Sideburn reconstruction with an expanded supraauricular trapezoidal flap

Aesthetic Sideburn Reconstruction Using an Expanded Hair Bearing Skin Flap With Natural Hairline

BACKGROUND

Hairline is the marginal line of hair growth on the scalp. Patients with sideburn defects, caused by tumor resection, severe infection, or burns, might have low self-esteem and mental stress. The purpose of this article was to explore a surgical method of applying the expanded scalp flap with natural hairline for cosmetic reconstruction of hairline, so as to provide reference for future clinical work.

METHODS

In this study, a retrospective analysis was conducted on 23 patients in the plastic surgery ward of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 2015 to December 2018, who underwent expanded scalp flap cosmetic reconstruction of the sideburns with natural hairline (14 males and 9 females; average age, 18.7 ± 13.7 years). The follow-up time was 8 to 44 months.

RESULTS

Patient satisfaction rate (scored 4 or more) was 95.7%, with an average score of 4.59. A total of 16 patients were very satisfied, and 6 were satisfied. There were 21 patients who had good flap survival, and 2 patients who had venous congestion at the distal end of the flap. One case relieved voluntarily 3 days postsurgery, and the other case had partial skin necrosis at the distal end, healing phase II. These 2 cases were classified as grade I according to the Clavien-Dindo classification. In 9 of the patients, the reconstructed sideburn presented a natural look with good hair angle and great size and shape, with average scores of 4.61, 4.52, and 4.48. The scars at the donor site were inconspicuous, and there were no complaints (average score, 4.61). The rest of the patients received satisfactory appearances after surgery.

CONCLUSION

In conclusion, the technique described above presented a fine method for sideburn reconstruction. Based on the achieved aesthetic scores of our study, as well as the high patient satisfaction rate (95.7%), the aforementioned technique is acceptable for both surgeons and patients.

Sideburn Reconstruction Using a Pre-Expanded Island Scalp Flap Based on the Parietal Branch of Superficial Temporal Vessels

ABSTRACT

Sideburns are crucial for head and face esthetics. Absence of sideburns is associated with physical and psychological consequences. Many methods have been described for sideburn reconstruction; however, characteristics of the ideal method include optimal vascularization, ideal hair density, natural hair growth, and facial symmetry with minimum donor-site morbidity. In this study, the authors describe a novel method of sideburn reconstruction using a pre-expanded island scalp flap based on the parietal branch of the superficial temporal artery. Between February 2012 and December 2020, 9 patients underwent sideburn reconstruction surgery that involved 2 stages. During the first stage, an appropriately sized tissue expander was inserted underneath the scalp. After sufficient inflation of the expander, at the second stage, an island scalp flap based on the parietal branch of the superficial temporal vessels was elevated to reconstruct the sideburns. The mean size of the defects was 8 × 4.4 cm (range, 6 × 3-12 × 5 cm), whereas the average flap dimension was 10.22 × 5.67 cm (range, 8 × 4-13 × 8 cm). All flaps survived completely without any perfusion-related complications. Patients were followed up after surgery, ranging from 4 to 34 months (mean, 15.67 months). All patients and/or their parents were satisfied with the final appearance in terms of hair density, hair growth direction, and facial symmetry. Although a 2-stage procedure, this novel technique allows the reconstruction of a new sideburn with natural growth and orientation of the hair and minimal morbidity for patients.

Treatment of Postsurgical Scalp Scar Deformity Using Follicular Unit Hair Transplantation

Background

Although stable cicatricial alopecia (SCA) secondary to surgical events of the scalp can affect patients' psychosocial status, hair transplantation onto postsurgical scar tissue on the scalp is challenging because of tissue stiffness and poor blood circulation.

Objective

In contrast to traditional surgical treatments, such as excision, local flap, and tissue expansion, follicular unit (FU) hair transplantation offers aesthetically pleasing results in the treatment of postsurgically induced SCA.

Materials and Methods

This study included 15 patients with SCA of the scalp due to postsurgical scarring. The patients underwent a single session of hair transplantation of approximately 35 units/cm² density. The graft survival rate was evaluated 12 months after the procedure. The Patient and Observer Scar Assessment Scale (POSAS) was used to analyze the preoperative and postoperative satisfaction.

Results

The FUE hair transplantation had a mean survival rate of 80.67% (range 70-90%). The patient and observer satisfaction significantly improved after the procedure; the POSAS scores were 24.47 (range 16-38) preoperatively and 11.60 (range 7-18) postoperatively.

Conclusion

FU hair transplantation could be an effective method for managing scar tissue on the scalp and offers several advantages, including a high transplantation survival rate and satisfactory postoperative results.

The reconstruction of male hair-bearing facial regions

BACKGROUND

Loss of hair-bearing regions of the face caused by trauma, tumor resection, or burn presents a difficult reconstructive task for plastic surgeons. The ideal tissue substitute should have the same characteristics as the facial area affected, consisting of thin, pliable tissue with a similar color match and hair-bearing quality.

METHODS

This is a retrospective study of 34 male patients who underwent reconstruction of hair-bearing facial regions performed by the senior author (J.J.P.). Local and pedicled flaps were used primarily to reconstruct defects after tumor extirpation, trauma, infections, and burns. Two patients had irradiation before reconstruction. Two patients had prior facial reconstruction with free flaps.

RESULTS

The authors found that certain techniques of reconstructing defects in hair-bearing facial regions were more successful than others in particular facial regions and in different sizes of defects.

CONCLUSION

The authors were able to develop a simple algorithm for management of facial defects involving the hair-bearing regions of the eyebrow, sideburn, beard, and mustache that may prospectively aid the planning of reconstructive strategy in these cases.

Follicular transplantation for the correction of various stigmas after rhytidoplasty

BACKGROUND

Rhytidoplasty may cause permanent and unwanted stigmas, such as dislocation of the temporal and cervical hairline. Widened scars inside the hairline may cause considerable social embarrassment. Furthermore, pretrichial incisions, even if well placed, may widen or become hypochromic, thus revealing that an aesthetic procedure has been performed. Various procedures for the correction of these undesirable telltale signs of a face-lift have been published. This report aims to present the results of correction for postrhytidoplasty stigmas using follicular transplantation. Patient assessment is discussed, and relevant technical aspects are detailed and illustrated.

METHODS

A prospective study at the Ivo Pitanguy Clinic investigated patients who underwent hair transplantation to correct unaesthetic signs secondary to rhytidoplasty from January 2001 to December 2004. The aesthetic results and complications were evaluated, as well as the patients' satisfaction rate. The patients presented in this series either were referred from another service or had their rhytidoplasty originally performed in the authors' service.

RESULTS

A total of 33 female patients were included in this study. Two patients were lost to follow-up evaluation and not included. The complications were minor. In the late follow-up assessment, 24 patients classified the result as excellent, 4 as satisfactory, and 3 as unsatisfactory. Only the patients who classified the results as unsatisfactory requested a second procedure (i.e., another follicular transplantation).

CONCLUSIONS

When performed by an experienced surgical team, the follicular unit transplantation technique is a simple, safe, and efficient way to correct stigmas secondary to a rhytidoplasty, such as a visible scar or a displaced hairline, with satisfactory results and a very low complication rate.

Aesthetic reconstruction of large scalp defects by sequential tissue expansion without interval

Tissue expansion is indicated in the reconstruction of various scalp defects when there is inadequate adjacent tissue to allow either primary closure of the defect or repair with a local flap. It is the most important armamentarium for aesthetic hair-bearing scalp reconstruction in cases of congenital or required defects. This technique was used sequentially without interval to achieve scalp reconstruction for 12 patients with a defect ranging from 30% to 75% of the scalp (average, 55%). For 12 patients, 32 expansion treatments were undertaken between September 1997 and January 2002. The 12 patients included 3 women, 4 men, and 5 children with a mean age of 20 years (range, 45 days to 36 years). All patients had more than one period of treatment. The most common conditions treated were burns (n=7), trauma (n=1), congenital naevi (n=2), and male pattern baldness (n=2). Reconstruction of 12 large scalp defects has been performed with a 3.1% rate of major complications. Results show that tissue expansion is a safe and efficient but time-consuming technique for aesthetic scalp reconstruction, especially in the case of "sideburn" scenario or large defects. There was no significant alteration in ratio of complications although tissue expansions were made sequentially.

Hair transplantation to the eyebrow, eyelashes, and other parts of the body

Since its earliest applications, hair transplantation has been used for treating not only the scalp in pattern baldness but also other parts of the body, commencing with eyebrow reconstruction. The earliest micrografts were applied to the eyebrow more than 30 years before their application to the scalp became the standard of care. Today hair transplantation is applied to a number of other areas. The principle behind transplanting these areas is the same-once transplanted, the hairs continue to grow because of the phenomenon of donor dominance. This article reviews the role and technique of hair transplantation to the eyebrows and eyelids, chest, beard and moustache, and pubic escutcheon.

The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp

Hair transplantation by use of micrografts (one- to two-hair follicular unit grafts) and minigrafts (three- to four-hair follicular unit grafts) used in large numbers (>1000 grafts) in a single session was initially described for the treatment of male pattern baldness. More recently, the author has found many other applications, particularly in facial and scalp reconstruction. The most common causes for aesthetic hair restoration of those areas in the author's experience include hair loss resulting from aesthetic facial rejuvenation surgery, revision of unsatisfactory results from previous hair transplantation, burn alopecia, congenital reasons, and hair loss after oncologic resections. The basic technique is described in detail, with variations given for each of the challenging anatomic areas, including the sideburns and temporal hairline, eyebrows, eyelashes, mustache, beard, and remaining scalp. Special attention is given to the direction of hair growth, hair texture, aesthetic planning, and absence of detectable scars, in order to mimic nature and to result in a minimal number of procedures. The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp has been found to be safe and predictable, and has provided a high level of patient satisfaction.

Long-term results of surgical excision and skin grafting for a giant hairy naevus of the face: time for a return to conventional wisdom?

In a publication climate demanding modern innovative treatments for congenital giant hairy naevi, we report a case with excellent long-term results following early surgical excision and split-thickness skin grafting.

Sideburn reconstruction with an arterial V-Y hair-bearing scalp flap after the excision of basal cell carcinoma

A new flap is presented for sideburn reconstruction. It has good vascularity and hair direction. There is some tension in the closure of the scalp donor site that can be associated with alopecia. The flap should be advanced only to the desired sideburn level, with a cervicofacial flap covering any remaining defect. Follow-up at 2 years 4 months confirmed the satisfactory result. This flap adds another option to those discussed in this article for sideburn reconstruction.

The use of micrografts and minigrafts for the correction of the postrhytidectomy lost sideburn

A tell-tale and unsightly deformity that can result from a rhytidectomy is the loss of the sideburn. As redundant skin is lifted, the hairless skin of the cheek may be advanced into the sideburn area. Several techniques have been described for sideburn reconstruction, mainly punch grafts and various scalp flaps. I use micrografts and minigrafts to effectively correct this deformity in a single session, under local anesthesia and mild intravenous sedation. I use basically the same technique previously described for the treatment of male-pattern baldness, with the direction of graft insertion being at a very acute angle to obtain the growth of hair in a natural downward direction. I found the procedure safe and predictable, and the patients treated were very satisfied with the aesthetically pleasing and natural result.