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Hair Transplantation Workup

  • Author: Jeffrey S Epstein, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Aug 13, 2015
 

Approach Considerations

When healing or bleeding characteristics are concerns, consider performing screening blood tests, including tests of following:

  • CBC count with platelets
  • Prothrombin time (PT)
  • Activated partial thromboplastin time (aPTT)

Further testing (eg, chemical profile) is occasionally performed as the patient's medical condition dictates.

In female patients, extensive workup is indicated to rule out potentially treatable causes of the hair loss. Include tests of the following:

  • CBC count
  • Total iron and ferritin
  • Thyroid function tests and thyroid-stimulating hormone
  • Total and free testosterone
  • Dehydroepiandrosterone (DHEA) sulfate, in cases of irregular menses

Further testing (eg, ECG) is occasionally performed as the patient's medical condition dictates. It also may be prudent to screen for antibodies to HIV hepatitis B and C.

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Classification

Staging alopecia into both pattern and degree of severity can be accomplished through the Hamilton classification. Patients with Hamilton patterns I and II have very early limited alopecia requiring minimal treatment if accepted as candidates. Conversely, patients with patterns VI and VII may no longer be candidates for the surgery since their alopecia is so extensive. The very best candidates fall into patterns IV to V, which produce the best, most natural results. See the image below.

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Contributor Information and Disclosures
Author

Jeffrey S Epstein, MD, FACS Clinical Professor, Department of Otolaryngology, Division of Facial Plastic Surgery, University of Miami, Leonard M Miller School of Medicine; Consulting Surgeon, Foundations for Hair Restoration and Plastic Surgery

Jeffrey S Epstein, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Carlos K Wesley, MD Private Practice in Hair Restoration Surgery

Carlos K Wesley, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, International Society of Hair Restoration Surgery, American Hair Loss Association, International Alliance of Hair Restoration Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Keith A LaFerriere, MD Clinical Professor, Fellowship Director, Department Otolaryngology-Head and Neck Surgery, University of Missouri-Columbia School of Medicine

Keith A LaFerriere, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Missouri State Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Received grant/research funds from Genentech for investigator.

Joseph A Molnar, MD, PhD, FACS Medical Director, Wound Care Center, Associate Director of Burn Unit, Professor, Department of Plastic and Reconstructive Surgery and Regenerative Medicine, Wake Forest University School of Medicine

Joseph A Molnar, MD, PhD, FACS is a member of the following medical societies: American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Plastic Surgeons, North Carolina Medical Society, Undersea and Hyperbaric Medical Society, Peripheral Nerve Society, Wound Healing Society, American Burn Association, American College of Surgeons

Disclosure: Received grant/research funds from Clinical Cell Culture for co-investigator; Received honoraria from Integra Life Sciences for speaking and teaching; Received honoraria from Healogics for board membership; Received honoraria from Anika Therapeutics for consulting; Received honoraria from Food Matters for consulting.

Jorge I de la Torre, MD, FACS Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Robert S Bader, MD Dermatologist, Section of Dermatology, Department of Medicine, Broward Health - North

Robert S Bader, MD is a member of the following medical societies: American Academy of Dermatology, Florida Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery

Disclosure: Nothing to disclose.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

J David Kriet, MD, FACS Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Facial Plastic and Reconstructive Surgery, University of Kansas School of Medicine

J David Kriet, MD, FACS is a member of the following medical societies: Society of University Otolaryngologists-Head and Neck Surgeons, AO Foundation, Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate-Craniofacial Association, American College of Surgeons, American Medical Association

Disclosure: Received honoraria from AO North America for speaking and teaching.

Mark E Krugman, MD Assistant Professor of Plastic Surgery, Clinical Professor of Otolaryngology-Head and Neck Surgery, University of California at Irvine School of Medicine

Mark E Krugman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Plastic Surgeons, American Academy of Facial Plastic and Reconstructive Surgery, American Society for Aesthetic Plastic Surgery, American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

R Stan Taylor, MD The JB Howell Professor in Melanoma Education and Detection, Departments of Dermatology and Plastic Surgery, Director, Skin Surgery and Oncology Clinic, University of Texas Southwestern Medical Center

R Stan Taylor, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Walter P Unger, MD FRCP(C), FACP, ABHRS, Clinical Professor, Department of Dermatology, Director, Cosmetic Dermatologic Fellowship Program, Mount Sinai School of Medicine; Associate Professor, Department of Medicine (Dermatology), University of Toronto Faculty of Medicine

Walter P Unger, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Canadian Medical Association, Ontario Medical Association, Canadian Dermatology Association, International Society of Hair Restoration Surgery

Disclosure: Nothing to disclose.

References
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  5. Magro CM, Rossi A, Poe J, Manhas-Bhutani S, Sadick N. The role of inflammation and immunity in the pathogenesis of androgenetic alopecia. J Drugs Dermatol. 2011 Dec. 10 (12):1404-11. [Medline].

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  7. Rassman WR, Bernstein RM, McClellan R, Jones R, Worton E, Uyttendaele H. Follicular unit extraction: minimally invasive surgery for hair transplantation. Dermatol Surg. 2002 Aug. 28 (8):720-8. [Medline].

  8. Harris JA. Powered blunt dissection with the SAFE System for FUE. Hair Transplant Forum International. Nov/Dec 2011. 20:188-89.

  9. Salanitri S, Gonçalves AJ, Helene A Jr, Lopes FH. Surgical complications in hair transplantation: a series of 533 procedures. Aesthet Surg J. 2009 Jan-Feb. 29 (1):72-6. [Medline].

  10. Knudsen RG, Unger M. Unger W, et al. Hair Transplantation. 5th ed. New York, NY: Marcel Dekker; 2011. 419-22.

  11. Chiang YZ, Tosti A, Chaudhry IH, Lyne L, Farjo B, Farjo N, et al. Lichen planopilaris following hair transplantation and face-lift surgery. Br J Dermatol. 2012 Mar. 166 (3):666-370. [Medline].

  12. Wesley CK. Enhanced Patient Selection: The Folliscope. Unger and Shapiro, eds. Hair Transplantation. 5th ed. New York, NY: Marcel Dekker; 2011. 82-3.

  13. Jimenez JJ, Wikramanayake TC, Bergfeld W, Hordinsky M, Hickman JG, Hamblin MR, et al. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study. Am J Clin Dermatol. 2014 Apr. 15 (2):115-27. [Medline].

  14. Epstein JS. Hair transplantation in women: treating female pattern baldness and repairing distortion and scarring from prior cosmetic surgery. Arch Facial Plast Surg. 2003 Jan-Feb. 5 (1):121-6. [Medline].

  15. Frechet P. Donor harvesting with invisible scars. Hair Transplant Forum Intl. 2005. 15(4):119-20.

  16. Nordström RE, Greco M, Vitagliano T. Correction of sideburn defects after facelift operations. Aesthetic Plast Surg. 2000 Nov-Dec. 24 (6):429-32. [Medline].

  17. Barrera A. The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp. Plast Reconstr Surg. 2003 Sep. 112 (3):883-90. [Medline].

  18. Harris JA. Follicular unit transplantation: dissecting and planting techniques. Facial Plast Surg Clin North Am. 2004 May. 12 (2):225-32. [Medline].

  19. Lee SJ, Lee HJ, Hwang SJ, Kim DW, Jun JB, Chung SL, et al. Evaluation of survival rate after follicular unit transplantation using the KNU implanter. Dermatol Surg. 2001 Aug. 27 (8):716-20. [Medline].

  20. Haber RS, Unger M, Unger W, et al. Hair Transplantation. 5th ed. New York, NY: Marcel Dekker; 2011. 279-80.

  21. Rashid RM, Morgan Bicknell LT. 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 Sep 15. 18 (9):12. [Medline].

  22. Seager DJ. Micrograft size and subsequent survival. Dermatol Surg. 1997 Sep. 23 (9):757-61; discussion 762. [Medline].

  23. Limmer R. Micrograft survival. Stough D, Haber R, eds. Hair Replacement. St. Louis, Mo: Mosby; 1996. 147-49.

  24. Kim JC. Unger W, Shapiro R, et al. Hair Transplantation. 5th ed. New York, NY: Marcel Dekker; 2011. 404-6.

  25. Unger WP. Delineating the "safe" donor area for hair transplanting. Am J Cosmetic Surg. 1994. 239-43.

  26. Wesley CK, Teo LH, Xu T, Unger RH, Unger WP. The influence of peri-incisional triamcinolone acetonide injection on wound edge apposition. J Dermatolog Treat. 2014 Aug. 25 (4):345-9. [Medline].

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Case 1. Views before and 6 months after a procedure performed by using 2000 follicular-unit micrografts.
Case 1. Close-up view of the hairline of a patient 6 months after a procedure performed by using 2000 follicular-unit micrografts.
Case 2. Views before and after 3500 follicular-unit micrografts performed in 2 procedures.
Case 2. Close-up view of the hairline of a patient after transplantation of 3500 follicular-unit micrografts performed in 2 procedures.
 
 
 
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