Follicular Unit Extraction [FUE] Scarless Hair Transplant?

 Follicular unit extraction (FUE) turned into initially observed by means of William Rassman et al. In 2002 as a minimally invasive hair recuperation surgical procedure for androgenetic alopecia.[1] The New York dermatologist Dr. Norman Orentreich is known as as the “father of modern hair transplantation.”[2] The phenomenon of “donor dominance” was additionally coined by Dr. N. Orentreich.[2] Donor dominance is defined as the hair transplanted from the donor location of the scalp (occiput) will keep growing within the recipient area as if it's miles in its original site.

In FUE, the grafts are extracted as person follicular units from the donor area in a -step or 3-step approach and are implanted within the recipient region. It has numerous blessings like it's far comparatively “scarless”, has quicker recuperation time, has much less downtime, and calls for less technical staff.

FUE is famous for its application in androgenetic alopecia. In this newsletter, the authors intention to focus on no longer best the traditional indicators of follicular unit extraction however also to elicit the multifaceted and “out-of-the-box” software of FUE in dermatological indications like facial hair healing, body hair transplant, strong vitiligo, scarring alopecia, traction alopecia, alopecia areata, and hirsutism.

The position of FUE in the above list of indications is discussed in detail as beneath [Table 1]:

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Table 1: Uses of follicular unit extraction in dermatology

FUE in Androgenetic Alopecia

FUE is an established method for androgenetic alopecia (AGA) in males as well as girls. According to traditional hints of care, hair transplantation can be carried out in any individual with pattern hair loss, with an amazing donor location, who is in precise widespread fitness and has affordable expectations. However, one have to exercise caution inside the following instances:

Young sufferers with early, evolving alopecia.[3]

Patients with Norwood grade VI or VII with bad hair density.[3]

The expert panel opined that counselling could be very essential in patients present process of Scarless Hair Transplant in Dubai.Criteria to be taken into consideration for sufferers who require hair transplantation include[3] :

Grade 3 Norwood type

Stable hair loss that is not hastily modern

Failure of good enough clinical treatment

If age <25, the transplant should be done only in cases of extensive baldness; if age >25 years with grade 3 Norwood's type, transplant may be considered

Bitemporal hair loss or frontal hairline baldness

In girl patients, transplantation can be taken into consideration only after adequate trial of clinical remedy, with proper investigations to become aware of the motive.

FUE and follicular unit transplant (FUT) through strip method are two normally used procedures for hair transplant in androgenetic alopecia in recent times. Patients with important vertex hair loss within the early ranges of AGA respond to the medical line of management better in comparison to people with bitemporal recession.[4]

Among the 2, FUE has won exquisite reputation within the latest past. Both strategies have their personal deserves and demerits. Thus, a treating doctor needs to have a better scientific judgment to pick between the two techniques on a case-to-case foundation. However, a mixture of both can show to be properly for a few patients.

Figure 1a and b suggests pre-procedure and publish-procedure images of FUE in androgenetic alopecia.

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Figure 1: (a) FUE in androgenetic alopecia (earlier than FUE). (b) FUE in androgenetic alopecia (after FUE)

FUE in Alopecia Areata (AA)

Alopecia areata (AA) is a non-scarring autoimmune form of alopecia. AA is a cell-mediated autoimmune disorder, in which autoreactive cytotoxic T cells recognize melanocyte-related proteins which include tyrosinase. Hair follicle is a completely unique “miniorgan” with its very own immune and hormonal microenvironment. The immunosuppressive milieu of the anagen hair bulb modulated by way of immunosuppressive factors is called “hair follicle immune privilege.” The fall apart of the hair follicle immune privilege leads to autoimmune reactions towards hair follicle autoantigens. IFN-γ is one of the key elements that leads to the collapse of immune privilege.[5]

It generally responds moderately to medical control and is famend for its recurrence. Hair transplantation in lively/volatile varieties of alopecia areata is not the treatment of choice because the implanted follicular grafts is probably destroyed due to underlying autoimmune pathology; in uncommon cases, it might cause ailment exacerbation.

There is a massive literature that specializes in the disorder halting technique which mainly comprises of scientific management in the shape of intralesional steroids, oral and topical immunosuppresants, contact sensitizers, and many others. But there may be very much less information upon hair transplantation in alopecia areata. In 2005, Barankin et al., suggested a case of successful hair transplantation over alopecia areata of eyebrow.[6] In their report, they exact a partial recurrence of the disease all through the preliminary 8 months of comply with-up, which become conscious of intralesional steroids (ILS). Ultimately, they done 80% hair growth on the give up of 24 months. The patch which became in advance unresponsive to ILS became responding nicely to ILS after the hair transplant. Unger et al., in 2008, also mentioned a case of a hit FUT in alopecia areata over the scalp and eyebrow.[7]

In their case, the authors did no longer use any concomitant clinical immunosuppressive remedy in conjunction with FUT in comparison to the case record via Barankin et al. Unger reported that no longer only the transplanted grafts grew nicely, however in addition, new hair grew peripheral to the grafts. Civas E et al., in 2010, suggested HT in alopecia areata of eyebrow. They did not supply some other oral or topical immunosuppressants to their patient post-FUE.[8]