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Review | Journal Club

A Review of Medical and Surgical Treatment Options for Androgenetic Alopecia

Daniel E. Rousso, MD1,2; Sang W. Kim, MD1
[+] Author Affiliations
1Rousso Facial Plastic Surgery Clinic, Birmingham, Alabama
2Department of Surgery, University of Alabama at Birmingham, Birmingham
JAMA Facial Plast Surg. 2014;16(6):444-450. doi:10.1001/jamafacial.2014.316.
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Importance  Androgenetic alopecia is a highly prevalent condition that can profoundly impair the quality of life in both men and women.

Objective  To provide the up-to-date medical and surgical treatment options for patients with androgenetic alopecia.

Evidence Review  A Medline search of scientific literature was conducted from 1997 to 2013. Search terms included androgenetic alopecia, hair restoration, follicular unit transplantation, and follicular unit extraction.

Findings  Oral finasteride and topical minoxidil are the 2 mainstream medical treatments for androgenetic alopecia. These medications have different mechanisms of action and should be combined to have an additive effect in men. Follicular unit transplantation is the gold standard for surgical management. There are 2 types of graft harvest technique: donor strip and follicular unit extraction. Each technique has its own advantages and disadvantages and should be tailored to the individual patient. Understanding of the anterior hairline design is essential to achieving a natural-appearing result.

Conclusions and Relevance  Medical treatment should be used in conjunction with surgery to achieve a synergistic effect. For the right candidate, follicular unit hair transplantation can lead to a long-lasting, natural result with appearance of dense scalp hair.

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Figure 1.
At the Donor Site: Strip Harvest Technique

A, Follicular units at the donor site shown as a cluster of 1 to 4 individual follicles exiting the scalp. B, A harvested donor strip ready for dissection into slivers that are 1 follicular unit thick. C, Trichophytic closure at the donor site. Notice the beveled inferior edge of the wound where preserved hair follicles are visible. D, Individual follicular unit transplants are ready for implantation.

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Figure 2.
At the Donor Site: Follicular Unit Extraction Technique With NeoGraft

A, A 1-mm vacuum-assisted punch device engaging onto a follicular unit on the donor scalp. B, Implantation of the follicular unit transplant using a vacuum-assisted implantation device.

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Figure 3.
At the Recipient Site

A, Frontotemporal recess is designed appropriate to the age of the patient. Notice the zigzag distribution and acute angle of slits at the anterior hairline. B, Creation of recipient site using a modified 18-gauge hypodermic needle. C, The graft is handled at the shaft to protect the follicle.

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Figure 4.
Preoperative and postoperative Views of Follicular Unit Extraction Technique

Preoperative (A and B) and postoperative (C and D) views.

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