Contemporary Management of Alopecia: A Systematic Review and Meta-analysis for Surgeons

  • Jacqueline Stoneburner
  • Orr Shauly
  • Joseph Carey
  • Ketan M. Patel
  • W. Grant Stevens
  • Daniel J. GouldEmail author
Review Special Topics



The decision of surgical approach for hair restoration often involves evaluation of the type of alopecia; however, the impact of surgical hair restoration from existing techniques in specific population subsets has not been comprehensively investigated.


The authors sought to systematically review the literature on micrografts, minigrafts, mini-micrografts, tissue grafts, tissue flaps and expanders, as well as evaluate graft survival and satisfaction within specific populations in a meta-analysis.


PubMed and Scopus literature searches between 1980 and 2018 yielded 57 articles for systematic review and 34 articles for meta-analysis. Study design, mean patient age and gender, patient alopecia type, surgical hair restoration technique, number of treatment areas, mean follow-up, graft survival rate and satisfaction rate were extracted from each study, and a meta-analysis was performed.


The pooled rates of graft survival were 84.98% (95% CI 78.90–91.06) using micrografts and 93.11% (95% CI 91.93–94.29) using micrografts and minigrafts in nonscarring alopecia patients, as well as 88.66% (95% CI 80.12–97.20) using micrografts and 86.25% (95% CI 74.00–98.50) using micrografts and minigrafts in scarring alopecia patients. The pooled rates of satisfaction were 89.70% (95% CI 82.64–96.76) using micrografts and 97.00% (95% CI 92.48–100.0) using micrografts and minigrafts in nonscarring alopecia patients, as well as 97.80% (95% CI 94.59–100.0) using micrografts and 88.70% (95% CI 66.49–100.0) using micrografts and minigrafts in scarring alopecia patients. Dot plots depict rates of graft survival rate from micrografts and satisfaction from micrografts and minigrafts.


Surgical hair restoration for nonscarring and scarring alopecia yields high graft survival and satisfaction rates.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Surgical hair restoration Hair transplantation Follicular unit transplantation Alopecia Graft survival Satisfaction 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Human and Animal Rights Statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, informed consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Keck School of Medicine of USCUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Plastic and Reconstructive Surgery, Keck Hospital of USCUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Marina Plastic SurgeryMarina Plastic Surgery AssociatesMarina Del ReyUSA

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