4°C for almost 2 days, but the delayed transplant should be performed not later than 48 h (5,6). There is no previous report on delayed hair graft transplant in the literature in clinic situation. Here we report a case of delayed FUE in a 32-year-old male patient. The hair follicles were preserved at 4°C and the hair transplantation was performed on the same day, 24 and 48 h later. After a 5-month
follow-up, we observed normal hair growth in 95.7% of implanted hair grafts on day 1, 84% implanted on day 2, and 68% implanted on day 3. Although the viability of the hair follicles was reduced during that time, it is demonstrated that it is possible to extract hair follicles in one day and implant them after several days.
Consent Written informed consent for publication of clinical details and clinical images was obtained from the patient.
Grant information The author(s) declared that no grants were involved in supporting this work. Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References
Figure 2. Outcome of hair implant after 5 months.
1. Hunt N, McHale S. The psychological impact of alopecia. BMJ. 2005;331:951–953. 2. Bicknell LM, Kash N, Kavouspour C, Rashid RM. Follicular unit extraction hair transplant harvest: A review of current recommendations and future considerations. Dermatol Online J. 2014;20:pii: doj_21754. 3. Rashid RM, Bicknell LM. Follicular unit extraction hair transplant automation: Options in overcoming challenges of the latest technology in hair restoration with the goal of avoiding the line scar. Dermatol Online J. 2012;18:12. 4. Harris JA. Follicular unit extraction. Facial Plast Surg. 2008;24:404–413. 5. Kurata S, Ezaki T, Itami S, Terashi H, Takayusu S. Viability of isolated single hair follicles preserved at 4 degrees C. Dermatol Surg. 1999;25:26–29. 6. Jiange Q, Wenzhong L, Guocheng Z, Liangbin Y, Wei S. How long can hair follicle units be preserved at 0 and 4 degrees C for delayed transplant? Dermatol Surg. 2005;31:23–26.
