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Not yet recruitingNCT07850011Updated Sep 30, 2026

Evidence-Based Integrated Protocol to Maximize Hair Follicle Survival in Follicular Unit Extraction (FUE)

An interventional study of Integrated Evidence-Based FUE Protocol and Standard FUE Practice in Androgenetic Alopecia and Cicatricial Alopecia, sponsored by Assiut University. Not yet recruiting. Open to male participants aged 18 Years to 60 Years. Per ClinicalTrials.gov, last updated 2026-09-30.

Sponsored by Assiut University · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
30
Allocation
Randomized
Ages
18 Years to 60 Years
Sex
Male
01

Study summary

Follicular unit extraction (FUE) is a widely used surgical technique for hair restoration, yet hair follicle survival rates vary depending on surgical instrumentation, graft handling, and perioperative care.

The purpose of this clinical trial is to evaluate whether an evidence-based, integrated perioperative protocol maximizes hair follicle graft survival compared with standard departmental practice in male patients undergoing FUE for androgenetic alopecia or localized scarring alopecia.

Participants will be randomly assigned to one of two groups:

  • Integrated Protocol Group: Patients receive FUE surgery guided by a standardized workflow featuring algorithmic punch selection (0.8-1.0 mm), pre-set extraction depth and angulation, chilled holding solutions maintained at 4 °C, strict graft out-of-body time limits (target ≤2-4 hours), and standardized recipient site implantation.
  • Standard FUE Practice Group: Patients receive FUE surgery according to routine departmental practice, where punch selection, harvesting parameters, and graft handling follow the operating surgeon's standard routine.

Follicle survival and hair density will be tracked using digital trichoscopy in pre-marked 1×1 cm reference scalp areas over a 12-month follow-up period. Investigators will also assess intraoperative follicular transection rates, procedural complications, and patient satisfaction between the two groups.

02

Conditions studied

  • Androgenetic Alopecia
  • Cicatricial Alopecia

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Keywords

  • Follicular Unit Extraction
  • FUE
  • Hair Transplantation
  • Graft Survival
  • Follicular Transection Rate
  • Hair Restoration
03

Who can participate

Ages eligible
18 Years to 60 Years
Sexes eligible
Male
Accepts healthy volunteers
No

Inclusion criteria

  • Male patients aged 18 to 60 years.
  • Clinically diagnosed androgenetic alopecia (Norwood-Hamilton grade II-V) or localized scarring alopecia suitable for follicular unit extraction (FUE).
  • Adequate donor area hair density (≥ 40 FU/cm²) confirmed by trichoscopic evaluation.
  • Minimal or no response to at least 6 months of medical treatment (e.g., topical minoxidil, oral finasteride), where applicable.
  • General good health with no contraindications to minor outpatient surgery under local anesthesia.
  • Willingness and ability to provide written informed consent and comply with the full 12-month follow-up schedule.

Exclusion criteria

Exclusion Criteria:

  • Active scalp infection, dermatitis, or other active dermatological disease at the donor or recipient site.
  • History or tendency of keloid or hypertrophic scarring.
  • Bleeding diathesis or current use of anticoagulant/antiplatelet therapy that cannot be safely discontinued.
  • Uncontrolled systemic disease (e.g., uncontrolled diabetes mellitus, cardiovascular, hepatic, renal, or pulmonary disease).
  • Immunosuppression or current use of immunosuppressive medication.
  • Endocrine disorders directly causing hair loss (e.g., uncontrolled thyroid disease) or active telogen effluvium.
  • Psychiatric illness affecting the capacity to provide informed consent or comply with follow-up, or unrealistic patient expectations.
  • Previous hair transplantation in the same donor or recipient area within the preceding 12 months.
  • Known hypersensitivity to local anesthetics used in the study.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
30 participants (estimated)

Study arms

  • Experimental
    Integrated Protocol Group

    Participants undergo follicular unit extraction (FUE) using a standardized, evidence-based perioperative workflow. This includes algorithmic punch selection (0.8-1.0 mm) based on donor hair caliber and scalp characteristics, pre-set extraction depth (2.5-4 mm) and natural exit angulation, atraumatic microsurgical forceps handling, chilled holding solution maintained at 4 °C, strict time-stamping with graft out-of-body time targeted to ≤2-4 hours, and standardized recipient site implantation density (30-50 FU/cm²).

    Procedure: Integrated Evidence-Based FUE Protocol

  • Active comparator
    Standard FUE Practice Group

    Participants undergo follicular unit extraction (FUE) according to routine departmental practice, where punch selection, harvesting depth, extraction angle, and graft handling/storage procedures are performed according to the operating surgeon's standard, non-standardized routine. All perioperative medications and post-operative care instructions remain identical to the experimental arm.

    Procedure: Standard FUE Practice

Interventions

  • ProcedureIntegrated Evidence-Based FUE Protocol

    A standardized perioperative FUE protocol consisting of: algorithmic micromotor punch selection (0.8-1.0 mm diameter; sharp, blunt, or serrated/trumpet-shaped) based on hair caliber, curl, and scalp laxity; pre-set extraction depth (2.5-4.0 mm) aligned with natural hair exit angles; atraumatic graft extraction using Foerster-type microsurgical forceps; graft preservation in a chilled holding solution maintained at 4 °C; strict monitoring targeting total out-of-body time to ≤2-4 hours; and standardized recipient site creation and implantation (30-50 FU/cm²) via micro-blades or Choi-type implanter pens.

  • ProcedureStandard FUE Practice

    Conventional follicular unit extraction performed according to routine departmental practice, wherein extraction punch selection, harvesting depth, incision angles, graft holding conditions, and out-of-body handling times are determined based on the operating surgeon's individual routine without standardized protocolized constraints. Postoperative care and medical regimens remain identical to the experimental arm.

05

What researchers measure

Primary outcomes

  1. Hair Follicle Survival Rate

    Hair follicle graft survival rate assessed within the pre-marked 1×1 cm recipient study reference boxes using digital trichoscopy. The survival percentage is calculated using the following formula: \[(Number of follicles counted at 12 months - baseline follicle count in recipient area) ÷ (Number of grafts transplanted into the reference box)\] × 100%.

    Time frame: 12 months postoperatively

06

Study locations

No study locations are listed for this record.

07

Registry details

Key details

Study ID
NCT07850011
Lead sponsor
Assiut University
Responsible party
Abdelrahman Tawfeek (Resident, Assiut University) — Principal investigator
First posted
Sep 30, 2026
Start date
Oct 2026 (estimated)
Primary completion
Oct 2027 (estimated)
Completion
Nov 2027 (estimated)
Last update
Sep 30, 2026

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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