10.Research and future techniques
未来技术的期望

Stem cells and dermal papilla cells have been discovered in hair follicles. Research on these follicular cells may lead to successes in treating baldness through hair multiplication (HM), also known as hair cloning. HM is being developed by ARI (Aderans Research Institute, a Japanese owned company in the USA).[citation needed]
人们已经发现在毛囊中有干细胞和真皮乳头细胞。现在已经有人正在研究通过将这些毛囊自身扩充数量（或者叫毛囊克隆），然后移植到人的头上，这是有可能会成功的。一个叫ARI机构（Aderans研究机构，是一个日本人在美国开的公司）正在研究这一课题。

9.History
FUE历程

The use of both scalp flaps, in which a band of tissue with its original blood supply isshifted to the continue bald area, and free grafts dates back to the 19th century. Modern transplant techniques began in Japan in the 1930s,[6] where surgeons used small grafts, and even "follicular unit grafts" to replace damaged areas of eyebrows or lashes, but not to treat baldness. Their efforts did not receive worldwide attention at the time, and the traumas of World War II kept their advances isolated for another two decades.
早在19世纪，人们就知道运用头皮瓣这种组织将血液供到秃了的部位。现代的毛发移植手术起源于20世纪30年代的日本，当时的人们主要是用于治疗眉毛或是睫毛的损伤，而并不是针对脱发。这在当时一直没引起人们注意，在之后的20年一直处于领先的地位。

The modern era of hair transplantation in the western world was ushered in the late 1950s, when New York dermatologist Norman Orentreich began to experiment with free donor grafts to balding areas in patients with male pattern baldness. Previously it had been thought that transplanted hair would thrive no more than the original hair at the "recipient" site. Dr. Orentreich demonstrated that such grafts were "donor dominant," as the new hairs grew and lasted just as they would have at their original home.[citation needed]
直到在20世纪50年代后期，西方才开始了现代的植发手术。当时，纽约的皮肤科医生Norman Orentreich开始免费为脱发的男性患者植发。以前，人们一直认为植完的头发达不到脱发之前的效果。然而，Orentreich博士告诉大家，这种从自身上移植的头发不会有排斥效应，效果会很好。

Advancing the theory of donor dominance, Walter P. Unger, M.D. defined the parameters of the "Safe Donor Zone" from which the most permanent hair follicles could be extracted for hair transplantation.[7] As transplanted hair will only grow in its new site for as long as it would have in its original one, these parameters continue to serve as the fundamental foundation for hair follicle harvesting, whether by strip method or FUE.
随着这方面的理论不断推进，Walter P. Unger M.D.认为移取的毛囊应该是那些永久都不会脱发的毛囊。因为被移植的毛囊还是要保持永久性的生长，这样才能从根本上保证你的植发（通过条状头皮移植手术或是FUE手术）成功。

For the next twenty years, surgeons worked on transplanting smaller grafts, but results were only minimally successful, with 2–4 mm "plugs" leading to a doll's head-like appearance. In the 1980s, strip excisions began to replace the plug technique, and Carlos Uebel in Brazil popularized using large numbers of small grafts, while in the United States Dr. William Rassman began using thousands of “micrografts” in a single session.[8]
在接下来的20年里，医生们尝试着移植较少的毛囊，但是几乎都没成功。在20世纪80年代，条状头皮移植手术开始流行起来。对于一个疗程，巴西的Carlos Uebel每次移植很少量毛囊，然后移植多次；与此同时，美国的William Rassman博士每次移植更少的毛囊，移植次数也就更多了。

In the late 1980s, Dr. B.L. Limmer introduced the use of the stereo-microscope to dissect a single donor strip into small micrografts.
在20世纪80年代后期，B.L. Limmer博士开始将立体显微镜解剖毛囊技术引入到临床研究中。

The follicular unit hair transplant procedure has continued to evolve, becoming more refined and minimally invasive as the size of the graft incisions have become smaller. These smaller and less invasive incisions enable surgeons to place a larger number of follicular unit grafts into a given area. With the new "gold standard" of ultra refined follicular unit hair transplantation, over 50 grafts can be placed per square centimeter, when appropriate for the patient.[9]
以毛囊为单位的移植手术得到持续的发展，技术已经发展到更精细和微创的手术切口。由于这是些更小和更少侵入型切口，这样医生就能在一个头皮区域放置更多的毛囊了。并随着更精细的头发移植“金标准”技术的发展，有些病人的头皮上1平方厘米能移植超过50个的毛囊。

Surgeons have also devoted more attention to the angle and orientation of the transplanted grafts. The adoption of the “lateral slit” technique in the early 2000s, enabled hair transplant surgeons to orient 2 to 4 hair follicular unit grafts so that they splay out across the scalp's surface. This enabled the transplanted hair to lie better on the scalp and provide better coverage to the bald areas. One disadvantage however, is that lateral incisions also tend to disrupt the scalp's vascularity more than sagittals. Thus sagittal incisions transect less hairs and blood vessels assuming the cutting instruments are of the same size. One of the big advantages of sagittals is that they do a much better job of sliding in and around existing hairs to avoid follicle transection. This certainly makes a strong case for physicians who do not require shaving of the recipient area. The lateral incisions bisect existing hairs perpendicular (horizontal) like a T while sagittal incisions run parallel (vertical) alongside and in between existing hairs. The use of perpendicular (lateral/coronal) slits versus parallel (sagittal) slits, however, has been heavily debated in patient-based hair transplant communities. Many elite hair transplant surgeons typically adopt a combination of both methods based on what is best for the individual patient.
医生门也开始关注毛囊的生长方向。在21世纪早期，随着“边缝”技术的引用，医生可以将2到4单位的毛囊移植到头皮表面上。这样确保了头发能够在头皮上更好地生长，同时也能更好地改变秃头形象。然而，这种技术有一个缺点，就是侧边切口会破坏头皮的血管。因而，切口位置的头发较少，并且切断的血管跟切口尺寸差不多。这种方式的移植头发有一个很大的好处是，会避免你现有头发的滑动。这必然会造成医生不需要给你需要植发的头皮区域理发。外侧切口的方向和你现有的头发垂直，像一个T字；而矢状的切口和现有的头发是垂直的关系。然而，切口方向是垂直方向还是平行的方向，一直不能确定。一些高明的医生会根据病人的情况考虑两种方法的组合。

8.Side effects
副作用

Hair thinning, known as "shock loss", is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day. Post-operative hiccups have also been seen in around 5% of transplant patients.
头发变得稀薄，这是一种常见的临时性副反应。另外，斑秃也是常见一种，这种病人一般每天掉50到100跟头发。大约有5%的人手术之后会出现喜欢打嗝的现象。

Other side effects include swelling of areas such as the scalp and forehead. If this becomes uncomfortable, medication may ease the swelling. Additionally, the patient must be careful if their scalp starts itching, as scratching will make it worse and cause scabs to form. A moisturizer or massage shampoo may be used in order to relieve the itching.
其他的副作用包括头皮和前额的肿胀。如果肿胀得厉害，可以吃一些药缓解。还有，如果头皮开始瘙痒。一定要非常当心。因为抓破了痂，后果就变得非常麻烦了。可以用润肤霜或是清洗头皮，可以减轻瘙痒程度。

7.Post-operative care
手术后的护理

Advances in wound care allow for semi-permeable dressing, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have the patient shampoo the day after surgery. Shampooing is important to prevent scabs from forming around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.
手术后，一般选用半渗透型的敷料，这种敷料能够让血液和组织液透过，这样有利于伤口的恢复。手术后的两天之内，伤口处一定不能晒太阳，也不能用水清洗。手术结束后，有些医生会帮助患者马上进行清洗。清洗对之后的伤口结痂是有好处的。结的痂会粘在移植的头发上，这样增加了术后7到10天之内掉发的危险。

During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out. This is referred to as "shock loss". After two to three months new hair will begin to grow from the moved follicles. The patient's hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.
在第一个10天内，那些移植的头发都会掉的。2到3个月之后，这些掉的头发会重新长出来。以后就正常地生长，一直到接下来6到9个月之后，头发就会很浓密了。如果以后还有掉头发的现象，一定不是移植的头发。之后真的脱发了，有些人会选择一些药物来治疗，而有些人这继续选择植发手术。

6.Types of surgery[edit]
毛发移植手术分类

There are a number of applications for Hair Transplant Surgery, including:
•        Androgenetic Alopecia
•        Eyebrow Transplant
•        Frontal Hair Line Lowering or Reconstruction (naturally high hairlines without an existing hair loss condition)
目前，毛发移植手术已经在很多方面有了运用，主要包括以下几类：
        用于雄性脱发的毛发移植
        眉毛的毛发移植
        降低或是重塑发际线的毛发移植（针对那种天生有高的发际线的人，他们不属于脱发的类型）

If donor hair numbers from the back of the head are insufficient, it is possible to perform Body Hair Transplantation (BHT) on appropriate candidates who have available donor hair on the chest, back, shoulders, torso and/or legs. Body Hair Transplant Surgery can only be performed by the FUE harvesting method and, so, requires the skills of an experienced FUE Surgeon. However, there are several factors for a potential BHT candidate to consider prior to surgery. These include understanding the natural difference in textural characteristics between body hair and scalp hair, growth rates, and having realistic expectations about the results of BHT surgery.
如果一个人后脑勺的毛囊不够，其实将他的体毛进行移植到头上也是有可能，比如：胸毛、后背的毛、肩膀的毛、腿毛等等。而体毛移植手术只能采取FUE这种方式，手术的难度要困难一些，所以要找一个经验丰富的医生做手术。但是，手术之前，还是得考虑这些毛囊适不适合移植到头上。一般来说，毛发的质构特征、生长速度和自然程度都要和头发比较匹配。

5.Follicular unit extraction (FUE)
抽取毛囊技术（无痕植发）

With Follicular Unit Extraction or FUE harvesting, individual follicular units containing 1 to 4 hairs are removed under local anesthesia; this micro removal typically uses tiny punches of between 0.6mm and 1.0mm in diameter. The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place.
在麻醉的情况下，我们可以通过FUE技术将一个个的毛囊（每个毛囊可长出1到4根头发）移出。通常是用一个微型的冲压机（直径为0.6mm到1.0mm）进行操作。然后，医生用很小的刀片或是细针将需要植发的地方刺成“孔”，他是将按照一定的密度和设计的发型“打孔”的，等伤口好之后，看起来像自然的头发一样。最后，医生将一个个的毛囊插入“孔”中。

FUE takes place in a single long session or multiple small sessions. The FUE procedure is more time consuming than strip surgery. An FUE surgery time varies according to the surgeons experience, speed in harvesting and patient characteristics. The procedue can take anywhere from a couple hours to extract 200 grafts for a scar correction to a surgery over two consecutive days for a megasession of 2,500 to 3,000 grafts.[1] With the FUE Hair Transplant procedure there are restrictions on patient candidacy.[2] Clients are selected for FUE based on a fox test,[3] though there is some debate about the usefulness of this in screening clients for FUE.
FUE一般是由一个长的疗程或是多个短疗程组成。FUE治疗时间比移植条状头皮手术的时间要长很多。FUE的时间由多方面的因素决定的，比如：医生的经验、患者自身的情况等。一般来说，要修复一个伤疤，需要200个单位的毛囊，这要花费好几个小时；如果要进行2500到3000单位的毛囊移植，则至少得连续2天才行。什么样的病人适合FUE手术也是有限制要求的。患者在进行FUE手术之前，是有一个灵活的测试的，但有些人说这些测试根本没什么用。

FUE can give very natural results. The advantage over strip harvesting is that FUE harvesting negates the need for large areas of scalp tissue to be harvested, so there is no linear incision on the back of the head and it doesn't leave a linear scar. Because individual follicles are removed, only small, punctate scars remain which are virtually not visible and any post-surgical pain and discomfort is minimized. As no suture removal is required, recovery from Micro Grafting FUE is less than 7 days.
FUE这种手术效果非常好的一点是，它看起来很自然。FUE这种手术较移植头皮手术另一个优势在于：它不需要大面积的移植头皮，所以在头皮上也没有什么直线的切口，也就不会在头皮上造成伤疤。因为毛囊从头皮取出之后，毛孔的伤疤太小，你根本就看不见，而且术后你的疼痛感和不适感也减到最小的程度。再就是FUE这种技术不需要什么伤口缝合之类的操作，所以恢复起来很快，一般7天之内就好了。

Disadvantages include increased surgical times and higher cost to the patient.[4] Some surgeons note that FUE can lead to a lower ratio of successfully transplanted follicles as compared to strip harvesting. Others also suggest that in case a patient would need more than one transplant, it would be difficult to find a good strip after an FUE.[citation needed]
但是，它的缺点在于：手术的时间增加了，还有花费也昂贵一些。有一些医生提到，跟头皮移植手术相比，FUE手术的失败率也要大一些。还有一些人认为，如果你手术失败，你再改为条状头皮移植手术，那接下来的手术将很难，因为你头皮上的毛囊由于FUE手术而变得不完整了。

Robotic Hair Restoration is another innovative device in the field of hair restoration. The robot allows detection of the follicular units and its topography with several cameras. The images from the cameras can detect the location, distribution, and the angulation of the follicular grafts. The robotic arm has been able to increase the speed of graft extraction and minimize the exhaustion of the surgeon during an FUE transplant. Despite the advantages of robotic hair restoration systems, there are still some disadvantages such as the size of the punches being relatively large in comparison to what is used in other methods of FUE and the high price of the device . [5]
机器毛发修复手术是该领域运用机器设备的又一创新。机器设备将会检查头上的毛囊，然后拍一些照片。它然后根据照片分析毛囊的情况，如：毛囊位置、分布、毛囊生长角度等。在进行FUE手术的时候，机器手会加快手术进程，而且将手术损伤减到最小。尽管使用机器确实带来了一些便利，但是它的运用还是有一些缺点要克服，比如：和人工FUE手术相比，机器设备刺的“孔”要大一些；费用也相对要高很多。

4.Strip harvesting
条带获取(有痕手术)

Strip harvesting is the most common technique for removing hair and follicles from a donor site. The surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. A single-, double-, or triple-bladed scalpel is used to remove strips of hair-bearing tissue from the donor site. Each incision is planned so that intact hair follicles are removed. The excised strip is about 1–1.5 x 15–30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts, which are small, naturally formed groupings of hair follicles, from the strip. Working with binocular Stereo-microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting. The latest method of closure is called 'Trichophytic closure' which results in much finer scars at the donor area.
条带收获是最常见的技术，用于从供体获得头发和毛囊。外科医生从在头发生长良好的后头皮上收获一条皮肤。用单，双，或三刃刀来去除供体的发带组织。每一个切口都是规划过的，使完整的毛囊被清除。切除带约1–1.5 x 15–30 厘米大。当手术结束后，助手开始分解从发带自然分组形成的小的单个毛囊移植单位。他们在双目立体显微镜上工作，仔细地除去多余的纤维和脂肪组织并且避免损伤需要移植的毛发。最新的封闭手术称为发藓菌封闭，能使得供体区域的疤痕更好的闭合。

The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place.
Strip harvesting will leave a "pencil thin" linear scar in the donor area, which is typically covered by a patient's hair even at relatively short lengths. The recovery period is around 2 weeks and will require the stitches/staples to be removed by medical personnel or sub cuticular suturing can be done.
医生根基一个预定的密度和形状用很小的微型叶片或细针穿刺接受移植部位，和钓鱼的伤口以一致的方式来推动现实的发型。用同一种方式来角化伤口使得达到理想的发型。技术人员一般做最后一部分的工作，插入单独的毛囊到受体。条带的获取将在供体区域留下铅笔一样大小的伤疤，这些伤疤能被患者很短的头发覆盖。恢复期大概两周左右，可以要求医护人员将针/钉移除，并且进行表皮缝合手术。

Procedure
移植过程

2.Pre-operative assessment and planning
手术前评估与规划

At an initial consultation, the surgeon analyzes the patient's scalp, discusses their preferences and expectations, and advises them on the best approach (e.g. single vs. multiple sessions) and what results might reasonably be expected. Pre-operative folliscopy will help to know the actual existing density of hair, so that postoperative results of newly transplanted hair grafts can be accurately assessed. Some patients may benefit with preoperative topical minoxidil application and vitamins.
在最初的咨询中，外科医生会分析病人的头皮，讨论他们的喜好和期望，并用最佳的方法建议他们（例如：单对多会话）并且告诉他们可能会出现什么样的结果。术前毛囊镜将有助于了解头发实际的密度，使新移植的头发移植术后结果可以得到准确评估。一些或者在术前使用维生素和米诺地尔将为植发效果带来好处。

For several days prior to surgery the patient refrains from using any medicines which might result in intraoperative bleeding and resultant poor "take" of the grafts. Alcohol and smoking can contribute to poor graft survival. Post operative antibiotics are commonly prescribed to prevent wound or graft infections.
手术前几天患者要避免使用任何会可能导致手术出血并且导致提取的毛囊数量变少的药物。酒精和吸烟可以降低移植毛发的存活率。术后需要使用抗生素预防伤口感染 。