Dermatologic Microsutures Using Human Hair

A Useful Technique in Cutaneous Stitching

Mohammed Al azrak, MBBCh, MSc, FEBOPRAS, FACS; Rei Ogawa, MD, PhD, FACS


ePlasty. 2017;17(e24) 

In This Article


Scarring is a crucial hallmark of skin reconstitution. Since only humans scar, there are few animal models of scarring as well. This has significantly hampered our understanding of the mechanisms that underlie wound healing and normal and abnormal scar formation. Nevertheless, recent research has improved our understanding of these mechanisms.[22–24] In particular, we are now aware that the size, texture, and color of scars are influenced by various cells and local growth factors.[25] However, the clinical approaches that best prevent or ameliorate scarring remain unclear. As a result, patient satisfaction with the aesthetic results of wound closure still varies markedly.[24] In particular, given the social consequences of facial disfigurement, the aesthetic outcomes of stitched wounds on the face can give rise to patient dissatisfaction. Thus, it is essential to handle facial wounds meticulously.

Our case series analysis showed that using autologous hair for suturing facial wounds resulted in excellent aesthetic outcomes: the wounds were often invisible or scarcely visible after only a few months of follow-up, and most of the patients and their relatives were satisfied with the outcome. It should be noted, however, that to prevent scar prominence, patients should be encouraged to protect themselves from sun exposure after hair-based suturing.

We found that the hair-based sutures did not generate any unwanted cutaneous reactions. This may reflect the fact that the hair was derived from patients themselves; thus, it was not recognized as a foreign body and did not trigger wound inflammation, which can yield unappealing large and reddened scars. However, further basic studies on the immunogenicity of autologous hair-based sutures are warranted.

During facial suturing, we paid particular attention to possible nerve injuries and ensured that they were repaired. This reflects the research conducted by Yannas et al.,[26–29] who studied the repair and regeneration of the skin and nerves and reported the similarities and differences between these 2 structures. Their observations showed that it is important to meticulously repair injured nerves at the cut site to prevent neuroma formation. Also, we were keen to meticulously handle the cutaneous cut site to decrease scar formation.

Our autologous hair-based wound closure approach is likely to be particularly useful in settings characterized by facility and equipment limitations, such as those experienced by second-world countries. It may also be suitable for the battlefield. Our technique involves 2 aspects. First, the surgery is atraumatic surgery because micro- or fine tools are used. In our case series, we used fine tools and instruments similar to the ones we usually use in microsurgery procedures. This significantly minimized tissue trauma, gave precise control during stitching, and facilitated the handling of the fine hair filament. Second, the hair filament is a low-cost natural monofilament that can be used instead of synthetic threads. Its fineness also obliges the surgeon to perform the surgery in a highly meticulous and delicate manner. In fact, on some occasions, it increased the skill of the surgeon in terms of fine handling of the facial skin wound.

We did observe variations in terms of the thickness and length of the hair filaments in our case series. For this reason, hair-based suturing was performed in 2 steps: the hair thread ampoule was generated first and then the wound was sutured.

It is also important that the wound should be cared for properly before and after stitching. Thus, the wound bed should be prepared properly by removing foreign bodies, performing conservative debridement, and ensuring hemostasis. After stitching, the wound should be managed with sterile dressings and topical antibiotics until the stitches can be removed.

We are experienced in using most (if not all) commercially available suturing threads.[30,31] This experience together with our long-term case series results suggests that for superficial suturing, autologous hair filament can be an effective alternative to other materials. Thus, given its excellent mechanical properties as a suturing material along with its low cost and ready availability, this nonabsorbable and natural thread can be added to the panoply of suturing materials. It should be noted, however, that its effectiveness in terms of reducing poststitching scarring is likely to be maximized when micro- or fine instruments are used.