Masking the Close Eye Appearance in the East Asian Female Population: Infratemporal Hairline Reduction with Hair Grafting

Post-Hair Transplantation Complication: Kinky or Severely Curly Hair

OBJECTIVE

To investigate the etiology and preventive measures of posttransplant kinky or curly hair growth after female hairline correction surgery.

BACKGROUND

Hair transplant surgery can be accompanied by various adverse effects, one of which is severely kinky or curly hair after surgery. Posttransplant kinky or curly hair is not well-understood for its cause or prevention.

METHODS

The study was targeted at a total of 980 patients who were confirmed whether they developed kinky or curly hair after female hairline correction surgery. Incidence, surgical method, degree of curliness, predisposed location, characteristics, hair caliber (thin, medium, and thick), and left-right differences were examined.

RESULTS

Among the total 980 patients, posttransplant curly hair (PTCH) was manifested in 38(3.9%) patients. None of the patients who underwent surgery at the present clinic developed posttransplant kinky hair; all 38 patients showed PTCH growth. In 36 cases, transplanted hair started to grow in curly patterns around 4 months after surgery. However, the remaining 2 cases showed no curly growth pattern when the transplanted hair was short at postoperative 4 months, but started to grow curly starting at 6 to 8 months after surgery as the hair growth direction was obstructed or compressed by the existing hair.

CONCLUSION

Familiarity with the cause, prevention, and management of posttransplant kinky hair and PTCH will be of great help to hair surgeons.

Hairline Correction by Hair Transplantation for Reducing Apparent Face Length in Long-Face Women

BACKGROUND

The long-face morphology is associated with aesthetic concerns, and surgery is often necessary to correct excess length in the frontal plane, in the upper, middle, and lower thirds of the face. However, correcting midline facial length in the frontal plane alone does not provide facial harmony. This study introduces a novel approach to correcting long-face morphology using measurements in the frontal, oblique, and lateral views, and reducing hairline measurements using hair transplants.

METHODS

Eighty-three patients were enrolled in the study. The authors measured the midline facial length in the frontal plane and the lengths of the upper, middle, and lower thirds of the face. The authors also measured four additional distances in the oblique and lateral views, including the distance from the infratemporal hairline to the chin and from the sideburn to the chin. The patients' midfrontal hairlines were lowered, and the distances from the infratemporal hairline to the chin and from the sideburn to the chin were also shortened. The results were evaluated by patients and the surgeon using a five-point Likert scale.

RESULTS

The mean patient Likert score was 4.5 (range, 3 to 5), and the mean surgeon Likert score was 4.9 (range, 3 to 5). No patients experienced adverse events. Three patients required touch-up surgery at the recipient sites to increase the hair density.

CONCLUSION

This novel approach to correcting long-face morphology using hair transplants to decrease hairline measurements provided excellent facial harmony and symmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Temporal augmentation using autologous fat grafting in Chinese women: Effect on temporal hairline

BACKGROUND

Temporal hollowing causes an old and gaunt appearance. An inward curve of the temporal hairline adds to the severity of temporal hollowing, which is visually exacerbated by the dark-colored hairline in most Chinese women. Whether temporal augmentation using autologous fat grafting (AFG) is effective for correcting an inwardly curved temporal hairline remains unclear.

AIMS

To assess the effect of temporal augmentation using AFG on the temporal hairline.

METHODS

Forty-six women with an inward-curved temporal hairline, who underwent temporal augmentation using AFG, were recruited. The preoperative and postoperative severity of temporal hollowing was evaluated, and anthropometric measurements regarding the temporal hairline were performed on photographs taken in the frontal and lateral views. Subject satisfaction and incidence of complications were documented.

RESULTS

A slight increase in forehead width was observed. The minimal forehead width and minimal forehead width/forehead width ratio were increased. The width, depth, and height of the temporal peak were all increased as well, indicating that the previously inwardly oriented temporal peak was shifted slightly outward, upward, and backward after augmentation.

CONCLUSION

Autologous fat grafting satisfactorily smoothened the temporal hairline without excessively increasing forehead width in subjects with temporal hollowing and an inward-curved temporal hairline.

Secondary Revision of Female Hairline Correction Surgery: Personal Experience

Patients undergoing secondary female hairline correction surgery present with dissatisfaction of various causes that require specific solutions. Satisfactory results following secondary revision surgery are achieved only after consideration of the reasons for the patient's dissatisfaction as well as specific factors regarding the state of the hairline, height and width of the forehead, and overall facial type; all of these must be considered when choosing the most suitable surgical method. In the present study, the authors used various surgical approaches according to the patient's characteristics and presenting symptoms in the performance of secondary hairline correction surgery and evaluated the adequacy of each method using a satisfaction survey. In total, 246 patients who underwent hairline correction surgery by hair transplantation were enrolled in this study. As adjunctive procedures prior to surgery, 24 patients received triamcinolone injections every 1-2 weeks to ameliorate severe hyperfibrotic scarring, and laser hair removal was performed in part of the recipient area in 18 patients to remove old transplanted grafts that had created an awkward appearance or were unnecessary. Revision of female hairline correction surgery was performed with FUT (follicular unit transplantation) in 156 patients (63.4%), partial-shave FUE (follicular unit extraction) in 12 patients (4.9%), a combination technique (FUT + FUE) in 24 patients (9.8%), and non-shaven FUE in 54 patients (22.0%). LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hair transplantation in patients with hair loss or scar deformity in the side hairline after midfacelifting surgery

Background

Successful aesthetic plastic surgery is devoid of both unsightly scarring and postoperative disfigurement. Patients undergoing midface-lifting surgery are very often disconcerted by an altered side hairline, including sideburns, despite considerable amelioration of facial wrinkles. This study was conducted to identify an effective means of approaching an altered hairline and the unavoidable scarring arising from midface-lifting surgery.

Methods

A total of 37 patients who underwent corrective surgery with hair transplantation for hair loss or scar deformity arising from midface-lifting surgery from June 2014 to June 2017, and were observed for more than 6 months thereafter, were enrolled in the study. Prior to corrective surgery, the patients were administered a multiple-choice survey regarding their dissatisfaction arising from midface-lifting surgery. Among the 37 patients, 24, 12, and one underwent donor harvesting by the strip method, non-shaven follicular unit extraction, and partial shaving follicular unit extraction, respectively. Additionally, 33 of the 37 patients underwent hair transplantation in the frontotemporal recess area along with hairline correction surgery. The average number of transplanted grafts was 1,025.

Results

Surgery resulted in a natural and satisfactory appearance in all patients. The average patient and physician subjective satisfaction scores were 4.6 and 4.8, respectively. No adverse events such as folliculitis occurred.

Conclusions

Side-hairline correction surgery by hair transplantation can be considered an effective method of realigning an altered hairline accompanied by scars following midfacelifting surgery.

Hair Diameter Variation in Different Vertical Regions of the Occipital Safe Donor Area

BACKGROUND

Little is known concerning hair diameter variation within the safe donor area for hair transplantation surgery. Thicker or thinner hair may be needed, depending on the recipient area, hairline design, and the purpose of surgery.

METHODS

Twenty-seven patients (7 men and 20 women; mean age, 28 years; range, 20-47 years) were included in this study. The midoccipital point was used as the reference point on the horizontal plane at the upper border of the helical rim. The target area width was 15 cm (7.5 cm to the right and left of the reference point) and the height was 8 cm (2 cm above and 6 cm below the reference point). The study area was divided horizontally into 3 5-cm sections (A, B, C) and vertically into 4 2-cm sections (1-4), creating a total of 12 zones. Ten anagen hairs were randomly obtained from each zone and their diameters were measured.

RESULTS

Hair diameter in the 4 vertical sections varied significantly, gradually decreasing from sections 1 (superior) to 4 (inferior) in all 3 horizontal sections (A, B, and C).

CONCLUSIONS

Our results suggest that sections 1 and 2 of the occipital safe donor area would be useful for obtaining thicker hair, such as in procedures to treat male- and female-pattern hair loss, whereas hair from zones 3 and 4 could be useful for transplantation surgery requiring thinner hair, such as eyebrows, eyelashes, and female hairline correction. Our results may be clinically valuable for planning hair transplant surgery and choosing the optimal donor region.