2016
Post-Finasteride Syndrome (PFS) Update: Point/Counterpoint
Edwin S. Epstein, Hair Transplant Forum International January 2016, 26 (1) 1-6
The author reviews the evidence on breast and prostate cancer risk in users of 5-aplpha reductase inhibitors. He presents results of large studies that demonstrate that risk is not increased. He further presents the lack of compelling evidence of causality between use of 5-alpha reductase inhibitors and the array of symptoms referred to as Post Finasteride Syndrome.
How I Do It: 3D FUE: A New Dimension for Better, Easier FUE
Tseng-Kuo Shiao, Hair Transplant Forum International January 2016, 26 (1) 16-17
The author introduces a new powered device for performing FUE – the 3D Shiao Motor. The device is touch-activated and has programmable multiphasic controls. Mechanizing a repetitive action also reduces repetitive motion injury and potentially reduces muscle tension for any operator, from the novice to the advanced.
FUE Graft Placement with Dull Needle Implanters into Premade Sites
Mauro Speranzini, Hair Transplant Forum International March 2016, 26 (2) 49-56
The advantages, disadvantages, and technique of Dull Needle Implanters are discussed. Advantages include: (1)delegation of placement to technicians who can become proficient much more quickly than with forceps placement, whereas delgation of sharp needle placement too technicians may have legal and ethical ramifications, (2) grafts can often be harvested and placed simultaneously, (3) depth can be better controlled compared to sharp implanters and recipient incisions can be made smaller than the implanting needles or sites implanted with forceps, (4) premade sites that are subsequently placed with dull implanters can produce precise density, (5) grafts planted with dull implanters, as with sharp implanters, are protected better than those with forceps placement, and t(6)he procedure is less fatiguing to personnel. Disadvantages are that grafts are placed more slowly than with sharp implanters and there can be more bleeding and popping with dull implanters.
An Innovation in Suction Assisted FUE
Roberto Trivellini, Hair Transplant Forum International March 2016, 26 (2) 58-59
Described is a new device and technique for hair transplantation employing follicular unit extraction (FUE) based upon an original array of programmable variables including punch motion, i.e., rotation, oscillation and vibration that can run independently or in sequence. The device has autoclavable, lightweight ergonomic handpieces with attached suction and a rotary chuck that allows punches of different sizes. The many variables are coordinated by an HMI (Human Machine Interface) The sequence with rationale for extracting the follicle is pressure, drill rotation, rest, drill vibration and the rapid manual motion without drill motion which is called the “mamba strike".
Combining Scalp Micropigmentation (SMP) and Hair Transplantation
William R. Rassman, Jino Kim, Jae P. Pak, Antonio Ruston and Bessam Farjo, Hair Transplant Forum International May 2016, 26 (3) 85-95
Equipment, technical details, pitfalls and their corrective measures and indications for Scalp Micropigmentation (SMP) are discussed. Indications include the characteristic low donor density of Asian hair, scar correction from both FUE and strip scars, and creating the appearance of greater density in donor-depleted scalps as well as in situations where the patient wants to wear his hair very short. The procedure generally takes three passes spaced a week apart and takes 20-30 hours for an entire scalp. Occasionally a patient will undergo 7 or 8 passes. Such effort makes the use of permanent, as opposed to temporary, inks the only reasonable choice. The learning curve required has the authors recommend beginning on patients with donor scars who plan to wear their hair at longer lengths. The goals of the first, second and third sessions are discussed.
Powered FU Extraction with the Short-Arc-Oscillation Flat Punch FUE System (SFFS)
Jean Devroye, Hair Transplant Forum International July 2016, 26 (4) 129-136
The creator of the “WOW” motor and flat punch describes his thinking that resulted in this oscillating, flat punch system. Key points: Tethering is probably the main factor obtaining good quality grafts. 2) Splay is also a major obstacle to creating good FUE grafts without transection. 3) Sharp punches are associated with a high transection rate. 4) A flat punch moving with low speed decreases dramatically the rate of transection and produces FUE grafts that look more like FUT grafts.
FUE vs. FUT-MD: Study of 1,780 Follicles in Four Patients
Michael L. Beehner, Hair Transplant Forum International July 2016, 26 (4) 160-161
A study of 1780 follicles from 4 patients followed over 3 years looks at graft survival for Abstract: those obtained from follicular unit extraction (FUE) vs follicles obtained from strip harvest with microscopic dissection (FUT-MD). The two groups were 890 FUE follicles and 890 FUT-MD follicles. The SAFE and SAFE II Systems were used to harvest the FUE follicles. Specifics of expertise and other aspects of the techniques are detailed. The author found 61% survival for FUE and 86% for FUT-MD. Details of hair counts are described.
Methylene Blue: Its Efficacy and Safety as a Storage Solution in Hair Transplantation
Chinmanat Tangjaturonrusamee, Patcharee Thientaworn, Natenapa Arunrattanapong, Dell Kristie O. Castillejos and Damkerng Pathomvanich, Hair Transplant Forum International September 2016, 26 (5) 194-196
A study of 3 patients using normal saline, and two strengths of methylene blue (MB) to assess whether MB could be used as an inexpensive storage solution in view of its multiple properties, including anti-oxidation actions. The study failed to show benefit.
Long Hair FUE and the Donor Area Preview
Otavio Boaventura, Hair Transplant Forum International September 2016, 26 (5) 200-202
The author developed an “open punch” to facilitate long hair FUE. The associated technique is described as are the advantages including having a preview of donor density diminishment and disadvantages including doing a 1000 graft procedure over two or three days.
Naturally Occurring Hairlines in Orientals of Southeast and East Asian Origin and Their Application in Hair Restoration Surgery
Tyng Yuan Tan and Damkerng Pathomvanich, Hair Transplant Forum International September 2016, 26 (5) 204-207
The authors address characteristics of the naturally occurring hairlines in 209 orientals of Southeast and East Asian origin ranging in age from 18 to 70+. They looked at density at various locations in the scalp, hairline height, hairline shape, face shape and hair direction. They were unable to assess angle of exit of follicles since the scalps were unshaven. These observations are contrasted to the natural hairline in Caucasians.
How I Do It: Ahmad’s NPRT System: A New Classification System for Documenting Male Pattern Baldness
Muhammad Ahmad, Hair Transplant Forum International September 2016, 26 (5) 218-219
The author suggests simple additions to the Norwood Baldness Scale to address specifically the three specifics of Male Pattern Balding not well addressed with the Norwood Scale: “temporal peak recession”, reverse thinning that can occur in the occipital and mastoid areas and “overall thinning”.
Peri-operative Antithrombotic Therapy in Hair Transplantation
Kuniyoshi Yagyu, Hair Transplant Forum International November 2016, 26 (6) 241-252
Dr. Yagyu, a cardiologist as well as former President of the ISHRS gives a detailed discussion of the management of patients with a history of cardiovascular disease who are considering undergoing hair transplantation. He breaks cardiovascular conditions into high and low risk and recommends antithrombotic therapy modifications for surgery accordingly. Special note is made that “bridging anticoagulation” wherein warfarin and antiplatelet therapy is stopped preoperatively in patients with mechanical heart valves for low molecular weight heparin is based on bad science and should no longer be utilized. Another high risk condition is coronary artery stents and is complicated by the type of stent, drug eluting or not, for instance. The use of beta blockers is also addressed, and the author advises against stopping them for surgery as his experience is that they do not cause a problem in combination with low dose epinephrine in the tumescence. Other recommendations are made and, in addition to monitoring the patient and an intravenous cannula, he uses nitroglycerin tape in patients over 60 or with a history of cardiovascular disease.
Coincidental Epigenetics or Post-Finasteride Syndrome (PFS)
Dow B. Stough, Hair Transplant Forum International November 2016, 26 (6) 246
Dow Stough presents a balanced summary of behavioral neuroendocrinologist Alan Jacobs’ presentation of the Post-Finasteride Syndrome (PFS) to the 2016 ISHRS World Congress in Las Vegas. Dr. Jacobs presents considerable evidence supporting a scientific basis for PFS. Participants at the conference raise valid points that could refute his science. Dr. Stough offers his conclusions for when to prescribe finasteride based upon “first do no harm” and the science that is not irrefutable in establishing PFS.
ISHRS Legal Update: Delegation of Surgery in Hair Transplantation
Hair Transplant Forum International November 2016, 26 (6) 253
An update is provided regarding the permissibility of delegating portions of hair restoration procedures to unlicensed personnel. The Florida Board of Medicine issued a Declaratory Statement in June 2016 outlining a position similar to the Virginia’s Board of Medicine in 2011 and the ISHRS’s position which basically prohibits subordinates to provide patient care outside of the subordinates’ scope of practice. The article also mentions examples USA of charges in countries outside of the being brought against two individuals practicing surgery without a diploma or without a doctor’s being present. The case is pending as of 2016 and the prosecution is seeking prison sentences of 2 to 5 years. Ethical and legal considerations are posed for all physicians regarding the use of allied health care or unlicensed personnel.
Another Way to Look at Donor Harvesting Effects with FUE
Paul T. Rose, Hair Transplant Forum International November 2016, 26 (6) 254-255
This article by one of the original pioneers of FUE raises important issues that address the question of how many follicles can be removed from the donor area before diminished donor density becomes apparent. His initial premise is the presumption, long accepted by our specialty and based upon a study on a single patient by Manny Marrett, MD, that 40-50% of hair can be removed before diminished density becomes apparent. Dr. Rose proceeds to show mathematically and photographically that extraction of one follicular unit (FU), without removing an adjacent FU which would create a local density below 50%. This requires leaving approximately 7 FUs for every FU extracted. This, in turn, means that approximately 14% of donor follicles can be removed. With a donor density of 70-80 FUs/cm2, this equates to 1800 – 2200 grafts being available for harvest from what has been traditionally considered the “Safe Donor Zone”. Other considerations such as finer hair, low hair density, few 3 and 4 hair FUs and hair becoming finer with age can further limit the amount of hair that can be harvested from the Safe Donor Zone without the patient having to wear longer hair styles. Since the ability to wear shorter hair styles is often one of the “selling points” of FUE, patient education regarding donor thinning is critical for adequate Informed Consent.
A Side-by-Side Study of 20 Consecutive FUE Patients Comparing the Use of a 0.9mm Sharp vs. 0.9mm Blunt Punch
David Josephitis and Ron Shapiro, Hair Transplant Forum International November 2016, 26 (6) 256-259
20 consecutive patients undergoing FUE were enrolled in a study to evaluate a sharp versus blunt punch. Parameters assessed were 1) hair transection rate, 2) hairs per graft, 3) yield/missing grafts, 4) speed, 5) graft quality and 6) scarring. 200 attempted graft extractions were made from boxes 3 cm wide on either side of the midline in the Safe Zone for a density of extraction of approximately 18FU/cm2 using 0.9mm punches. Transection rates which excluded the most superficial were distal transections 20.4% for sharp and 6.1% for blunt. Hairs per graft rates were similar: 2.5 hairs sharp vs 2.6 hairs blunt. Selecting an arbitrary 50% survival for the more significant transections resulted in an adjusted hairs/graft of 1.9 for sharp and 2.2 for blunt. Missing grafts presumably from capping or buried grafts were 7% for sharp and 13% for blunt. The speed of creation and extraction was similar for the two punches. Graft quality assessment showed slightly more tissue surrounding blunt grafts with less splaying of the follicles in the lower portions of the grafts. With hair trimmed with a #1 clipper guard, no scarring was apparent in the donor with this percentage of extraction, but, scarring typical of FUE was apparent when no guard was used. The authors point out that studies such as this depend, of course, upon the skills of the surgeon, but that this study is useful for assessing blunt vs sharp punches in the hands of a surgeon who is very competent, but perhaps not the world’s best, with both types of punches.
2017
Dealing with a Hybrid Trumpet Punch
Arthur Tykocinski, Hair Transplant Forum International January 2017, 27 (1) 14-16
The author describes the concept behind the Hybrid Trumpet punch. The purpose is to decrease transection during Follicular Unit Excision (FUE). The cutting surface is directed 90 degrees perpendicular to the axis of the punch, allowing for initial sharp entry into the surface. The inner edge is dull, allowing the graft to move undamaged into the punch, which is further facilitated by the oscillating motion from the WAW machine. The author describes several finer points for its use and the developer of this punch, Dr Jean DeVroye, provides a nice commentary at the end.
Graft Placement Using the Dull Needle Implanter (DNI) Technique
Mauro Speranzini, Hair Transplant Forum International March 2017, 27 (2) 45-56
While the idea of using dulled implanters to place grafts is not new, the concept has been given new life in the FUE era, especially by Brazilian surgeon Mauro Speranzini. In this article, the author gives a detailed “how to” to create dulled implanters, including how to sand the tips and disassemble the implanter so it can be autoclaved.
Does the use of implanters affect the quality of FUE grafts?
Conradin von Albertini and Marie-Anne von Albertini, Hair Transplant Forum International May 2017, 27 (3) 96-99
The author performed a very nice study of the quality of grafts after placement with sharp implanters. Grafts were randomly plucked and analyzed, demonstrating damage in only 0.5% of follicles when examined under the microscope.
The Association Between Scalp Laxity, Elasticity, and Glidability and Donor Strip Scar Width in Hair Transplantation—A New Elasticity Measuring Method
Jae Hyun Park, Hair Transplant Forum International July 2017, 27 (4) 133-140
Scalp laxity is a combination of elasticity and glidability. In this paper, these terms are defined and explained. A study of 88 patients was performed to correlate these factors with scar width after FUT. Those with hyperelastic scalps are at higher risk for wider scars.
Hair Transplant in the Age of MRSA
Sara Wasserbauer, Hair Transplant Forum International September 2017, 27 (5) 177-184
Methicillin resistant staphylococcus aureus (MRSA) is a growing health problem and something every practicing hair surgeon should expect to see. This paper reviews the current state of knowledge about this infection, including how it can be prevented and treated when it does occur.
Dynamics of FUE
Parsa Mohebi and Jeanette Straga, Hair Transplant Forum International November 2017, 27 (6) 232-236
This article provides a nice basic overview of FUE. Hair Follicle anatomy as it relates to FUE is covered, as is a step by step approach to extracting grafts with minimal transection. Numerous illustrations are given to demonstrated the points made in the article.
2018
Redefining the “E” in FUE: Excision = Incision + Extraction
Ricardo Mejia, Hair Transplant Forum International January 2018, 28 (1) 1-6
The author points out that using the term “excision” instead of “extraction” more accurately describes the fact that the surgeon is performing actual surgery in cutting out and removing each tiny portion of the scalp. After the initial incision is made, then the act of removing the graft from the scalp could be termed “extraction.”
Determining Safe Excision Limits in FUE: Factors That Affect, and a Simple Way to Maintain, Aesthetic Donor Density
Sharon A. Keene, William R. Rassman and James A. Harris, Hair Transplant Forum International January 2018, 28 (1) 1-11
The authors propose a way to safely stay under the limits, which could lead to over-harvesting for each patient. They define the “Hair Diameter Index” and also the “Hair Coverage Value” to help in this determination. Using these measures helps prevent donor area necrosis or the resultant moth-eaten appearance of the donor area.
The Successful Treatment of Alopecia Areata with Platelet Rich Plasma in a Case of Twins with Genetic Risk for Autoimmune Disorders
Anastasios Vekris, Hair Transplant Forum International January 2018, 28 (1) 12-13
The author describes the case of a 13 year old patient with severe alopecia areata who was successfully helped after using PRP treatment. Since it is only one case, it can’t be considered an official treatment for this disorder, but it may hold promise in the future for additional patients.
How I Do It: Using Velcro to Assist with Non-Shaven FUE
Timothy Carman and Marie A. Schambach, Hair Transplant Forum International January 2018, 28 (1) 14-15
The author shows how strips of Velcro can be used in the donor area harvest with FUE so that a “non-shaven” approach can be used. This is particularly valuable for female patients.
Advances in Robotic FUE
Robert M. Bernstein and Michael B. Wolfeld, Hair Transplant Forum International January 2018, 28 (1) 18-19
Recent improvements in robotic FUE are discussed. Some of these improvements have been the following: Increased speed of operation, increased accuracy, increased “functionality”(more flexible positioning of the machine’s arm and movements), and improvements in Artificial Intelligence.
Literature Review: Naltrexone: New Use for an Old Drug
Nicole E. Rogers, Hair Transplant Forum International January 2018, 28 (1) 27
4 patient cases are summarized, in which difficult long-term lichen planopilaris patients were helped by treatment with Naltrexone, an opiate antagonist alone or combined with pioglitazone. Side effects were minimal.
Literature Review: Nutrafol® vs. Microinflammation
Nicole E. Rogers, Hair Transplant Forum International January 2018, 28 (1) 27
This report shows that some of the supplements in Nutrafol can work on a molecular level to help suppress inflammation and help with treating hair loss.
Graft Quality Index: A Morphologic Classification of Follicular Unit Excision (FUE) Grafts
Robert H. True, Hair Transplant Forum International March 2018, 28 (2) 45-53
The author does a beautiful job of classifying the description of every variation for an FUE graft. The photos do a great job of showing examples of the various ways these grafts present after harvesting and trimming. Very easy-to-read graphs accompany the article. Using the author’s terminology will go a long way toward being able to compare apples with apples when discussing studies or patient results.
The Evolving Role for Autologous Adipose Tissue (Fat) in Treating Hair Loss
Gorana Kuka Epstein and Jeffrey S. Epstein, Hair Transplant Forum International March 2018, 28 (2) 54-56
The authors describe their clinical research using autologous fat transfer with PRP for the treatment of scars, cicatricial alopecia, and for male and female pattern alopecia. Their experience encompasses over 100 patients. They have been able to achieve improvements in hair growth using this method, but state more research is necessary, and presently it is not FDA approved.
A Histological and Clinical Evaluation of Plasma as a Graft Holding Solution and Its Efficacy in Terms of Hair Growth and Graft Survival
Anil Kumar Garg and Seema Garg, Hair Transplant Forum International May 2018, 28 (3) 89-96
The author describes a study of 6 patients, in whom autologous plasma was used as a holding solution for the grafts while outside of the body during the study. He lists some of the benefits of this modality: less expensive than intra-cellular solutions, prevents dehydration of grafts, and several others. Study compared this solution with lactated ringers as a control.
Hair Restoration in Cranial Surgery Patients
Parsa Mohebi and William R. Rassman, Hair Transplant Forum International May 2018, 28 (3) 97-99
Author presents photos and clinical stories for 4 patients who previously had intra-cranial surgery and were left with detectable donor scars. He reviews several “pearls” for transplanting these patients, that will minimize risk to the patient.
A New Multi-Graft Implanter System
Jean M. Devroye, Hair Transplant Forum International May 2018, 28 (3) 100-101
The author describes in detail his new multi-graft implanter. It features a dull tip, so that it is only used in pre-made holes. This allows assistants to place the grafts, as they are not making the initial incisions.
Literature Review: Topical Finasteride: To Use or Not to Use?
Nicole E. Rogers, Hair Transplant Forum International May 2018, 28 (3) 112
Six studies are combined and commented upon. This summary suggests a current maximally effective concentration of finasteride to use, which suppresses scalp DHT, but has a minimal effect on serum DHT. Many questions remain to be answered with this therapy. In most of the patients, good hair density was maintained. One study combined topical finasteride along with topical minoxidil and dutasteride, which showed improvement in hair density.
Fine-Tuning Your Local Anesthesia
Nicole E. Rogers, Hair Transplant Forum International May 2018, 28 (3) 113
Elegant study comparing pain experienced by patients using 30g and 33g needles. Epinephrine and sodium bicarbonate were added to 0.5% lidocaine. There was no difference when used on the neck. When used on the scalp, 94% related “no pain” with 33g needle, compared to 54% with the 30g needle.
Notes from the Editor Emeritus, 2005–07
Robert S. Haber, Hair Transplant Forum International July 2018, 28 (4) 137
Dr. Haber reviews the history of modern hair transplantation and points out the challenges that each new decade presents for us. The current challenge is trying to keep the high quality of hair transplant surgery high, with properly trained and experienced physicians performing the key surgical and artistic steps of the procedure.
A Brief Study Examining the Variability of PRP with Different Preparation Systems
Paul T. Rose and Aron G. Nusbaum, Hair Transplant Forum International July 2018, 28 (4) 140-141
The authors point out that not all PRP preparations are equal, making for different concentrations of platelets in the system being used. They compared four different systems and found a wide variance in platelet concentrations.
How to Avoid Overharvesting During Repeat Follicular Unit Excision Sessions by Calculating the Number and Density of Previously Excised Grafts
Kuniyoshi Yagyu, Hair Transplant Forum International July 2018, 28 (4) 142-144
Dr. Yagyu presents an elegant, detailed study of five patients who had a previous FUE procedure and now returned for a second one. He emphasized not over-harvesting, as an increased amount of scarring and resultant low-density scalp may result. He also noted that often the 3 and 4-hair FU grafts are often removed at the first FUE procedure, leaving mostly 1 and 2-hair grafts for subsequent harvests.
A Novel Device to Insert FU Grafts into Premade Sites
Parsa Mohebi, Hair Transplant Forum International July 2018, 28 (4) 146-148
Dr. Mohebi demonstrates a new dull-tip graft implanter. This is ideal as assistants can more easily plant the grafts in pre-made sites made by the surgeon.
Medical and Professional Ethics: Spotlight on Honesty with Patients
Gregory Williams, Hair Transplant Forum International July 2018, 28 (4) 149
The author discusses ethical communication with the patient prior to the procedure, so that expectations and the limitations of the procedure are fully understood by the patient. He stresses that honesty and integrity are of paramount importance.
Controversies: Losing Our Patients
Russell Knudsen, Hair Transplant Forum International July 2018, 28 (4) 150
A number of issues are addressed regarding “medical tourism” and the undesirable result of patients seeking the cheapest hair transplant at some of “mills” that have sprung up around the world. The author discusses that hair transplantation should be a comprehensive service, not just a “product,” with the surgeon involved with every aspect of the procedure. With FUE becoming more prevalent, many non-physicians are now actually performing the entire procedure.
If hair is dead, when does it die? The Zombie Hypothesis
Michael G. Davis and Brad B. Jarrold, Hair Transplant Forum International September 2018, 28 (5) 173-177
This highly technical biochemistry research study tries to determine when a follicle is finally “dead.” It also reviews the molecular processes that occur in this transition.
FUT vs. FUE Graft Survival: A Side-by-Side Study of 3 Patients Undergoing a Routine 2,000+ Graft Hair Transplantation
David Josephitis and Ron Shapiro, Hair Transplant Forum International September 2018, 28 (5) 179-182
This study of three patients looked at the survival of grafts harvested by FUE and from strip dissection. The results were statistically the same, with very minor differences in graft survival between the 3 patients.
Surgical Hairline Advancement: Patient Candidacy and Best Techniques
Jeffrey S. Epstein and Gorana Kuka Epstein, Hair Transplant Forum International September 2018, 28 (5) 184-187
The surgical approach to lowering the front hairline is covered. Most patients are female, but the occasional male patient and also trans-gender patients are good candidates, as long as the hair located posteriorly is of sufficient density. Photos of actual patient results are shown.
The Trivellini System and Technique
Roberto Trivellini, Hair Transplant Forum International September 2018, 28 (5) 188-190
This article reviews a new method for harvesting FUE grafts. It utilizes suction and vibration to facilitate keeping the graft in the center of the punch. The author states that this method results in more tissue being around the bulb area after extraction.
Medical and Professional Ethics: Spotlight on Surgery by Unlicensed Practitioners
Gregory Williams, Hair Transplant Forum International September 2018, 28 (5) 192-193
This article reviews the issue of who should be doing each portion of the hair transplant procedure. The ISHRS strongly states that legally only physicians should be performing the essential portions of the procedure: namely, the planning, anesthesia, making all of the recipient sites, and caring for any complications. The ideal of the physician making each FUE site is controversial in some countries and states, as there is a certain fatigue with making thousands of these sites.
The Use of Body Hair with Scalp Hair for “Combination Grafting” to Enhance Visual Density of Hair Transplantation and Increase Coverage in Advanced Alopecia
Anil Kumar Garg and Seema Garg, Hair Transplant Forum International November 2018, 28 (6) 217-223
The authors performed a combination of scalp hair along with donor hair from the beard and body also. They contend that, for certain patients, this enables them to create greater visual density. A personal word from this reviewer: The extremely thick diameter of beard hair and the almost “invisible” quality of some body hair can sometimes result in an unnatural contrast between it and the regular scalp hair.
President’s Message: The Future of the Hair Transplant Industry
Arthur Tykocinski, Hair Transplant Forum International November 2018, 28 (6) 219
The current president of the ISHRS reviews the present situation in the world, in which many “assembly line” hair clinics are becoming numerous, resulting in poor results, which harm the reputation of hair surgery for all of us. The Black Market Awareness Campaign is one effort the ISHRS is taking to alert the public of this abuse around the world.
Why I Switched to a Multiphasic FUE Device
Marie A. Schambach, Hair Transplant Forum International November 2018, 28 (6) 224-226
A very detailed article about the Trivellini FUE machine set-up, which utilizes rotation, oscillation, vibration, and mild suction to excise FUE grafts. The author states it has reduced the time necessary for the harvest and that the grafts are of higher quality. The photos accompanying this article are excellent in showing how it is done.
Case Report: Those pesky dots. What are they?
Paul T. Rose and Michael Morgan, Hair Transplant Forum International November 2018, 28 (6) 228
The authors took 2mm diameter punch segments from the donor area where FUE grafts had been previously harvested in the past. The tissue was stained and sent for dermatopathology exam, and was found to contain a large amount of scar tissue in the space where the graft was extracted from. They also have frequently seen that the resultant circular scar in the donor area would later be larger than the original punch diameter, because of the lack of contractile forces in the tissue.
Medical and Professional Ethics: Spotlight on Cosmetic vs Non-Cosmetic Hair Transplant Surgery
Gregory Williams, Hair Transplant Forum International November 2018, 28 (6) 230-231
The author discusses whether or not hair replacement surgery maybe should be considered a non-cosmetic procedure, and indeed a medical one, with hereditary alopecia being considered a disease. The implications this would carry regarding reimbursement from insurance and who should be doing this surgery are also touched upon.