DOI: 10.1097/dss.0000000000003881 ISSN: 1076-0512

Follicular Unit Excision in Patients of African Descent: A Skin-Responsive Technique

Sanusi Umar, Raveena Khanna, Boudin Lohlun, Juan Carlos Maldonado, Maria Zollinger, Achiamah Osei-Tutu, Alejandro Gonzales, Kavish Chouhan, Aron Nusbaum
  • Dermatology
  • General Medicine
  • Surgery


Follicular unit excision is a favored minimally invasive hair transplantation method. However, it is suboptimal for many patients of African descent because of wide variations in hair and skin characteristics.


To evaluate the performance of a skin-responsive follicular unit excision device, which accommodates hair curliness, skin thickness, and firmness in patients of African descent.


The authors retrospectively evaluated patients who underwent scalp follicular unit (FU) excision using a skin-responsive technique at 7 multinational clinics. The preoperative donor grading for the anticipated difficulty used a scale with Class V indicating the highest degree of hair curliness, skin thickness, and firmness.


Of 64 eligible patients (45 males and 19 females), 28 had Class V FU excision donor grades. The mean transection rate for all patients was 3%–6%, which was highest in class V patients. Skin thickness and firmness had a greater effect on the maximum transection rate than hair curliness. Only 19 or 18 G punches were used.


The authors report consistence success of a new skin-responsive FU excision device for all patients of African descent with a mean graft transection rate of less than 10%. The findings support skin thickness and firmness as major influencers of graft attrition rate.

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