Management of Cowlick in Female Hairline Correction Surgery

PURPOSE

To investigate the results of two grafting methods to manage CLs in the FHL of women.

BACKGROUND

The present study was performed to investigate the results of two grafting methods to manage cowlicks (CLs) in the frontal hairline of women.

METHODS

Patients were categorized into two groups based on the grafting method: the matching with the original hair direction (MOD) group and the matching with the CL hair direction (MCD) group. Satisfaction ratings were compared between the two groups.

RESULTS

Among 80 patients, 77 had a single CL and 3 had a double CL. In the MOD group, 7 of 12 (58.3%) patients underwent a touch-up procedure for density enhancement with an average of 123 follicular units; the average patient and physician satisfaction ratings were 4.84 and 4.60, respectively. In the MCD group, 7 of 68 (10.3%) patients underwent a touch-up procedure for density enhancement around the CL; the average patient and physician satisfaction ratings were 4.64 and 4.50, respectively.

CONCLUSION

In female hairline correction surgery, the surgeon must choose between MOD and MCD by considering the location, shape, and pattern of the CL; the facial shape; and the patient's preference. Delicate graft placement is required to obtain natural-looking results.

LEVEL OF EVIDENCE IV

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 .

Construction of a Hair Implantation Needle Using Injection Needles and Assessment of its Efficiency Compared with Other Planting Methods

INTRODUCTION

Hair transplantation surgery requires the efficient completion of hair follicles and thus appropriate hair implantation needles. The objectives of this study were to evaluate the effectiveness and feasibility of self-made hair implantation needles using injection needles and evaluate the speed of different hair implantation methods.

METHODS

Four patients were randomly assigned to four groups. A gem knife pre-punching planting method was used for the patient in Group A, while Group B received immediate implantation after punching with ordinary injection needles, Group C was treated with synchronized punching and planting using hair implanters, and Group D was treated with a self-made hair implantation needle. The speed of the different implantation methods for single and double hair follicles and the differences between the planting of single and double hair follicles were assessed.

RESULTS

Group D was found to have the fastest hair planting speed for both single and double hair follicles, followed by Groups C and A, with the slowest speed observed in Group B. Groups A and B were associated with significantly lower speeds of double hair planting than single hair planting, There was no significant difference between Groups C and D.

CONCLUSIONS

The self-made hair implantation needle is a novel and efficient tool for synchronized punching and planting. It has a faster planting speed and does not require assistance.

LEVEL OF EVIDENCE II

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 .

Follicular unit grafting in chronic ulcers: A valuable technique for integrated management

Chronic ulcers significantly affect the quality of life of patients and impose a high cost on the healthcare system. The therapeutic management should be comprehensive, taking into consideration the etiological diagnosis of the wound and the characteristics of the wound bed when deciding on a therapeutic proposal appropriate to the healing phase, correcting factors that delay healing. During the epithelialization phase, repair techniques with grafts are recommended to shorten re-epithelialization time, improve the quality of scar tissue, and achieve adequate pain management. Currently, due to the reported benefits of skin appendages, the technique of follicular unit auto-grafting obtained with a scalp punch is among the chosen strategies for wound repair. This is a minimally invasive, outpatient practice, whose technique has advantages over the donor site, patients recovery and well-being.

Impact of Hair Transplantation on Quality of Life

BACKGROUND

Alopecia is defined as partial or complete hair loss. The most common form is androgenetic alopecia, which occurs in both men and women. Despite the nonsurgical options available for treatment, the only permanent solution is hair transplantation. Hair loss has been shown to have significant psychological consequences associated with loss of self-confidence, poor self-image and difficulties in social functioning. We aim to examine the effect of hair transplantation on quality of life and psychosocial functioning.

METHODS

Forty-eight patients with androgenetic alopecia were enrolled in this two-center prospective study and underwent hair transplantation by the Follicular Unit Extraction method. Different questionnaires were used to assess their quality of life and other psychosocial parameters before and after hair transplantation.

RESULTS

According to SF-36 Physical and Mental Health Score patients showed significant improvement in life quality after hair transplantation. Diener's Life Satisfaction Scale (DASS-21) revealed increased life satisfaction after the procedure. Stress and anxiety DASS-21 subscales showed significantly reduced results; while, the DASS-21 depression scale and MSPSS were not significantly changed.

CONCLUSION

Taken together, quality of life and psychosocial functioning increased after hair transplantation. Structured abstract is required. Please provide.I insert name of paragraphs within abstract as follows: background, methods, results, conclusion Level of Evidence II: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An international expert consensus statement focusing on pre and post hair transplantation care

AIM

To achieve international expert consensus and give recommendations on best practices in hair transplantation surgery, focusing on pre- and post-transplantation care.

METHODS

A modified Delphi method was used to reach consensus. An international scientific committee developed an 81-statement questionnaire. A panel of 38 experts in hair transplantation from 17 countries across 4 continents assessed the questionnaire.

RESULTS

Two consensus rounds were carried out, with 59 out of 81 statements (73%) reaching consensus. Expert recommendations emphasize the correct selection of candidates for hair transplantation and the need for patients to have received adequate medical treatment for alopecia before transplant. Comorbidities should be assessed and considered while planning surgery, and an individualized plan for perioperative care should be drawn up before transplant. Certain medications associated with increased risk of bleeding should be withdrawn before surgery. Specific recommendations for post-transplantation care are given. After transplantation, patients should gradually resume their normal haircare regimen. Close follow-up should be carried out during the first year after transplant.

CONCLUSIONS

This study presents numerous consensus-based recommendations on general aspects of hair transplantation, including candidate selection, medical therapy prior to transplantation, anesthesia, and resuming haircare after transplantation.

Normal Trichoscopic Findings after Hair Transplantation in Androgenetic Alopecia: A Prospective Case Series

Background

Trichoscopy can be very useful for evaluation for hair transplantation (HT), helping rule out simulators of androgenetic alopecia (AGA). There are only a few reports about normal trichoscopic findings after HT.

Objective

The aim of this study was to evaluate donor and recipient area trichoscopy after FUE in HT without complications in AGA patients.

Method

A prospective study was carried out with 10 patients, for 24 weeks, with photographic follow-up, using FotoFinder®. Patients were evaluated from week 1 (w1) to week 8 weekly, then, at week 12 and week 24 post-HT.

Results

Main results were perifollicular crusts, donor area erythema, recipient area erythema, perifollicular erythema, white circles, perifollicular whitish halos, repilation black dots, dystrophic hairs, folliculitis, yellow dots. We discussed the meaning of each of these findings in the period in which they occurred.

Conclusion

Normal trichoscopic findings in post-transplant patients have not been well established yet. Our findings are an attempt to define a normal pattern. Future studies with a longer follow-up may be necessary to corroborate these results.

Recipient site creation for hair transplantation: A prospective half-side comparison study of hole versus slit

Follicular unit strip surgery and FUE (follicular unit extraction) are techniques used for donor harvesting in hair transplantation. For recipient site creation, the slit technique is now commonly used. The hole technique is an alternative technique in which holes are created in the tissue at the recipient site. This study compared these techniques in order to evaluate the effectiveness of the hole technique. Mean time for recipient site creation was significantly shorter with the hole technique than with the slit technique (95.5 s vs. 121 s; p = 0.021). This can be explained by better visibility of the holes compared with slits. This study focused on recipient site creation and found that the hole technique was a rapid and effective for recipient site creation.

The pros and cons of follicular unit extraction (FUE) versus elliptical donor harvesting (FUT)

Hair transplantation has evolved as a practice since the 1960's with advances in technology and surgical technique. With various surgical techniques in existence, patients and practitioners have an abundance of options to curate the best results for the patient. However, with many options come various benefits and consequences that must be examined on a patient-by-patient basis. This review article sought to examine the various surgical modalities of hair transplantation, to outline the pros and cons of various techniques, and to help outline considerations when choosing a given surgical technique.

Optimal Hair Transplant Recipient Site Slit Design: Minimizing Vascular Damage

An often overlooked aspect of hair transplantation is the art of recipient site design and slit creation. There is also a lack of consensus on which technique provides the optimum coverage while minimizing vascular damage. This paper aims to provide logical arguments to determine the optimal instrument and method of slit creation, in order to ensure maximum density, optimal survival, minimal pop-out, and minimal damage to scalp vascularity.

The use of semiconical blades reduces the damage to the dermis and vascular plexus as compared with rectangular blades and needles, as the depth of penetration required is lower. The use of acute angle reduces the depth of penetration for the same length of slit and decreases damage to deep plexus. Coronal slits produce less vascular damage than that of sagittal slits with the same size blades.

We believe that these recommendations provide the optimum volume slits while causing minimal vascular damage.

Head and Neck Restoration in Scar Alopecia: Hair Transplantation in Scalp, Eyebrows, Beard and Mustache

BACKGROUND

Surgical management of hair loss has become an increasingly challenging procedure, when dealing with scar alopecia. We investigated the efficacy of hair transplantation in patients with head and neck scar alopecia.

METHODS

From 2016 to 2018 in Shiraz, Iran, all patients with scar alopecia in head and neck were evaluated for efficacy of follicular unit extraction (FUE), follicular unit transplantation (FUT) or a combination of two methods from donor sites in scalp and beard various hair-grafts were compared.

RESULTS

Fifty-six patients were enrolled. Most of them were between 31 and 40 yr old (48.3%) and male (71.4%). Trauma, burn, surgical excision of adjacent skin, radiotherapy and leishmaniasis were the registered causes. Scars were visible in scalp (39.3%), beard (28.6%), eyebrow (21.4%), and moustache (10.7%) regions. FUE (87.5%), FUT (10.7%) and a combination (1.8%) were the used methods. One-hair-grafts were used in eyebrows (100%), moustache (100%), beard (88%) and scalp (7.9%), while 2-hair-grafts in beard (6%) and scalp (47.4%) and 3-haired grafts in beard (6%) and scalp (44.7%) transplantations.

CONCLUSION

In head and neck scar alopecia, hair transplantation was selected based on type and depth of scar. FUE was targeted when huge grafts were not needed, including beard, moustache, and eyebrow, while FIT was used when extensive scars were present in scalp. One-hair-grafts were mostly applied for eyebrow, moustache and beard, 2-hair- and 3-hair- grafts for beard and scalp transplantation. These findings can be added to the literature when FUE, FIT, or their combination are targeted in hair restoration of scar alopecia in head and neck.

Hair Transplantation and Follicular Unit Extraction

This article introduces the reader to the key components of hair transplantation, including evaluating the surgical patient, deciding whether to perform follicular unit transplantation (FUT) or follicular unit extraction (FUE), understanding the key components of these procedures, and establishing practical preoperative and postoperative protocols.

Follicular Unit Transplantation

Hair transplant is a powerful and reliable procedure that provides a natural and high-impact result. This procedure can be used to restore scalp hair, eyebrow hair, beard hair, body hair, or areas of hair loss due to scarring. The hair transplant techniques of the past (hair plugs, scalp reductions) have etched a negative impression of hair restoration surgery in the public memory. With the improved techniques of follicular unit transplantation, more natural and discreet results can be obtained with minimal downtime and preservation of patient privacy. This article focuses on follicular unit transplantation and performance of the strip technique.

Hair transplantation by follicular unit extraction for male androgenetic alopecia: A retrospective observational study from two centers

Background

Follicular unit extraction (FUE) is the most popular method of hair transplantation in today's world. Hair transplantation in androgenetic alopecia (AGA) in males can restore the frontal hairline and provide hair density in alopecic areas to the satisfaction of most patients.

Methods

Consecutive male patients of AGA who underwent hair transplantation by FUE method in two centers between the period of January 2016 and June 2017 have been included in this study based on inclusion and exclusion criteria. Photographic images, trichoscopy and Likert's scale were used to assess patient's improvement in hair density after the transplantation procedure. Statistical methods using SPSS software was used to analyze the results. Institutional ethical clearance and patients' written consent for procedure and images was obtained. The study was an observational retrospective study using data and images from records for which consent and ethical clearance was obtained from patients and the institution.

Results

Average number of follicular units transplanted in patients was 1290 (improvement in hair density: of 30.61 follicular units/sq cm). There was a statistically significant difference in improvement in hair density in patients younger than 33 years and in patients with Norwood classification below stage 4a. Forty-nine patients were satisfied with the results after assessment by the Likert scale.

Conclusion

Hair transplantation by follicular extraction method provides good hair cover in AGA in males. This modern dermatosurgical technique with its many innovations is a very helpful technique to improve quality of life in male pattern baldness.

Hair Transplantation in Frontal Fibrosing Alopecia and Lichen Planopilaris: A Systematic Review

OBJECTIVE

Evolving hair transplantation (HT) techniques have offered new possibilities for hair restoration. However, the role of HT in patients with frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) remains unclear. This study aims to evaluate the outcomes and temporal relationship of HT in this population.

METHODS

A literature search of three databases was conducted. We reviewed 1) literature reporting outcomes of patients with LPP or FFA who received HT, and 2) studies reporting the development of LPP or FFA resulting from HT.

RESULTS

Thirteen articles included 42 patients that provided data for evaluation. Fifteen patients had previously been diagnosed with FFA or LPP, and the remaining 27 patients developed disease after undergoing HT. Seven patients with FFA and eight patients with LPP received HT, with a mean sustained disease remission of 2.69 years prior to HT. In total, two of seven (29%) patients with FFA and five of eight (75%) patients with LPP experienced positive HT results over a follow-up period of 8-72 months. Interestingly, 27 patients without evidence of previous disease developed FFA or LPP following HT after a median duration of 16 months.

CONCLUSIONS

HT for LPP and FFA is feasible but results may be less favorable compared to HT for other causes. Outcomes may be more favorable for LPP than FFA but this was not statistically significant and evidence is very limited. FFA and LPP can also develop following HT in patients without previous evidence of disease.

LEVEL OF EVIDENCE

NA Laryngoscope, 131:59-66, 2021.

Contemporary Management of Alopecia: A Systematic Review and Meta-analysis for Surgeons

BACKGROUND

The decision of surgical approach for hair restoration often involves evaluation of the type of alopecia; however, the impact of surgical hair restoration from existing techniques in specific population subsets has not been comprehensively investigated.

OBJECTIVES

The authors sought to systematically review the literature on micrografts, minigrafts, mini-micrografts, tissue grafts, tissue flaps and expanders, as well as evaluate graft survival and satisfaction within specific populations in a meta-analysis.

METHODS

PubMed and Scopus literature searches between 1980 and 2018 yielded 57 articles for systematic review and 34 articles for meta-analysis. Study design, mean patient age and gender, patient alopecia type, surgical hair restoration technique, number of treatment areas, mean follow-up, graft survival rate and satisfaction rate were extracted from each study, and a meta-analysis was performed.

RESULTS

The pooled rates of graft survival were 84.98% (95% CI 78.90-91.06) using micrografts and 93.11% (95% CI 91.93-94.29) using micrografts and minigrafts in nonscarring alopecia patients, as well as 88.66% (95% CI 80.12-97.20) using micrografts and 86.25% (95% CI 74.00-98.50) using micrografts and minigrafts in scarring alopecia patients. The pooled rates of satisfaction were 89.70% (95% CI 82.64-96.76) using micrografts and 97.00% (95% CI 92.48-100.0) using micrografts and minigrafts in nonscarring alopecia patients, as well as 97.80% (95% CI 94.59-100.0) using micrografts and 88.70% (95% CI 66.49-100.0) using micrografts and minigrafts in scarring alopecia patients. Dot plots depict rates of graft survival rate from micrografts and satisfaction from micrografts and minigrafts.

CONCLUSION

Surgical hair restoration for nonscarring and scarring alopecia yields high graft survival and satisfaction rates.

LEVEL OF EVIDENCE III

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.

Large-Scale Beard Extraction Enhances the Cosmetic Results of Scalp Hair Restoration in Advanced Androgenetic Alopecia in East Asian Men: A Retrospective Study

INTRODUCTION

Beard hair serves as an important additional donor supply to support hair transplantation in hirsute patients with extensive alopecia and lacking sufficient occipital hair. However, the efficacy and safety of large-scale beard hair extraction have not been studied extensively in the East Asian population.

METHODS

Data obtained from hirsute patients with extensive alopecia who underwent hair transplantation between March 2017 and December 2018 at Nanfang Hospital were analyzed. Occipital and beard hair were evaluated separately during the pre-, intra-, and post-operative periods. Individual beard hair follicular units (FUs) were harvested under tumescence using a hollow punch with an outer diameter of 0.8-0.9 mm. Follow-up examinations were scheduled at 3-5 days, 1 month, and 9 months postoperatively to check for complications, determine the survival rate of mixed, transplanted FU grafts, and assess patient satisfaction. Data were collected and analyzed statistically.

RESULTS

A total of 36 hirsute, male patients with advanced androgenetic alopecia (AGA) (Norwood-Hamilton V-VI) were included in this study. The density of the occipital and beard areas was 78.6 ± 4.6 and 48.4 ± 9.3 FU, respectively. It took 3.1 ± 0.9 h to harvest 3135 ± 863 FUs from the occipital area and 2.1 ± 0.6 h to harvest 2352 ± 599 FUs from the beard area. The transection rate for occipital FUs and beard FUs was 3.7 ± 0.4 and 3.9 ± 0.2%, respectively. Completion of the operation took approximately 10.0 ± 0.9 h, and no serious complications were reported 5 days after the procedure. An FU survival rate of 95.7 ± 1.6% was observed at 9 months after transplantation, with no visible hypopigmented scars observed in the bare areas. All patients were satisfied with the resulting cosmetic appearance.

CONCLUSION

Large-scale beard extraction, when combined with occipital hair extraction, is a safe and effective treatment to enhance the cosmetic appearance of East Asian men with advanced AGA.

Method for Human Eccrine Sweat Gland Isolation from the Scalp by Means of the Micropunch Technique and Vital Dyes

The isolation of eccrine sweat glands from human skin has always been a difficult task. The human scalp contains thousands of eccrine glands. Recently, the close anatomic relationship of the eccrine gland with the scalp hair follicle has been described. Taking advantage of this anatomic relationship as well as of the availability of follicular units (FUs) obtained in hair transplant procedures, we describe here a simple and efficient method to isolate eccrine sweat glands from the human scalp. This method is identical to the micropunch hair graft harvesting method known as follicular unit excision (FUE), used in modern hair transplantation. Once the FU has been extracted, it needs to be stained with methylene blue or neutral red in order to make the sweat gland visible for stereoscopic microdissection. Only the secretory (coiled) portion of the sweat gland can be obtained with this method. The efficiency of this isolation method should encourage further research into human eccrine sweat glands and opens possibilities for new translational applications.

A Systematic Review of Outcomes and Patient Satisfaction Following Surgical and Non-surgical Treatments for Hair Loss

INTRODUCTION

This systematic review aims to examine surgical and non-surgical treatments and identify those procedures that are most effective in terms of patient satisfaction.

MATERIALS AND METHODS

A systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. The search was conducted in accordance with the PRISMA guidelines, the Cochrane handbook. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, and Cochrane databases was performed to identify studies on hair loss causes and hair loss treatment with different surgical and non-surgical techniques RESULTS: Our search generated a total of 781 articles; 646 studies were excluded based on the content of the abstracts, and an additional 105 studies were excluded based on the content of the complete article. We performed a review of the 30 remaining studies, which had sufficient data for inclusion, and met all the aforementioned inclusion criteria. Of the 30 studies, four were about minoxidil, four about finasteride, two about dutasteride, three about phototherapy, six about platelet-rich plasma injection, four about follicular unit transplantation technique, six about follicular unit extraction technique, and one about patient satisfaction following surgical treatment without a specified surgical technique. Only three studies used a patient-reported outcome measurement.

CONCLUSIONS

Our study is the first comprehensive systematic review of hair loss, looking at the problem from different points of view, and focusing on finding the best solution for the patient. In the literature, there is currently no algorithm for the management of patients who go to a plastic surgeon for a solution to the problem of hair loss.

LEVEL OF EVIDENCE III

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.

Evaluating the Satisfaction of Patients Undergoing Hair Transplantation Surgery Using the FACE-Q Scales

BACKGROUND

It is necessary to evaluate a successful cosmetic procedure from the patients' perspective. FACE-Q is a patient-reported outcome scale for patients undergoing cosmetic procedures. However, currently there are no FACE-Q scales used in the field of hair transplant surgery. This article aims to apply FACE-Q scales to evaluate the satisfaction of patients undergoing hair transplantation surgery.

METHODS

FACE-Q scales were modified to contain both preoperative and 6-month postoperative self-assessment, including baseline preoperative information of patients (such as age, family history of alopecia, Hamilton' alopecia grade),preoperative self-assessment (satisfaction with appearance, the preoperative visual age, expected visual age) and postoperative self-assessment (satisfaction with appearance, postoperative visual age, satisfaction with decision, psychological well-being and social function). Besides, early life impact and recovery early symptoms were also re-evaluated.

RESULTS

The mean difference between the 6-month satisfaction with appearance and baseline scores showed a significant increase of 29.62 (baseline, 46.97; 6-month, 76.59; P < 0.001) and patients perceived they appeared 5.81 years younger after surgery (P < 0.001). Postoperative satisfaction with appearance has no significant relevance with gender (P = 0.460), age (P = 0.529), marriage (P = 0.811) or family history of alopecia (P = 0.641). However, income (P = 0.003), educational level (P = 0.003), the purpose of hair transplantation (P = 0.018) and early life impact (P = 0.002) were shown to have a significant impact on satisfaction with appearance.

CONCLUSIONS

The FACE-Q scales are a valid and reliable patient-reported outcome tool for patients undergoing hair transplantation and can be widely used to evaluate the satisfaction of patients undergoing such surgery.

LEVEL OF EVIDENCE IV

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 .

Recycling of Previously Transplanted Hair: A Novel Indication for Follicular Unit Extraction

BACKGROUND:

Hair transplantation has enhanced the realm of procedural dermatology. Before the advent of follicular transplantation, androgenetic alopecia was a difficult disease to manage, as there is a limited armamentarium of topical and systemic pharmaceuticals. However, as with other novel surgical procedures, there is a steep learning curve, that may result in poor transplantation or cosmesis.

CASE REPORT:

We present a case of androgenetic alopecia, where previously, poorly implanted hairs were recycled by follicular unit extraction to increase hair density at the vertex of the scalp, which resulted in improved cosmesis and patient satisfaction.

CONCLUSION:

We have demonstrated that re-transplantation is not only feasible but is effective; therefore redesigning of previous transplantations should be considered as a possible indication follicle unit extraction, particularly in the setting of scarce follicular reserves. The utility of our recycling method may also inspire hope in patients that have undergone failed or unsatisfactory hair transplantations.

Localized Telogen Effluvium Following Hair Transplantation

Telogen effluvium is categorized in nonscarring alopecia, which shows scalp hair thinning and shedding diffusely resulting from inducing factors such as physiological stressful events and several acute or chronic diseases. It usually appears in female patients following parturition, as well as after febrile disease, major surgery, emotional stress, abrupt diet, chronic illness, or the taking of certain medication pills. Two patients who both recalled an operational history of hair transplantation visited our department with their frontal and both temporal hair loss. Physical examination of the both patients showed localized but diffuse hair loss, especially in the frontal and temporal scalp. Histopathological examination of biopsy specimen taken from their temporal scalp revealed normal follicular density and increased numbers of telogen hair follicles without any inflammatory cell infiltration around follicles. These clinical and histopathological findings were consistent with telogen effluvium. Both of them were reassured and placed on close follow-up without any treatment. From these cases, we demonstrate that localized telogen effluvium could be a cause of hair loss after hair transplantation.

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

Purpose

To investigate the effectiveness of hairline advancement in treating patients with perceived close-set eyes due to a wide infratemple area.

Materials and Methods

Infratemple area hairline advancement was performed in 19 patients with perceived close-set eyes caused by a wide infratemple area; all were women with a mean age of 29.4 years.

Results

The wide infratemple area was effectively narrowed in the frontal view in all patients. The mean reduction in the distance between the bilateral infratemple hairlines in the frontal view was 5.2 mm (range 3.9–6.3 mm). The appearance of close-set eyes was ameliorated, and patient satisfaction was high. No side effects, such as asymmetry or wound infection, were encountered.

Conclusion

Hairline advancement surgery appears to be a safe and effective means of treating patients with perceived close-set eyes due to a wide infratemple area.

Level of Evidence IV

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.

Using Pork Skin as a Practice Medium for Learning Hair Transplantation Techniques

A simple technique using pork skin and excess hair and epidermis harvested from anti-wrinkle surgeries was used to practice hair transplantation techniques. This allows inexperienced physicians to practice and perform the traditional steps of hair transplantation without involving an actual patient in the early stages of perfecting technique. The technique uses pork skin during the procedure, while performing real-time hair transplantation simulation. The surgical result of the procedure can then be visualized, and the training process can be repeated at will; peer evaluation is performed after completion. Results showed that residents that practiced this technique scored consistently better than those without the same training background. Every score increased with practice, and the length of time needed to complete the hair transplantation process decreased. A simple technique using pork skin for practicing hair transplantation technique is a valuable training tool, and gives residents a way to practice sound techniques along with more precise anatomical familiarity for hair transplantation surgery, without the risks associated with training on live patients.

Lichen Planopilaris in the Androgenetic Alopecia Area: A Pitfall for Hair Transplantation

BACKGROUND

Classic lichen planopilaris (LPP) is a patchy form of primary lymphocytic cicatricial alopecia localized on the vertex of the scalp. It is important, however, to be aware of other, less recognized presentations that may be missed without dermatoscopy and pathology.

METHODS AND RESULTS

We report 26 patients with LPP presenting with subtle erythema and scaling colocalized in the area of patterned thinning (androgenetic alopecia, AGA). All patients had been treated for seborrheic dermatitis in the past. Dermatoscopy showed the presence of 2-4 hairs emerging as a tuft from the same ostium surrounded by erythema, peripilar casts and interfollicular scaling associated with hair miniaturization. Histopathology obtained from those areas corresponded to LPP with concomitant follicular miniaturization.

CONCLUSION

Subtle or focal cases of LPP may be missed for seborrheic dermatitis when overlapping with AGA. Dermatoscopy-guided biopsy from the affected scalp is the best approach to make a timely diagnosis. This is particularly important in patients with AGA evaluated to undergo hair transplantation, as active LPP is a contraindication for these patients.

Follicular unit transplantation for the treatment of secondary cicatricial alopecia

BACKGROUND

Cicatricial alopecia encompasses a diverse group of disorders characterized by the permanent destruction of hair follicles and irreversible hair loss. Follicular unit transplantation was developed in 1994. However, large-scale clinical trials are necessary to study follicular unit transplantation for treating Chinese cicatricial alopecia patients.

OBJECTIVE

To investigate the efficacy of follicular unit transplantation in the treatment of cicatricial alopecia in Chinese patients.

METHODS

Patients with cicatricial alopecia were enrolled. The designated recipient area, follicular unit density of the donor site, transplanted density and operative time were recorded. Postoperative follow-up was conducted within six to 24 months; the density of hair in the recipient area was calculated using a Folliscope (Hansderma Co, USA). Patients' self-reported satisfaction and long-term complications were recorded.

RESULTS

Thirty-seven patients were enrolled. Cicatricial alopecia was caused by burns (n=8), trauma (n=21) and plastic surgery (cleft lip and palate repair [n=8]). Burn patients had a significantly larger bald area than the other patients (P<0.01). The operative time was significantly correlated with recipient area. The longest operation was 14.5 h; the largest transplanted area was 96 cm(2). At follow-up, the surviving follicular unit density/transplanted follicular unit density rate was 64.29% to 95.00% (mean 78.96%); the surviving/transplanted (S/T) area was 100% for 30 patients, 90% to 100% for five patients and <90% for two patients. The lowest S/T area was 82.81%. The S/T index was significantly and inversely correlated with operative time. Regarding long-term complications, two patients had postoperative epidermoid cysts that healed with local treatment.

CONCLUSION

Follicular unit transplantation is an effective method for treating cicatricial alopecia. It is relatively safe and yields satisfactory postoperative results. Extending the results of the present study to Chinese clinical practice is warranted.

Outcomes of staple closure of the donor area during hair transplant by follicular unit transfer

Background:

Donor area closure in hair transplantation by follicular unit transfer (FUT) is being done by various techniques. This study aims to assess the outcomes of staple closure for donor area in FUT.

Aim:

To study the outcome, efficacy and complications of staples in donor area closure for FUT.

Materials and Methods:

A total of 50 consecutive patients who underwent staple closure for donor area in FUT were included in the study and their data were collected retrospectively. Patients were followed up one year after the surgery and photographic documentation of the scar at the donor site was done. Objective measurement of the width of the scar was done for all the patients.

Results:

The average length of the donor area was 22 cm. The average width of the scar was 1.82 mm. There was no infection or tissue necrosis at the staple closure site in any of the patients.

Conclusion:

Staple closure resulted in cosmetically acceptable scar, but post operative discomfort was the major limitation. The potential to conserve the hair follicles along the line of closure makes using staples worthwhile if conservation of follicles is the goal.

A study of donor area in follicular unit hair transplantation

BACKGROUND

The advent of follicular unit transplantation (FUT) has given a natural appearance in the recipient area in the past two decades, but has left behind an unsightly scar in the donor area. A study of donor area and techniques to make it cosmetically acceptable is lacking.

AIM

The aim of this study was to evaluate the donor area after follicular unit hair transplantation and to show a few techniques to make the donor scar aesthetically pleasing.

MATERIALS AND METHODS

The donor area was examined for scar width and patient satisfaction scores of donor area in 30 consecutive patients from March 2012 to February 2013 retrospectively after a minimum of 3 months after the procedure. Complications such as effluvium along suture line, wound infection, dehiscence, necrosis, folliculitis, keloids and wide scars were also noted.

RESULTS

Scar width increased with increase in width of the donor strip. Patient satisfaction scores declined with larger strip widths. The most common complication seen was folliculitis-like lesions. Double trichophytic closure yielded the most aesthetically acceptable scar.

CONCLUSION

FUT produces a linear scar in the donor area, which can be a significant concern in patients wishing to cut their hair short. Restricting the width of the donor strip and trichophytic closure has greatly improved the appearance of the scar.

Management of the crown

Treatment of alopecia of the crown possesses several unique challenges for hair restoration physicians. In this article, the distinctive anatomic features and specific management paradigms related to the crown are discussed. This review also offers details on which surgical technique to implement for obtaining the most natural result possible that also yields the best possible apparent density.

Beard reconstruction using hair grafts in a free flap

Hair transplantation using micrografts or minigrafts is a standard procedure used for hair restoration in androgenic, burn scar and cicatricial alopecia. These grafts have also been used to reconstruct the eyebrow, eyelash, mustache, beard and pubic escutcheon. A patient who underwent successful micrograft and minigraft hair transplantation into a free osteocutaneous mandibular flap reconstruction is presented. The patient was very satisfied with his reconstruction, and the hair transplants provided excellent camouflage for the flap.

Review of factors affecting the growth and survival of follicular grafts

Great strides have been made in hair restoration over the past 20 years. A better understanding of natural balding and non-balding patterns along with more respect for ageing has helped guide proper hairline design. Additionally, the use of smaller grafts has created a significantly improved natural appearance to the transplanted grafts. Inconsistent growth and survival of follicular grafts, however, has continued to be a problem that has perplexed hair restoration surgeons. This review attempts to explore the stresses affecting grafts during transplantation and some of the complexities involved in graft growth and survival. These authors reviewed the literature to determine the primary scope of aspects influencing growth and survival of follicular grafts. This scope includes patient selection, operating techniques, graft care, storage solutions and additives. The primary focus of the hair restoration surgeons should first be attention to the fundamentals of hair care, hydration, temperature, time out of body and gentle handling. Factors such as advanced storage solutions and additives can be helpful once the fundamentals have been addressed.

Hair Transplantation: Preventing Post-operative Oedema

Swelling or oedema of forehead or eyelids is a common consequence of hair transplantation surgery. However, this results in increased morbidity and absence from work due to unaesthetic appearance. To study various physical and therapeutic modalities to reduce or completely prevent the occurrence of such oedema. Three hundred forty hair transplant patients were recruited in the study and were categorized into 8 groups depending upon the intervention employed. There were 32 dropouts in the study due to various reasons. Patients who were administered steroid with tumescent solution had the highest number of patients without oedema, with only 3 out of 117 patients developing oedema. Physical measures like position of head during sleeping, application of occlusion bands or ice packs did not show satisfactory results. Addition of triamcinolone to tumescent anaesthetic solution is a very effective technique of preventing post-operative swelling.

Hair transplantation surgery

Techniques in hair transplantation have evolved recently which make results look more natural. Hair restoration is one of the most exciting and innovative surgical fields in aesthetic surgery today. A precise appreciation of anatomy has allowed the use of follicular unit grafts. With better methods of harvesting and implantation, hair transplantation results represent a blend of art and science.