Large-Scale Beard Extraction Enhances the Cosmetic Results of Scalp Hair Restoration in Advanced Androgenetic Alopecia in East Asian Men: A Retrospective Study

Abstract

Introduction: Beard hair serves as an important additional donor supply to support hair transplantation in hirsute patients with extensive alopecia and lacking sufficient occipital hair. However, the efficacy and safety of large-scale beard hair extraction have not been studied extensively in the East Asian population. Methods: Data obtained from hirsute patients with extensive alopecia who underwent hair transplantation between March 2017 and December 2018 at Nanfang Hospital were analyzed. Occipital and beard hair were evaluated separately during the pre-, intra-, and post-operative periods. Individual beard hair follicular units (FUs) were harvested under tumescence using a hollow punch with an outer diameter of 0.8-0.9 mm. Follow-up examinations were scheduled at 3-5 days, 1 month, and 9 months postoperatively to check for complications, determine the survival rate of mixed, transplanted FU grafts, and assess patient satisfaction. Data were collected and analyzed statistically. Results: A total of 36 hirsute, male patients with advanced androgenetic alopecia (AGA) (Norwood-Hamilton V-VI) were included in this study. The density of the occipital and beard areas was 78.6 ± 4.6 and 48.4 ± 9.3 FU, respectively. It took 3.1 ± 0.9 h to harvest 3135 ± 863 FUs from the occipital area and 2.1 ± 0.6 h to harvest 2352 ± 599 FUs from the beard area. The transection rate for occipital FUs and beard FUs was 3.7 ± 0.4 and 3.9 ± 0.2%, respectively. Completion of the operation took approximately 10.0 ± 0.9 h, and no serious complications were reported 5 days after the procedure. An FU survival rate of 95.7 ± 1.6% was observed at 9 months after transplantation, with no visible hypopigmented scars observed in the bare areas. All patients were satisfied with the resulting cosmetic appearance. Conclusion: Large-scale beard extraction, when combined with occipital hair extraction, is a safe and effective treatment to enhance the cosmetic appearance of East Asian men with advanced AGA.

Relieving postoperative pain using tumescent solution with ropivacaine in follicular unit excision

“…However, FUE is time‐consuming and laborious and is strictly demanding on surgeons 17 . Nevertheless, FUE can extract follicular units outside the typical donor site, increase harvestable grafts, shorten postoperative recovery time, and mitigate postoperative pain, 18–20 even without shaving hair to extract follicular units 21 …”

“…16 However, FUE is time-consuming and laborious and is strictly demanding on surgeons. 17 Nevertheless, FUE can extract follicular units outside the typical donor site, increase harvestable grafts, shorten postoperative recovery time, and mitigate postoperative pain, [18][19][20] even without shaving hair to extract follicular units. 21 Although postoperative pain would continue for at least 48 h in hair transplantations, 4 it has been alleviated by various methods, such as icing and vibrators.…”

Using Nonscalp Hair in Scalp Hair Restoration—Theory and Execution

“…The advent and refinement of follicular unit excision (FUE) harvesting technology over the past two decades has opened a new avenue for the repair of these cases via harvesting and transplanting of hair follicles from nonscalp body sources. 5 6 7 8 9 10 11 12 13 The utilization of body hair also allow us to provide more coverage for patients with advanced balding and preserve scalp donor in younger patients. When transplanting a nonscalp body area, the same area's hair is best suited if present in sufficient quantity, for example, beard hair is taken from below the jawline transplanted to the cheek beard.…”

Effect of De-epithelialization on Graft Survival Rate After Follicular Unit Extraction

“…H air transplantation is the most effective treatments for hair loss, 1,2 it is known that a good cosmetic result in hair transplantation requires an adequate density of transplanted grafts, high survival rate of transplanted grafts, and natural immediate postoperative appearance. 3 However, traditional follicular unit dissection during hair transplantation usually leaves the epidermal portion intact, so this area may remain above the incision at the recipient site, leading to a "goose bumps" appearance, 4 or bury into recipient site and further causing cyst and/or scar formation.…”