• Hair Workshop 360, Volume 4 Part 2, Chapter 35

    Chapter 35 Abstract:

    Follicular unit excision (FUE) hair transplantation has experiences inconsistent growth and survival of follicular grafts. To maintain maximal follicular-graft survival, the choice of the appropriate graft-storage media, additives, and storage conditions is an important decision for surgeons. Unlike organ preservation, follicular-graft preservation has been poorly investigated, and there is no specific graft-holding solution for hair restoration surgery. Here, we examine the most widely used graft-holding solutions and how the composition of the graft-holding solution and conditions of storage may impact graft survival.

    • William D Ehringer, Kristyn H Smith
    • (Editors: Samuel M Lam, Kenneth L Williams Jr)

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  • Practical Aspects of Hair Transplantation in Asians, Chapter 10

    Chapter 10 Abstract:

    Hair restoration surgery (HRS) has made great progress in regards to outcome and proper hairline design. The result is that the majority of HRS cases are considered “successful,” and this is reflected in the ever-increasing numbers of patients seeking HRS. However, issues with inconsistent growth and survival of follicular grafts have continued to plague surgeons. It is the inconsistency in patient outcomes that has focused attention on how to maintain maximal follicular graft survival. Follicular grafts are exposed to physical and biochemical trauma from the point of isolation to implantation. To address these issues, improved graft storage solutions and methods in which the grafts are isolated have been developed. Unlike organ preservation, follicular graft preservation has been poorly investigated, and there is no specific graft holding solution for HRS. In the majority of HRS, graft holding solutions are being used that are not intended for survival of follicular grafts. Further, the use of additives in the HRS process has not been sufficiently studied to understand how they may affect outcome. The purpose of this chapter is to explore the practical clinical limitations and benefits of current graft holding solutions and additives used in HRS.

    • William D Ehringer, Kristyn H Smith
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  • Impact of Preservation Solutions on the Trichogenicity of Hair Micrografts Ascertained by Dermal Papilla Gene Expression

    BACKGROUND Appropriate storage of human hair follicle (HF) grafts during follicular unit excision (FUE) is crucial toward successful hair shaft implantation. Several commercial storage solutions are currently used to ensure ex vivo maintenance of follicular grafts viability and trichogenicity. However, quantitative experimental evidence demonstrating molecular changes in HF cells associated with the usage of different storage solutions is largely missing.

    OBJECTIVE To identify gene expression changes in HF cells caused by ex vivo storage of hair grafts in different preservation conditions.

    METHODS The authors performed gene expression analysis in dermal papilla (DP) isolated from HF stored under different temperatures and solutions. The expression signature of key genes controlling hair growth and cycling, apoptosis, inflammation, and senescence was assessed for (1) chilled versus room temperature (RT) and (2) DP cell medium, saline, Hypothermosol, platelet-rich plasma, and ATPv-supplemented saline. RESULTS The authors found chilled versus RT to prevent inflammatory cytokine signaling. Under chilled conditions, ATPv-supplemented saline was the best condition to preserve the expression of the trichogenic genes HEY1 and LEF1. CONCLUSION Data disclose DP gene expression analysis as a useful methodology to ascertain the efficacy of preserving solutions and elucidate about the best currently available option for FUE clinical practice.

    Castro AR, Portinha C, Logarinho E. Impact of Preservation Solutions on the Trichogenicity of Hair Micrografts Ascertained by Dermal Papilla Gene Expression. Dermatol Surg. 2019 Dec;45(12):1649-1659. doi: 10.1097/DSS.0000000000001895. PMID: 30865019.

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  • Bio-Enhanced Hair Restoration


    "I would like to share my clinical observations and opinions about bio-enhanced hair restoration. I define “bio-enhanced hair restoration” as the utilization of biologic-based products and techniques in the medical and surgical treatment of hair loss. These include growth factors, extracellular matrix products, platelet rich plasma (PRP), tissue holding solutions, adenosine triphosphate (ATP), and other naturally occurring substances (Figure 1). Usually, these have been developed for other fields, such as wound healing and regenerative medicine."

    Cooley, J. Bio-Enhanced Hair Restoration. Hair Transplant Forum International Jul 2014, 24 (4) 121-130; DOI: 10.33589/24.4.0121

    Link to ISHRS Forum Article 
  • The Effect of ATPv Solution on Graft Survival and Growth Rate in Hair Transplantation: The DHT Clinic Experience

    Dell Kristie O. Castillejos, Damkerng Pathomvanich, Chontirot Srikasedsarakul, Tyng Tan, Patcharee Thienthaworn, Natenapa Lu and Pattharin Rungfapaisan

    Hair Transplant Forum International March 2016, 26 (2) 60-63; DOI:

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  • 96-hour study of FU graft “out-of-body” survival comparing saline to Hypothermosol/ATP solution

    Michael Beehner

    Hair Transplant Forum International March 2011, 21 (2) 33-37; DOI:

    Link to ISHRS Forum Article (Requires Subscription)