Page 37 - Read Online

Page 6 of 8 Kayiran et al. Plast Aesthet Res 2018;5:9 I http://dx.doi.org/10.20517/2347-9264.2017.86

implanter; and a hollow-shafted micromotor handpiece with a punch blade in 0.8-1.25 mm. The transection
rates and the operation time are significantly lower with this device.

There are some advantages and disadvantages of FUE over FUT which was very well discussed previously .
[30]
FUE needs longer learning curve and operation time, excellent hand-eye coordination, patience, stamina
and hair must be short enough for appropriate harvesting. Moreover, the practitioner may be a candidate for
[30]
potential repetitive motion disorder in time . Besides, the outcomes of FUE may be better and the number
of follicles transferred may be higher when compared with FUT. In addition, FUE gives a scarless solution
for the patients insisting on not accepting an incision.

Another hair transplantation method, direct hair transplantation, is presented to attenuate the transit time
which may reduce the graft survival . Here, follicles are implanted as soon as they are harvested. This
[8]
technique was found a simple and feasible modification of FUE.

An automated FUE technique, Neograft , enables a suction-based follicle harvesting with one or two-step
®
extraction technique. The follicles are collected in a suction canister in which they are transplanted later
by using a hand-piece with 0.8, 1 and 1.2 mm punches that are produced specifically for this purpose. The
motor is silent and vibration free; however the steep learning curve and the cost of the machine are the
[35]
disadvantages .
Microrefined microfolliclular hair transplantation is a recently described method in which anterior hairline
is constructed with FUE whereas the bald area is transplanted with FUT including strip harvesting (with
beveled incisions) and slivering of the strip under magnification. The author proposes the graft transection
rate to nearly 0% .
[19]

DHI, a modified version of FUE, has similarities with FUE in hair follicle harvesting, whereas the implantation
of the follicles is carried out with unique instruments that is licensed by Konstantinos (US 8,801,743 B2) and
produced specifically for this purpose. The needle of the pen may vary in size; since there are 0.40-2 mm
oblique-cut needles in the market. After follicle harvesting, each pen is loaded with a micrograft containing
1 to 3 hair follicles and subsequently implanted to the recipient area that was not previously perforated.
This technique allows the practitioner graft the recipient area denser and gives less trauma and bloodless
field when compared with FUE. Moreover, this procedure lacks additional punching for grafting as noted
in other transplantation techniques. On the contrary, the learning curve is high meaning that this surgery
needs more qualified personnel per patient. In addition, the procedure is carried out with 3 or 4 personnel,
because every stage is assigned to a unique staff which means that the room is more crowded than the
other techniques. The pens and so this procedure are relatively expensive when compared to FUT or FUE.
Nevertheless, follicle harvesting is significantly cheaper than robotic systems.

Complications after hair transplantation can be placed in the following categories: (1) standard surgical
risks; (2) physician planning errors; (3) physician technical errors; (4) patient compliance factors; (5)
[36]
patient physiology factors; and (6) miscellaneous causes . In addition, we may observe some site-specific
complications after all including donor and recipient site problems . Donor site complications include wide
[36]
variety of unwanted scar formation, donor-site depletion, wound dehiscence, necrosis, effluvium (shock-loss),
hypoesthesia, neuralgia and neuroma and hematoma. Recipient site complications may be comprised of hairline
location or shape error, progression error, graft type error, graft placement error, hypopigmentation, hair color
mismatch, chronic folliculitis, necrosis, effluvium, ingrown hairs, cysts and low graft yield.

Animal studies reveal creation of human follicles from cultured dermal and epidermal cells in a mouse
model . A revolutionary breakthrough in this field is the discovery of induced pluripotent stem cells enabling
[37]