The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I-V. The best results are achieved in untanned patients with skin types I-IV.

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Follicular unit extraction is becoming an increasingly popular technique for hair transplantation, as it obviates the linear scarring associated with strip harvesting, and can provide highly presentable results. Using this technique, a few reports have described the small scale use of nonhead hair for head hair transplantation in men with inadequate head hair donor supply. In this report, 3 patients who were severely bald had hair transplanted from the chest, abdomen, legs, shoulders, or beard, as well as the head to achieve full coverage and excellent hairlines. Of the 3 cases, 2 had undergone previously unsuccessful hair transplant surgeries. Approximately 80% to 85% of the transplanted grafts survived. Although hair length and quality, surgery time, and the requirement for improved surgical skills remain challenges when using this technique, the sufficiently good outcomes from these selected candidates suggest that this technique may offer the possibility of restoring even severely bald states to normality in patients who would otherwise not be candidates for traditional hair transplantation surgery.

Background:Hair transplantation involving patients with tightly curled Afro-textured hair using follicular unit extraction (FUE) employing conventional rotary punches frequently leads to unacceptably high transection rates. These patients are unsuitable candidates for FUE hair transplantation. Transection rates were observed during FUE in a case series of 18 patients with tightly curled Afro-textured hair using different punches.Methods:Three different punches were sequentially used in patients to extract follicular units with several needle gauges until satisfactory transection rates occurred: conventional sharp and dull rotary punches, followed by a 2-pronged curved nonrotary punch.Results:In all instances, the curved nonrotary punch had the best transection rate of <5%. Sharp and dull rotary punches completely failed or had excessive transection rates in 8 patients. The dull rotary punch performed better than the sharp rotary punch in 9 patients in whom it was used with few restrictions compared to 5 patients in whom there were more restrictions.Conclusions:A curved nonrotary punch configured to accommodate the curliness of tightly curled Afro-textured hair can overcome high transection rates experienced using conventional sharp or dull rotary punches. Limitations of this study include it being a small, retrospective case series, and that the new technique that could require additional training by current FUE hair transplant practitioners.

BackgroundBody hair shafts from the beard, trunk, and extremities can be used to treat baldness when patients have inadequate amounts of scalp donor hair, but reports in the literature concerning use of body hair to treat baldness are confined to case reports.ObjectivesThis study aimed to assess the outcome of body hair transplanted to bald areas of the scalp in selected patients.MethodsFrom 2005 through 2011, 122 patients preselected for adequate body hair had donor hair transplanted from the beard, trunk, and the extremities to the scalp by follicular unit extraction (FUE) by the author at a single center. All patients were emailed surveys to assess surgical outcomes and overall satisfaction.ResultsSeventy-nine patients (64.8%) responded with a mean time of 2.9 years between date of last surgery and time of survey. Patients were generally very satisfied with results of their procedure, giving mean scores of at least a 7.8 on a Likert-like scale of 0 to 10 for their healing status, hair growth in recipient areas, and overall satisfaction with their surgeries. These scores were comparable to mean scores provided by patients whose transplants included scalp donor sources.ConclusionsFUE using body hair can be an effective hair transplantation method for a select patient population of hirsute individuals who suffer from severe baldness or have inadequate scalp donor reserve.Level of Evidence:4 Therapeutic

Background: The large caliber of head hair in hair transplantation imparts a coarse hairline, whereas natural hairlines are typically softer. In hirsute individuals, transplantation of leg hair to the hairline may result in a superior aesthetic appearance. Observation: A total of 1025 leg hair follicles in 1 patient were grafted to an area 0.5 to 1.0 cm in front of and 0.5 to 1.0 cm internal to the vanguard hair of the original hairline and temporal recesses; the other patient received approximately 1000 leg hairs and 600 head hairs to advance and soften his hairline and to create a custom widow's peak. Transplantation resulted in a fully grown and soft-looking hairline after 9 months in the first patient, with growth of 75% to 80% of the transplanted leg hair. The mean length of the transplanted leg hair was longer than the length of the original leg hair, with less curliness but similar hair width. Transplanted leg hair width was significantly finer compared with existing head hair width. After 4 years, results were sustained, minimizing concerns that subsequent hair loss might result from leg hair cycle variations. In the second patient, similar results were observed at 3 years. Conclusion: The use of leg hair in transplantation provides additional options in patients with hairlines that need to be refined.

The difficulty of the follicular unit excision (FUE) hair transplantation procedure is currently attributed to hair curliness and subsurface angulation. Patients possessing the curliest hair shafts are considered the most challenging. Consequently, patients with these features are often denied FUE. However, this practice does not consider intrapatient variation in the graft attrition rate and the rates themselves, which are frequently low in very curly hair where the skin firmness/thickness is average. To better aid practitioners in predicting FUE performance, we have developed a new scoring system (the Sanusi FUE Score Scale [SFS Scale]) based on two major donor variables (hair and skin characteristics). Material and Method:The scale assigns scores to each of three hair subtypes (straight-wavy, curly, and coily-kinky) and each of three skin subtypes (thick/firm, soft/thin, and medium thickness/firmness). The scores were weighted based on the assessment of 13 experienced FUE practitioners from around the globe, who were asked to score each of the three skin and hair characteristics for their contribution to FUE difficulty. Results: On the contribution of skin characteristics to FUE difficulty, 12/13 (92%) practitioners assigned the highest (most difficult) score to thick/firm skin, with medium skin thickness/firmness being the least challenging. The same percentage of practitioners gave the highest difficulty score to coiled-kinky hair subtypes regarding the contribution of hair characteristics to FUE difficulty. All agreed that straight-wavy hair presents the least challenge to FUE performance. Tallying the scores of the skin and hair variables generates a final score range of 2-9, which is associated with five grades/classes of challenge in the FUE procedure, influencing the need for a specialized skill/nuanced approach or equipment. Conclusion:We developed a universal FUE donor scoring scale that accounts for the diversity of human hair and skin types. Further evaluation to determine the validity of this new classification system in predicting and grading FUE difficulty and patient outcomes is warranted.