Androgenetic Alopecia From A to Z. Volume 3. Hair Restoration Surgery, Alternative Treatments, and Hair Care

This third of three related volumes is structured in 3 sections and 46 chapters covering every aspect of Hair Restoration Surgery (HRS), alternative and future treatments for AGA/FPHL, as well as hair loss concealment and hair care. The reader will find dedicated chapters on every aspect of HRS: from the initial, "prehistoric" HRS techniques that have cosmetically stigmatized countless patients and defamed the field to in-depth coverage of all modern HRS techniques endorsing a "cosmetic revolution". Modern HRS techniques that offer results indistinguishable from natural hair in male and female patients are described in detail, with invaluable surgical pearls and strategies on how to treat complications, repair substandard results and even how to build a successful HRS practice. Chapters include more than a thousand original and unique full-color photos of unique cases, figures, tables, and invaluable surgical tips. The safety and applicability of Low Level Laser Therapy, Genetic Engineering/Gene Therapy, Stem Cell Therapy, Hair Follicle Cloning, Platelet Rich Plasma, Scalp Microneedling and Exosomes on AGA/FPHL are thoroughly reviewed in dedicated chapters, validated by several updated and balanced literature citations. All types of cover-up products that can "camouflage" baldness are reviewed in detail through the author's vast experience in their clinical use. An elaborate chapter on hair prosthesis and wigs illustrates how patients with extensive AGA can have a natural appearance and unrestricted life. The psychological entrapment, social awkwardness, hidden costs, and downsides of the wig industry are assessed. Finally, details on hair hygiene and how they can drastically affect hair loss are offered in a separate chapter. Handy, thorough, and practical, Androgenetic Alopecia From A to Z, Hair Restoration Surgery and Alternative Treatments Volume 3 will meet the needs of dermatologists, plastic surgeons, general practitioners, and all other physicians involved in this fast growing and fascinating field. Foreword Foreword Preface Acknowledgments Contents Part VIII: Hair Restoration Surgery (HRS): Lessons from the Past and Basic Principles The Unregulated Field Behind Closed Doors Is HRS a Cosmetic Procedure? Steps Forward Who Cares About the Past? A Few Principles to Begin with International Society of Hair Restoration Surgery (ISHRS) Mission, Vision, Core Purpose, and Values of the ISHRS ISHRS as a Nonprofit, Scientific Organization American Board of Hair Restoration Surgery (ABHRS) Mission, Vision, Core Purpose, and Values of the ABHRS Becoming an ABHRS Diplomate Fourteen Things That Make HRS a Unique Procedure Everything You Need to Know About HRS in One Paragraph 84: The History of Hair Transplantation 84.1 The “Prehistory” of HRS 84.2 Initial Steps in the Right Direction 84.3 HRS in AGA: How It All Began 84.4 Evolution of HRS After Orentreich 84.4.1 A Sinful History 84.4.2 Techniques that “Defy” Common Sense References 85: Punch Grafts: Holes in the Head 85.1 The Lesser of Two Evils 85.2 Reinventing the Wheel Gone Wrong 85.3 What Happened to the Punch Graft Technique Patients? References 86: Scalp Reduction 86.1 Can 1 + 1 = 3? 86.2 A Historical Perspective 86.3 The Alopecia Reduction Technique 86.4 Complications of AR Procedures 86.5 Cosmetic Issues with AR Procedures 86.6 The Absurdity of ARs 86.7 The Cost of Absurdity 86.8 AR and Modern HRS References 87: Scalp Expansion 87.1 Volumetric Expansion 87.1.1 Preoperative Volumetric Expansion 87.1.2 Intraoperative Volumetric Expansion 87.2 Nonvolumetric Expansion 87.3 Advantages and Disadvantages of Scalp Expansion 87.4 Scalp Expansion and Modern HRS References 88: Scalp Lifting 88.1 Scalp Lifting Technique 88.2 The Absurdity of Scalp Lifts References 89: Scalp Flaps 89.1 The Dawn of an Absurdity 89.2 The Juri Flap Technique 89.3 The Issues with Flaps 89.4 Understanding the Absurdity References 90: Laser-Assisted HRS 90.1 Why Lasers? 90.2 Technical Details on Lasers and HRS 90.3 The Absurdity of Lasers 90.4 The Endgame of Lasers References 91: Strip Excision Technique 91.1 One Small Incision, One Giant Leap for HRS! 91.2 Important Parameters of the Strip Excision Technique 91.2.1 Hair Follicle Trauma in the Donor Area 91.2.2 Single-Bladed Knife Vs. Multibladed Knife 91.2.3 Tumescent Anesthesia 91.2.4 Micrografts and Minigrafts 91.2.5 Microscopes and Magnifying Loupes 91.2.6 Graft Storing 91.2.7 Miniholes–Microholes 91.2.8 Dilators 91.2.9 Not the End of the Road Yet! References 92: Follicular Unit Transplantation (FUT) 92.1 What Is a Natural Follicular Unit (FU)? 92.2 What Is the Follicular Unit Transplantation Technique (FUT)? 92.3 What Is the Follicular Unit Strip Surgery (FUSS)? 92.4 A Historical Perspective 92.5 Why Are FUT Results More Natural? 92.6 Details of the Follicular Unit Implant, the Basic Building Block 92.7 Drawbacks of the FUT Technique 92.8 Author’s Notes References 93: Follicular Unit Excision (FUE) 93.1 An Early “Disclaimer” 93.2 A Historical Perspective 93.3 Childhood Illnesses 93.4 The Follicular Holocaust 93.5 Tools of the Trade 93.6 Divide and Conquer 93.7 The Prerequisites and the Right Process 93.7.1 Technical Aspects and Preparation Steps (Fig. 93.12) 93.7.2 Incision/Scoring Steps 93.7.3 Extraction Steps (Fig. 93.15) 93.7.4 Collection Steps 93.8 Recent Nomenclature of FUE 93.9 Advantages and Disadvantages of FUE 93.9.1 Advantages for the Surgeon 93.9.2 Advantages for the Patient 93.10 Drawbacks of the FUE Technique 93.10.1 Drawbacks for the Surgeon 93.10.2 Drawbacks for the Patient 93.11 Candidacy for FUE 93.12 Contraindications for FUE 93.13 Considerations and Controversies in FUE 93.13.1 Harvesting Rationale and Pattern 93.13.2 The Surface Area That Is Safe to Harvest from and Respecting the Donor Area Limits 93.13.3 Creative and Wishful Thinking 93.13.4 Graft Injuries 93.13.5 FUE Vs. FUSS Grafts 93.13.6 Effect of FUE on the Donor Area and the Plague of Overharvesting 93.13.7 Safety of FUE Megasessions 93.13.8 FUE Delegation and Other Ethical Considerations 93.14 Conclusion 93.15 Author’s Notes References 94: Βody Ηair Τransplantation FUE (ΒΗΤ FUE) 94.1 A Historical Perspective 94.2 Indications for BHT FUE 94.3 Technical Details of BHT FUE 94.4 Candidacy for BHT FUE 94.5 Benefits of the BHT Technique 94.6 Challenges with the BHT Technique 94.7 Complications of the BHT Technique References 95: Patient Selection in HRS 95.1 Major Criteria 95.2 Minor Criteria 95.3 What Else Should an HRS Surgeon Know? 95.4 Which Patients Should Not Undergo HRS? 95.5 Patient Selection 95.5.1 Medical Red Flags 95.5.2 Objective Red Flags 95.5.2.1 Details on Some Objective Red Flags 95.5.3 Subjective Red Flags 95.5.4 Body Dysmorphic Disorder (BDD) 95.6 An Unpleasant Truth About HRS References 96: Initial Interview, Evaluation, and Consultation 96.1 Same or Different Aims? 96.2 Medical History 96.3 Goals, Expectations, Incentives, and Fantasies! 96.3.1 Some Are too Bald, and Others Are too Young 96.4 Physical Examination 96.5 How to Build Correct and Accurate Expectations 96.6 How to Estimate Properly Recipient Area Requirements 96.7 Informed Consent 96.8 Preoperative Workup 96.9 Photography 96.10 After the Medical History and Physical Examination 96.11 Author’s Notes References 97: Overview of Anesthesia in Hair Restoration Surgery 97.1 Anesthesia in HRS Operations 97.2 Safety in HRS 97.3 Techniques of Regional Anesthesia 97.3.1 Field Blocks in HRS 97.3.2 Peripheral Nerve Blocks in HRS 97.3.3 Tumescent Anesthesia in HRS 97.3.3.1 Conscious Sedation 97.3.4 How to Reduce Pain from Injections 97.3.4.1 Local Analgesia 97.3.4.2 Ice Packs 97.3.4.3 Buffering the pH and Warming of the Anesthetic 97.3.4.4 Adjunctive Injection Techniques 97.4 Complications from Local Anesthetics 97.4.1 Adverse Reactions 97.4.2 Lidocaine in HRS 97.4.3 Bupivacaine in HRS 97.4.4 Local and Systemic Adverse Effects of Anesthetics 97.5 Epinephrine-Induced Complications 97.6 Other Techniques for the Management of Intraoperative Bleeding 97.7 Author’s Notes References 98: Overview of Safe Donor Area 98.1 How Safe Is Safe Enough? 98.2 The Size and Shape of the Safe Donor Area 98.3 Author’s Notes 98.4 SDA in FUE: What Is the Deal? 98.5 Evaluating of the Donor Area 98.6 Laxity = Glidability + Elasticity 98.7 How Much of the SDA Can Actually Be Moved During One FUSS Session? 98.8 How Much Surface of the SDA Can Actually Be Moved in a Lifetime? References 99: The Intricate Details of the Donor Area 99.1 The Density of the Donor Area 99.1.1 Follicular Density (FD) 99.1.2 Calculated Density (CD) 99.1.3 A Mathematical Approach to the Density Issue 99.1.4 Hair Density (HD) 99.2 Tools for the Measurement of Density and Other Parameters 99.3 Features of the Donor Area Hair 99.3.1 Hair Caliber 99.3.2 Hair Length 99.3.3 Hair Curl or Wave 99.3.4 The Color Contrast Between Hair and Scalp Skin 99.3.5 Hair Shine 99.4 How the Removal of the Strip Graft Affects the Density of the Donor Area 99.5 When One Hair Follicle Is Worth Two: The “Rule of 50%”! 99.6 How Is the Donor Bank Affected by Harvesting? 99.7 Author’s Notes References 100: Techniques of Dissection and Closure of the Donor Area 100.1 Harvesting Key Points 100.1.1 Positioning 100.1.2 Exposure 100.2 Anesthesia and Tumescence 100.2.1 Line of Incision 100.2.2 Depth of Scoring Incision and Relevant Tools 100.2.3 Type of Scalpel 100.2.4 Angle of Incision 100.2.5 Natural Dissection Plane 100.2.6 Hemostasis and Debris Cleaning 100.3 Donor Closure: Things Change 100.4 Suture or Staples? 100.4.1 Staples 100.4.2 Suturing 100.5 One or Two Layers? 100.6 Collateral Damages 100.7 Trichophytic Closure Technique 100.8 Author’s Notes 100.9 My Personal “Stepwise FUT Approach” 100.9.1 Natural Dissection Plane References 101: Donor Area Complications 101.1 Donor Area Complications 101.2 Cosmetic Complications 101.2.1 Wide/Visible Scarring (FUSS Only) 101.2.2 Too Deep Incisions 101.2.3 Too Wide Donor Strips 101.2.4 Too High Closing Tension Along the Suture Line 101.2.5 Poor Wound Edge Approximation 101.2.6 Too Deep and Wide Suturing 101.2.7 Loss of Hair Follicles Along the Incision Margins 101.2.8 Noncontour Incisions 101.2.9 Too Low Incision 101.2.10 Too High Incision 101.2.11 Not Removing the Previous Donor Scar 101.2.12 Idiosyncratic Reasons 101.2.13 Poor Patient Compliance 101.2.14 Keloid Scars and Hypertrophic Scars (FUSS and FUE) 101.2.15 Donor Area Effluvium 101.2.16 Donor-Area Complications Specific to FUE 101.3 Medical Complications 101.3.1 Bleeding and Hematoma 101.3.2 Wound Dehiscence 101.3.3 Wound Necrosis 101.3.4 Neuralgia, Anesthesia, Hypoesthesia, and Neuroma 101.3.5 Arteriovenous Fistula and Aneurism 101.3.6 Local Infection or Reaction 101.3.7 Folliculitis 101.3.8 Seborrheic Dermatitis Reaction 101.3.9 MRSA Scalp Infection References 102: The Surgical Zones of the Recipient Area 102.1 Definition of the Recipient Area 102.2 Definition of the Four Major Surgical Zones in HRS 102.2.1 Frontal Area 102.2.2 Midscalp 102.2.3 Vertex and Crown 102.2.4 Areas of Evolving AGA 102.2.5 Other Scalp Landmarks and Terms 102.3 The Surface Area of the Four Fundamental Surgical Zones in FUT References 103: Graft Survival Considerations and Strategies 103.1 Graft Survival: A Matter of Life and Death! 103.2 Factors Affecting Graft Yield 103.3 Factors Affecting Graft Survival 103.3.1 Graft Size 103.3.2 Dehydration or Desiccation: The No. 1 Killer of Grafts! 103.3.3 Storing Temperature 103.3.4 Physical Sharp Trauma (Follicular Transection) 103.3.5 Physical Blunt Trauma (Follicular Crushing) 103.3.6 Out-of-Body Time 103.3.7 Ischemia-Reperfusion Syndrome 103.3.8 Graft Popping 103.3.9 Too Deep Sites 103.3.10 Too Shallow Sites 103.3.11 Bending and Piggybacking 103.4 How to Maximize Graft Survival 103.5 What Else Can Cause Decreased Survival? 103.6 It All Boils Down to What? References 104: Recipient Area Injury and Relevant Parameters 104.1 Scalp Vascularization 104.2 How Does the Recipient Area Get Injured? 104.3 Tools for Site Creation 104.3.1 Microblades 104.3.2 Standard Needles 104.3.3 Micropunches 104.4 Are These Tools Truly Different? 104.5 Problems Due to Unsuitable Tools 104.6 Author’s Notes References 105: Overview of Graft Insertion Techniques 105.1 Basic Principles 105.2 Techniques of Graft Insertion 105.3 Stick-and-Place Technique (S&P) 105.4 Graft Insertion into Premade Incisions (GIPI) 105.5 Hair Implanters 105.5.1 Characteristics of Implanters 105.5.2 Implanter Technique 105.5.3 S&P Implanter Technique 105.5.4 Implanter GIPI Technique 105.6 Which Technique Is Superior? 105.7 Author’s Notes References 106: The Density and Coverage of the Recipient Area 106.1 Cosmetic Density 106.2 Density and Graft Survival 106.3 Dense Packing 106.4 Is Dense Packing Necessary in Modern FUE? 106.5 Author’s Notes References 107: Transplanting into Hair-Bearing Recipient Areas 107.1 Thinning and “Thickening” 107.2 When Can One Transplant Between Existing Hairs? 107.3 Shock Loss: Shocked Patient! 107.3.1 A Typical Story 107.4 Rescue Techniques for Pre-existing Hair in the Recipient Area 107.5 Author’s Notes References 108: Hairline Design and Grafting 108.1 What Makes the Hairline So Important? 108.2 What Are the Features of the Hairline? 108.3 Designing the Hairline 108.3.1 Height 108.3.2 Shape and Contour 108.3.3 Type of Grafts 108.3.4 Challenges with Single-Hair FUs 108.3.5 Angle and Direction 108.3.6 Curl 108.3.7 Microirregularities and Macroirregularities 108.3.8 Depth 108.3.9 Design of Lateral Margins 108.4 Temporal Hairline 108.5 Frontal Tuft 108.6 Pitfalls in Creating a Frontal Hairline 108.6.1 Too-Dense Hairline Border 108.6.2 Wrong Angle of Grafts 108.6.3 Wrong Type of Grafts 108.6.4 Too-Low Hairline 108.6.5 Too-High Hairline 108.6.6 Too-Round Hairline 108.6.7 Too-Flat Hairline 108.6.8 Too-Straight Hairline Border 108.6.9 Concave Contour Hairline 108.6.10 V-Shape Contour 108.7 Author’s Notes References 109: Midscalp Design and Grafting 109.1 Grafting Between Midscalp Hair 109.2 Graft Types in the Midscalp 109.3 Graft Angle in the Midscalp 109.4 Graft Distribution in the Midscalp 109.4.1 Frontal Forelock Design 109.4.2 Lateral Crease 109.4.3 Weighting Technique 109.5 Author’s Notes References 110: Crown and Vertex Design and Grafting 110.1 Anatomy of the Crown 110.2 Crown Area Unique Features 110.2.1 Anatomical Reasons 110.2.2 Cosmetic Reasons 110.2.3 Lack of Specific Guidelines for Crown Restoration 110.3 When Is it Safe to Transplant the Crown? 110.3.1 What about Hair Growth Medications? 110.4 Technical Issues when Transplanting the Crown 110.5 Author’s Notes References 111: Megasessions: Is More, Better? 111.1 What Constitutes a Megasession? 111.2 Advantages of Megasessions 111.2.1 Social and Practical Reasons 111.2.2 Medical Reasons 111.2.3 Donor Area Reasons 111.2.4 Recipient Area Reasons 111.2.5 Graft Distribution Reasons 111.2.6 Telogen Effluvium 111.2.7 Financial Reasons 111.2.8 Long-Term Convenience 111.3 Drawbacks 111.3.1 Social Reasons 111.3.2 Medical Reasons 111.3.3 Donor Area Reasons 111.3.4 Recipient Area Reasons 111.3.5 Practical Reasons Concerning FUSS in Particular 111.3.6 Telogen Effluvium 111.3.7 Financial Reasons 111.3.8 Post-op Care 111.3.9 Reasons Concerning the Surgical Team 111.3.10 Short-Term Inconvenience 111.4 FUE Megasessions: A Very Different Animal 111.5 Some Further Thoughts on the Matter References 112: Second Session and Subsequent Sessions 112.1 Adding Density 112.2 Candidates for a Second Session 112.3 When Is the Time Right? 112.4 Controversy on Additional Sessions 112.5 Author’s Notes References 113: The Combo Technique: Joined Forces 113.1 Principles of HRS Revisited 113.2 Why Isn’t a Single Technique Enough for Everybody? 113.3 Historical Background of TCT 113.4 Rationale for TCT 113.5 Indications for TCT 113.5.1 Medical Reasons 113.5.2 Social Reasons 113.6 Operative Considerations 113.6.1 Virgin Scalp Indications for TCT 113.6.2 Nonvirgin Scalp Indications for TCT (Besides the Ones Mentioned Above) 113.7 Categories of TCT 113.8 Virgin Scalp Indications for TCT 113.8.1 Operative Considerations 113.9 Nonvirgin Scalp Indications for TCT (Besides the Ones Mentioned Above) 113.9.1 Operative Considerations References 114: Postoperative Care and Follow-Up 114.1 Immediate Postoperative Care 114.1.1 Wound Moisture 114.1.2 Pain Management 114.1.3 Edema 114.1.4 Bleeding 114.1.5 Graft Dislodgement 114.1.6 Itching 114.1.7 Shampooing and Hygiene 114.1.8 Removal of Sutures/Staples 114.1.9 Return to Work/Activities/Sports 114.1.10 FUSS 114.1.11 FUE 114.1.12 Sun Exposure 114.2 Late Postoperative Care 114.2.1 Folliculitis–Cysts 114.2.2 Scabs and Crusting 114.2.3 Hypoesthesia 114.2.4 Central Scalp Necrosis 114.2.5 Postoperative Effluvium (Shock-Loss) 114.2.5.1 Shedding of Transplanted Hair Follicles Delayed Growth of Transplanted Hair Follicles 114.2.5.2 Shedding of Pre-existing Hair in the Recipient Area 114.2.5.3 Shedding of Pre-existing Hair in the Donor Area 114.3 Author’s Notes References 115: Hair Restoration Surgery in Female Patients 115.1 Disclaimer 115.2 HRS in Women vs. Men 115.3 Differential Diagnosis of Female Hair Loss 115.4 Candidacy for HRS 115.5 Differences of HRS in Women vs. Men 115.5.1 Anatomical Differences 115.5.1.1 Hairline Design 115.5.1.2 Hairline Preservation 115.5.1.3 Resident Hair in the Recipient Area 115.5.1.4 The Density of the Female Donor Area 115.5.1.5 Smaller Donor Area 115.5.1.6 Body Hair FUE 115.5.2 Technical Differences 115.5.2.1 Donor Area 115.5.2.2 Recipient Area 115.5.2.3 Better Coverage 115.5.2.4 Delayed Growth 115.5.2.5 Telogen Effluvium 115.5.2.6 Edema 115.5.2.7 Paresthesia 115.5.2.8 Other Exceptional Circumstances in Women 115.6 Indications for HRS in Women 115.6.1 General Surgical Design 115.6.2 Typical FPHL 115.6.3 Too High Hairline 115.6.4 Wide Forehead 115.6.5 Scars from Previous Cosmetic Surgery 115.6.6 Scarring-Traumatic Alopecias 115.6.7 Contraindications for Female HRS 115.7 Author’s Notes References 116: Medical Treatments and HRS 116.1 Minoxidil in Hair Restoration Surgery 116.2 Finasteride in Hair Restoration Surgery 116.3 The Strategy for the Use of Medical Treatment in HRS 116.4 Treatment “Background” of Patients Before HRS 116.5 When to Prescribe Treatment Instead of HRS? 116.6 Effect of Medical Treatment on HRS Planning 116.7 Medical Treatment and Malpractice 116.8 Author’s Notes References 117: Corrective and Repair HRS 117.1 Difference Between HRS vs. Repair HRS 117.2 Profile of the Repair HRS Patient 117.3 Problems Requiring Corrective HRS 117.3.1 Recipient Area 117.3.2 Donor Area 117.4 Repair Techniques Overview 117.5 Repair HRS in the FUE Era 117.6 Author’s Notes References 118: Scalp Micropigmentation 118.1 Tattooing and Medicine: A Colorful Story! 118.2 Histology of Tattooing 118.3 Scalp Tattooing 118.4 Scalp Micropigmentation (SMP) 118.5 SMP Technical Details 118.6 Semipermanent or Temporary SMP 118.7 Indications of SMP 118.8 Density SMP 118.9 Scar Camouflage SMP 118.10 Shaved-Look SMP 118.11 Adverse Effects of SMP 118.12 SMP vs. Tattooing 118.13 Tattoo Removal vs. SMP Removal References 119: Synthetic Hair Fiber Implantation: Fishing Lines on the Head 119.1 How It All Started 119.2 What Were the Problems? 119.2.1 Implantation Techniques 119.2.2 Histopathology of Artificial Hair Fibers [6, 21, 22] 119.3 Complications 119.3.1 Early Complications (Occurrence up to 4 Weeks) [24–30] 119.3.2 Late Complications (Occurrence After 4 Weeks) [24–30] 119.3.2.1 Local 119.3.2.2 Systemic 119.4 Management of Complications [34, 35] 119.5 Modern Synthetic Hair Fibers: History Repeating 119.5.1 Japanese Fibers 119.5.2 Italian Artificial Hairs 119.6 Publications on New Synthetic Hair Fibers 119.6.1 Concerning Peer-Reviewed Publications 119.7 Technical Details of Implantation of Newer Synthetic Fibers 119.8 Histopathology 119.9 So What Is the Truth? 119.10 FDA’s Rejection of Revoking the Ban on Prosthetic Hair Fibers 119.11 Why Some Doctors Choose Synthetic Fibers? 119.12 Why Some Patients Choose Synthetic Fibers? 119.13 Author’s Notes References 120: Future Trends in HRS 120.1 Hair Follicle Bisection 120.2 Robots and HRS 120.3 Platelet-Rich Plasma Growth Factors (PRP) 120.4 ACell MatriStemTM 120.4.1 FUSS Donor Harvesting 120.4.2 FUE Harvesting 120.4.3 Body Hair Transplant Harvesting 120.4.4 Graft Coating 120.4.5 Plucked Hair Transplantation 120.4.6 Use in AGA Treatment 120.4.7 Repair of Old Strip/FUSS Scars 120.5 Hair Follicle “Autocloning” 120.6 Holding and Graft Storage Solutions References Part IX: Alternative and Potential Future Treatments of AGA/FPHL 121: Low-Level Laser Therapy (LLLT) and AGA 121.1 Why Use a LASER? 121.2 LASERs in General 121.2.1 High Level Vs. Low-Level Lasers 121.2.2 Collimated and Coherent (LASER) Vs. Noncoherent Light (LED) 121.3 General Principles of LLLs Action 121.4 Applications of LLLT 121.5 LLLT Mechanism of Action 121.5.1 Subcellular Actions of LLLT 121.5.2 Cellular Actions of LLLT 121.5.3 The Arndt–Schultz Law or Biphasic Dose–Response of LLLT 121.6 Mechanism of Action of LLLT on Hair Follicles and How It All Started 121.6.1 Theories on the Mechanism of LLLT on Hair Growth 121.7 LLLT and Early Hair Growth Reports 121.8 LLLT and Alopecias 121.9 LLLT and Treatment of AGA/FPHL 121.9.1 LLLT Studies After FDA Clearance 121.10 Systematic Reviews and Meta-analyses on LLLT and Hair Growth 121.11 LLLT Safety and Related Adverse Effects 121.12 LLLT Devices and the FDA: An Inconvenient Truth 121.12.1 What Is the FDA 510(k)-Clearance Process? 121.13 LLLT Protocol of Use 121.14 Patient Selection 121.15 LLLT in the Future 121.16 Author’s Notes References 122: Genetic Engineering and Gene Therapy 122.1 What Is Genetic Engineering? 122.2 Why the Hair Follicle? 122.3 Technical Issues 122.4 Stages of Genetic Engineering One by One 122.4.1 Steps a and b: Gene Identification and Isolation 122.4.2 Step c: Targeting the Organ’s Stem Cells 122.4.3 Step d: Transfer and Proliferation 122.4.4 Step e1: Delivery of Genes to the Cell 122.4.4.1 Devices for Transdermal Absorption 122.4.5 Step e2: Delivery of Genes to the Nucleus 122.4.6 Step f: Integration of Genes into the DNA 122.4.7 Step g: Predictable Result 122.4.8 Step h: Prolonged Action 122.4.9 Step i: Short- and Long-Term Safety 122.5 Which Challenges Remain Ahead? 122.6 What Is the Conclusion? References 123: Stem Cells and Hair Follicle Cloning/Engineering 123.1 What Are Stem Cells? 123.2 How Could We Use Stem Cells in Hair Follicle Disorders? 123.3 A Legal Framework 123.4 Basic Embryology and Anatomy of Hair Follicles 123.5 Levels of Complexity 123.6 Tiny But Mighty 123.7 What Kind of Hair Follicles Do We Need to Create? 123.8 Growth Factors and Stem Cells 123.9 Mesenchymal Stem Cell Therapy and Adipose Tissue-Derived Stem Cells 123.10 Hair Growth-Promoting Effects of ADSCs 123.11 Latest Research on Humans 123.12 Neogenesis of Hair Follicles by Tissue Engineering 123.13 Folliculo-Neogenesis in Humans 123.14 Issues Remaining to be Solved 123.15 Where Can We Go from Here? 123.16 Role of Bulge Stem Cells in Tumorigenesis [1, 2] 123.17 Where Are We Standing Now? 123.18 But, Is Folliculo-Neogenesis the Answer? 123.19 Reminding Some Basic Knowledge on Hair Loss 123.20 So Why Are We Aiming for Stem Cell “Therapies?” 123.20.1 Concept of De Novo Folliculo-Neogenesis 123.20.2 Concept of Follicular Cell Implantation to Vellus Hair Follicles 123.21 Legal Framework and Caution in Stem Cell Therapies 123.22 Conclusion References 124: Platelet-Rich Plasma (PRP) 124.1 Platelet-Rich Plasma (PRP): What Is It? 124.2 General Applications of PRP 124.3 PRP and Regulatory Issues 124.4 PRP’s Mechanism of Action 124.5 More PRP Is Not Better PRP 124.6 PRP and the Hair Follicle 124.7 PRP and AGA/FPHL 124.8 PRP and ΑGΑ/FPHL Meta-analyses 124.9 PRP Contraindications and Safety in ΑGΑ/FPHL 124.10 Contraindications for PRP [130] 124.11 Are All PRPs Created Equal? 124.12 PRP Unanswered Questions on ΑGΑ/ FPHL 124.13 Things to Consider About PRP in the Treatment of ΑGΑ/FPHL 124.14 Conclusion References 125: Microneedling 125.1 General Mechanism of Action 125.2 Proposed Mechanisms of Action on Hair Follicles 125.3 Microneedling Procedure for Alopecia 125.4 Microneedling and AGA/FPHL 125.5 Adverse Effects 125.6 Regulatory Issues 125.7 Author’s Notes References 126: Exosomes 126.1 What Are the Exosomes? 126.2 How Exosomes Work 126.3 How Are Exosomes Produced and Purified 126.4 Exosomes and Stem Cells 126.5 Exosomes, Skin Functions, and Alopecias 126.6 Exosomes and Hair Growth 126.7 In Vitro Studies 126.8 Animal Studies 126.9 Human Studies 126.10 Legal Framework and Caution in Exosome Therapy 126.11 Challenges of Exosomes in Hair Growth Therapy 126.12 Exosome Unanswered Questions on ΑGΑ/FPHL References Part X: Coverage and Hair Care 127: Concealing of Hair Loss and Cover-Up Products 127.1 How Do These Concealers Work? 127.2 Hair Powders 127.3 Fluids and Pastes 127.4 Spray-On Products 127.5 Microfiber Products 127.6 Hair Crayons or Sticks 127.7 Benefits of Hair Loss Concealers 127.8 When More Is Too Much 127.9 Concealers and Daily Routine References 128: Wigs and Hair Prosthesis 128.1 Some History 128.2 Wigs in Dermatology 128.3 Wigs Today 128.4 Modern Trends on Wigs and ΑGΑ 128.5 Impression Management 128.6 The Fear of Exposure 128.7 A Key Distinction 128.8 Classification of Wigs 128.8.1 Types of Wigs According to Size 128.8.2 Types of Wigs According to Hair Fiber Type 128.8.2.1 Synthetic Fibers 128.8.2.2 Natural Fibers/Human Hair 128.8.3 Types of Wigs According to the Base Material 128.8.4 Types of Wigs Based on the Insertion of Fibers 128.8.5 Attachment/Fixation Methods 128.8.5.1 Fixed Adhesion 128.8.5.2 Temporary Adhesion 128.9 Wig Care and Replacement 128.10 Scalp Hygiene 128.11 Inconvenient Truths About Wigs in AGA 128.12 Cost 128.12.1 Unnatural Appearance 128.12.2 Progression of AGA 128.12.3 Feeling Trapped 128.12.4 Discomfort–Stress–Embarrassment 128.13 “Tricks of the Trade” 128.14 Conclusion References 129: Shampoos and AGA/FPHL 129.1 Key Issues 129.2 Needs and Requirements of ΑGΑ/FPHL Patients from Shampoos 129.3 Conclusions and Instructions 129.4 Instructions for Proper Hair Washing 129.5 Extra Tips References Index