Aim 

To achieve international expert consensus and give recommendations on best practices in hair transplantation surgery, focusing on pre- and post-transplantation care. 

Methodology

• Modified Delphi method for consensus
• International scientific committee, 81-statement questionnaire
• Panel of 38 experts in hair transplantation from 17 countries across 4 continents for the questionnaire assessment 

Results 

Two consensus rounds were carried out, with 59 out of 81 statements (73%) reaching consensus.  

Recommendations on pre-transplantation care: 

• Expert recommendations emphasize the correct selection of candidates for hair transplantation and the need for patients to have received adequate medical treatment for alopecia before transplant.
• Comorbidities should be assessed and considered while planning surgery, and an individualized plan for perioperative care should be drawn up before transplant.
• Certain medications associated with increased risk of bleeding should be withdrawn before surgery.  

No consensus reached: 

• Statements on the role of specific nutritional supplements as adjuvant therapies during the pre-transplantation period, as well as novel procedures such as low-level light therapy (LLLT) and mesotherapy.
• Use of caffeinated drinks on the day of surgery 

Recommendations on medical care during the hair transplant procedure: 

• Storage of grafts in extracellular holding solutions such as normal saline or Ringer’s Lactate, or in intracellular holding solutions such as Hypothermosol®, Collins or Custodiol® - HTK if surgery will take more than 6–8 h
• If intracellular holding solutions are used, grafts should be chilled at 2–8 °C.
• Grafts that are harvested more than 6–8 h before transplantation should be chilled at 2–8 °C. 

No consensus reached: 

• Storage of grafts in autologous plasma
• Use of intraoperative LLLT or mesotherapy 

Recommendations on post-transplantation care: 

• Importance of patient assessment on the days following hair transplant to rule out possible complications.
• After transplantation, patients should gradually resume their normal haircare regimen.
• Close follow-up should be carried out during the first year after transplant. 

Conclusions 

This study presents numerous consensus-based recommendations on general aspects of hair transplantation, including candidate selection, medical therapy prior to transplantation, anesthesia, and resuming haircare after transplantation.