White hair FUE: enhancing visibility and harvest quality with gentian violet staining

Objectives: Follicular Unit Excision (FUE) in patients with white hair can be challenging because the low color contrast between hair shafts and surrounding tissues makes follicle identification difficult. Poor visibility may increase extraction time, follicular injury, and damage to adjacent follicles. This study evaluated the effect of 1% Gentian Violet (G-V) staining on surgical visibility and assessed its impact on extraction time, harvesting efficiency, follicular safety, adjacent follicular damage, and FOX grading in white hair FUE. Introduction: Accurate identification of white hair follicles during FUE is challenging because of the poor contrast between hair shafts and surrounding tissues. Limited visibility may increase extraction time, follicular injury, and damage to adjacent follicles. Although several techniques have been introduced to improve white hair harvesting, objective clinical evidence remains limited. Therefore, this study evaluated the effectiveness of Gentian Violet (G-V) staining in improving visibility and enhancing the efficiency and safety of white hair FUE. Materials / method: A prospective self-controlled study was conducted in 30 patients aged 50–75 years with white hair. This study was performed through a collaborative research program between Union Hospital (China) and MOPLUS Plastic Surgery Clinic (South Korea). All procedures were performed at MOPLUS Plastic Surgery Clinic in South Korea. The donor area was divided into a G-V-stained side and an unstained control side. Surgical visibility, extraction time, follicular injury, average hairs per punch (AR), hidden follicular damage, and FOX grade were evaluated and compared between groups. Results: The G-V stained group showed significantly better outcomes in all evaluated parameters. Visibility scores improved from 1 to 5 (P<0.01). Mean extraction time decreased from 60.16±3.00 to 31.13±1.75 seconds (P<0.01), while AR increased from 2.21±0.37 to 2.78±0.41 hairs per punch (P<0.01). Follicular injury and hidden follicular damage were significantly reduced. FOX grades improved from a median of 3 to 1 (P<0.01), demonstrating improved harvesting efficiency, follicular preservation, and overall quality of white hair FUE. Conclusion: Gentian Violet (G-V) staining significantly improves visualization during white hair FUE, resulting in faster extraction, greater harvesting efficiency, and reduced follicular injury. By improving follicular preservation and minimizing hidden damage to adjacent follicles, this simple and cost-effective technique enhances both the safety and predictability of the procedure. G-V staining represents a practical adjunctive method that may contribute to improved surgical outcomes and a more reliable approach to white hair follicular unit extraction.