Groundbreaking Hair Transplant From Brother to Sister

Normally, a hair transplant is only possible between identical twins, but in this case the female had received a bone marrow transplant from he younger male sibling which gave her the identical immune system as her brother and made the hair transplant from brother to sister possible. At time of surgery the female patient was 25 and the brother was 22 years old.

Hair Loss History: Our female patient developed Acute Myelogenous Leukemia (AML). Her brother, our male patient, was a match, and she was able to receive an allogeneic bone marrow transplant from him in September 2015 when she was 19 years old.

The bone marrow transplant, along with the chemotherapy, cured the AML, but her hair never grew back normally. She then developed chronic Graft-Versus-Host Disease (GVHD) with subsequent alopecia at the age of 25. Biopsies were consistent with non-scarring alopecia and a telogen effluvium shift but showed no signs of inflammation. Steroid injections and finasteride were ineffective. Oral minoxidil increased the length of the hair but did not fill in the bald areas after 1 year of treatment. The hair was still thin and broke easily.

Medical Treatment for Hair Loss, Dose, and Length of Time:

finasteride 2.5 mg taken oral per day during a 6-month period, which patient discontinued taking medication due to minimal results.
oral minoxidil 2.5 mg oral per day
82M (topical, branded minoxidil treatment) recommended as an option but decided against topicals due to skin reaction.

Procedure(s)/Details and Dates:

Session 1: Test surgery performed on October 2021 with the patient’s brother Jack as the donor. Dr. Wasserbauer performed an FUE and FUT hybrid test surgery, extracting a total of 110 grafts with 51 grafts were taken using the FUT with a strip measuring 1.5 cm x 1.0 cm. 59 grafts were taken using the WAW FUE machine with a 0.95-mm punch. FUE grafts placed into left temple area, while FUT grafts were placed into the right temple area. Growth noted at 6 months and 1 year, and the patient was then approved for a full-sized surgery with Dr. Wasserbauer using her brother as her hair transplant donor. Grafts grew well on both sides but FUT was chosen in order to avoid shaving the hair or reducing the density of the donor hair postoperatively.
Session 2: FUT performed on December 22, 2022

Both patients were brought back to OR: the donor harvested in one room and the recipient sites/placement performed in the adjacent room. Donor area mapped out first on the male donor and prepared before anesthesia commenced.

Density: 80 FU/cm² and 30% elasticity

Once the strips were measured, both were then slivered and dissected into individual grafts while also being organized into Telfas for graft placement.

As the donor was being dissected, the recipient patient was prepared to undergo treatment.

Dr. Wasserbauer created 2,020 20G sites and 800 19G sites. Patient’s graft total was 2,831, with a total of 5,844 hairs.Placement started immediately once sites were completed and took a total of 4.5 hours to complete placement. Grafts were placed starting at the hairline, temple, and frontal area then making their way back towards the crown.

Follow-up(s) and Dates:

Donor patient had sutures removed with no complications.
Donor patient did have a follow-up visit due to a possible ingrown in suture area, area checked by our PA and injected with 0.2 ml triamcinalone to resolve any issues with no further complications or follow up appointments after steroid injection.
Recipient patient was advised to come back 10 days postop to check on the area, area appeared to be healing well at 10 days although patient did have a significant amount of swelling and bruising.
Patient then came in for a 6 month follow up to check on growth, and patient had visible growth at her 6 month appointment.
Patient came in for a final visit at 1 year with visible growth to the area and seemed pleased with the amount of coverage received by the first transplant and may consider a small touchup with her brother to fill in some small areas.

Resources:

https://pubmed.ncbi.nlm.nih.gov/17300612/

https://pubmed.ncbi.nlm.nih.gov/10491051/

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