Laser-assisted autologous hair transplantation with the Er:YAG laser

Autologous hair transplantation has become an established therapy for irreversible alopecia. With the advent of CO2 lasers, new procedures have developed. However, CO2 lasers are associated with some disadvantages, and the introduction of the erbium YAG laser has led to further improvements. A case illustration of this technique is given here, and a study of 50 patients has been initiated to further evaluate the potential of this laser.

Hair transplantation: New concepts in 2005

This article will provide a brief review of the current concepts in hair transplantation. Currently, hair transplantation creates natural appearing transplanted hair for men and women. Patient consultation is an essential component of a successful procedure. During the consultation realistic expectations are essential and are based on the patient's donor density, caliber of hair follicle, and rate of hair loss. Alternative and adjunctive therapies such as finasteride and minoxidil should be a basic component of any consultation. The only limit to the procedure is the amount of donor hair each patient has available. For the vast majority of patients, elliptical donor harvesting provides the most efficient technique for harvesting hair. Follicular unit extraction can be a useful technique for a minority of patients.

[Plastic surgical management of large cicatricial scalp alopecia]

OBJECTIVE

To investigate the proper ways to manage a large cicatricial scalp alopecia.

METHODS

Based on the location, size and condition of the scarring lesions, 218 patients with 20 - 75% scarring alopecia were selected and treated with either dense-packing hair grafting technique (136 cases) or tissue expansion (82 cases). There were 209 in burn, 5 in avulsed injury and 4 in tumor excision. The lesions with thick, stable scars in the frontal or/and temporal areas undergoing either hair grafting or tissue expansion process as desired by the patients. In addition, the alopecia in an unstable scar on the skull, with skull defect under the lesion and the lesion involved in the back of the head was only treated with tissue expansion. The hair-grafting technique was carried out by harvesting a scalp strip from the back of the head, then dividing it into a series of 1 - 3 hair grafts and finally implanting them into the prepared recipient holes of the lesion with a desired hair direction. Ten areas with 1 cm(2) size in 10 patients were randomly selected to examine the hair survival over 8 months post-operation. Tissue expansion was performed by firstly positioning a tissue expander in the subgaleal pocket of the scalp and serially inflating it with normal saline in 5 - 7 days intervals for about 3 months. Thereafter, an expanded scalp flap was designed, with the combination of advancement and rotation flap transplantation principles, to be transferred to the recipient site after lesion removal.

RESULTS

In patients with hair-grafting technique, hair density reaching 60 - 80 hairs/cm(2) per session. Over 8-months following-up, the grafted hairs grew good with 98% hair survival. Forty-five patients with 20% - 30% scalp hair loss were reaching very satisfactory results with only one session while 91 patients with 31% - 50% hair loss were needed a second session to improve their appearance. In those with tissue expansion, 56 patients with 20% - 50% scalp loss were managed in one session and 26 patients with 51% - 75% scalp loss needed secondary tissue expansion. All of the expanded hair-bearing flaps survived well with only minimal complications (9.8%) of the infective dome explosion in 3, slight skull depression in 2, seroma in 5 and early infection in 1.

CONCLUSION

Either hair grafting or tissue expansion is proven as a safe and effective technique for restoration of large cicatricial scalp alopecia. The former technique could be of benefits to simple, mini-surgical procedure, natural hair growth and good for lesion size under 30%. And the letter technique shows wider clinical indications, especially for the patients with unstable scar, skull defect under lesion and lesion over 50%. But the obvious drawbacks are multi-clinic visiting, disfigurement and long-term procedures.

Hair restoration

The impact of male hair loss as a personal and social marker of aging is tremendous and its persistence as a human concern throughout recorded history places it in the forefront of male concern about the physical signs of aging. Restoration of the frontal hairline has the visual effect of re-establishing facial symmetry and turning back time. Follicular unit transplantation has revolutionized hair restoration, with its focus on redistributing large numbers of genetically stable hair to balding scalp in a natural distribution. Follicular unit hair restoration surgery is a powerful tool for the facial plastic surgeon in male aesthetic facial rejuvenation because it offers high-impact, natural-appearing results with minimal downtime and risk for adverse outcome.

Hair transplantation: standard guidelines of care

Hair transplantation is a surgical method of hair restoration.

PHYSICIAN QUALIFICATION

The physician performing hair transplantation should have completed post graduation training in dermatology; he should have adequate background training in dermatosurgery at a centre that provides education training in cutaneous surgery. In addition, he should obtain specific hair transplantation training or experience at the surgical table(hands on) under the supervision of an appropriately trained and experienced hair transplant surgeon. In addition to the surgical technique, training should include instruction in local anesthesia and emergency resuscitation and care.

FACILITY

Hair transplantation can be performed safely in an outpatient day case dermatosurgical facility. The day case theatre should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place and all nursing staff should be familiar with the emergency plan. It is preferable, but not mandatory to have a standby anesthetist. Indication for hair transplantation is pattern hair loss in males and also in females. In female pattern hair loss, investigations to rule out any underlying cause for hair loss such as anemia and thyroid deficiency should be carried out. Hair transplantation can also be performed in selected cases of scarring alopecia, eyebrows and eye lashes, by experienced surgeons.

PREOPERATIVE COUNSELING AND INFORMED CONSENT

Detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and if more procedures are needed for proper results, it should be clearly mentioned. Patient should be provided with adequate opportunity to seek information through brochures, computer presentations, and personal discussions. Need for concomitant medical therapy should be emphasized. Patients should understand that proper hair growth can be expected after about 9 months after transplantation. Preoperative laboratory studies to be performed include Hb%, blood counts including platelet count, bleeding and clotting time (or prothrombin time and activated partial thromboplastin time), blood chemistry profile including sugar.

METHODS

Follicular unit hair transplantation is the gold standard method of hair transplantation; it preserves the natural architecture of the hair units and gives natural results. Mini-micro-grafting is a method hair transplantation involving randomly assorted groups of hairs, with out consideration of their natural configuration of follicular units, under loupe or naked eye examination. Mini-grafts consist of 4-5-6 hairs while micro-grafts consist of 1-3 hairs. Punch gives ugly cosmetically unacceptable results and should no longer be used.

PATIENT SELECTION

Hair transplantation can be performed in any person with pattern hair loss, with good donor area, in good general health and reasonable expectations. Caution should be exercised in, very young patients whose early alopecia is still evolving, patients with Norwood grade VI or VII with poor density, patients with unrealistic expectations, and patients with significant systemic health problems.

MEDICAL THERAPY

Most patients will need concurrent medical treatment since the process of pattern hair loss is progressive and may affect the remaining hairs.

MANPOWER

Hair transplantation is a team effort. Particularly, performing large sessions, needs a well trained team of trained assistants.

ANESTHESIA

2% lignocaine with adrenaline is generally used for anesthesia; tumescent technique is preferred. Bupivacaine has been used by some authors in view of its prolonged duration of action.

DONOR DISSECTION

Strip dissection by single blade is recommended for donor area. Steromicroscopic dissection is recommended for dissection of hair units in follicular unit transplantation; mini-micro-grafting does not need microscopic dissection.

RECIPIENT INSERTION

Different techniques and different instruments have been used for recipient site creation ;these depend on the choice of the operating surgeon and have been described in the guidelines. Graft preservation is important to ensure survival.

DENSITY

Minimum density of 35-45 units per sq cm is recommended. Results depend on donor characteristics, technique used and individual skills of the surgeon.

Expansion cutanée dans les alopécies cicatricielles du cuir chevelu: 18 cas

INTRODUCTION

Skin expansion technique used to increase the hair surface available at the scalp level was a major breakthrough in the surgical treatment of important cicatricial alopecia. This article had for aim to define the importance and limits of this technique in the treatment of alopecia and to highlight its relevance compared to other methods.

PATIENTS AND METHODS

Between November 1998 and April 2006, 18 patients (7 women and 11 men) presenting with one or many cicatricial alopecia areas were treated by skin expansion. The age of patients ranged between 14 and 68 years, with an average of 33 years. The indications were related to burn sequels in 44% of all cases. The average area of alopecia was 167 cm2. This technique combines two operating phases. In the first phase, the expansion balloon is inserted and then gradually filled. In the second phase, it is removed and the alopecic area is covered by the expanded flaps.

RESULTS

Thirty-nine expansion prostheses were used, with an average volume of 292 cc. Their number varied between 1 and 6 (two on average) for each patient. The average duration of expansion was 77 days. The tissue gained with this technique allowed the use of 38 flaps. The transposition flaps was the most frequently used (39.4%). The rate of major complications leading to total failure of the process reached 5.5%. The final result was considered good in 90% of the cases.

DISCUSSION

The results demonstrate that skin expansion technique is a simple, reliable, and efficient method in the healing of important cicatricial alopecia of scalp. It enables a wider use of the classical local flap technique, by expanding the surface and vascularization allowing for a direct suturing of the donor site. Skin expansion holds an important place in the treatment of significant skin cicatricial alopecia, since it represents the only surgical solution when the alopecia area exceeds 50 cm2.

Surgical interventions for the treatment of radiation-induced alopecia in pediatric practice

Permanent alopecia can occur following treatment for pediatric malignant disease, especially cranial irradiation, resulting in identity and self-image problems. This late effect is usually addressed through external cosmesis and psychological adjustment. Surgical options are less commonly utilized. The experience of reconstructive procedures in patients at RLC NHS Trust, Alder Hey with alopecia is presented. Four patients had scalp tissue expansion and one had hair transplantation. The reconstructive options available are discussed as well as the potential opportunities and difficulties in this population. Post-radiotherapy alopecia can be successfully addressed by reconstructive surgery, and should be considered more often in this population.

New flap for restoration of the temporal hair line

The authors have devised a novel method of designing a flap for coverage of posttraumatic temporal hairline alopecia. They have successfully performed restoration of temporal hairline alopecia as large as 18 x 4 cm resulting from a previous trauma treated with a primary grafting. The new method uses a simple flap designed preoperatively by Doppler based on the supraorbital vessels up to the flap's anastomosis with the occipital vessels. This flap is easy to design and elevate with sufficient blood flow. Alopecia resulting from scar formation at the suture line is not conspicuous. The donor site can be closed primarily, and no dog ear has resulted from its application.

Laparoscopic adrenalectomy - a cure for male pattern baldness

A 64-year-old woman presented to a dermatologist with male pattern hair loss and was found to have grossly elevated testosterone levels at 22.3 nmol/l (normal range, 0.0-2.9 nmol/l). The diagnosis of an androgen-secreting adrenal tumour was made and she underwent a laparoscopic retroperitoneal right adrenalectomy with an uneventful speedy recovery, being discharged in less than 48 h, underlining the clear advantage of this approach.

Evolution of Techniques in Hair Transplantation: A 12-Year Perspective

Few if any fields of medicine have undergone such dramatic advancements in technique and outcomes as surgical hair restoration over the past 12 years. Not very long ago, the procedure produced results that were, from a cosmetic perspective, acceptable at best; we are now capable of creating results that truly are natural and undetectable in appearance. These developments have clearly resulted in a procedure-follicular unit hair transplanting-far superior in outcome to the once popular other surgical hair restoration procedures of bald scalp reductions and scalp flap surgery, as well as micro- and mini-grafting.

[A "silicone suture" technique aided to scalp reduction for the treatment of scarring alopecia]

OBJECTIVE

To evaluate a "silicone suture" technique for enhancing the effect of scalp reduction.

METHODS

Under the local anesthesia, when an incision was made in the midline of the lesion, the dissection was carried out underlying the sub-galea on both sides of the lesion, as far as the width of the lesion. A 3 mm silicone suture in diameter was placed in the galea beyond the lesion. After the first suture bite was anchored in the tissue at one end, the suture device was continued across the midline in such a way as a running, buried, horizontal mattress suture and it was brought out to the skin surface through the deep tissue at the another end of the lesion with a locker. The extra-tissue of the lesion was then excised and the wound was directly closed in layers. After one week of the operation, the silicone suture was gradually tightened in 2-3 times a week for about 3-5 weeks, until both sides of the lesion were approximately closed. The device was there after removed and the wound was directly closed in layers after the scar was excised.

RESULTS

Between October of 1999 and March of 2006, 12 scarring-scalp patients, 7 males and 5 females, were treated by using the silicone suture device without complications. The excised defects were 5-10.5 cm in width. The stretching period was 26.4 days in mean. With the following-ups over 3 months, no hypertrophic scar and widening scar cases appeared.

CONCLUSIONS

The silicone suture as an alternative device for tissue extension could be a safe, simple, effective and economical device. It could significantly enhance the efficiency of scalp reduction.

[Prevention and treatment of postoperative complications after skin soft tissue expansion for scar alopecia]

OBJECTIVE

To summarize the prevention and treatment of postoperative complications after the skin soft tissue expansion for scar alopecia.

METHODS

From January 1995 to June 2005, 57 patients with scar alopecia were admitted to our department for treatment. Of the patients, 25 were males and 32 were females with their ages ranging from 5 to 55 years. The causes were burn in 33 patients, trauma in 14, alopecia after head surgery in 8, and other causes in 2. Their disease courses ranged from 6 months to 15 years. For treatment, 89 therapeutic expanders were utilized in 57 patients. The retrospective analysis on the complications and their prevention and treatment were performed.

RESULTS

The follow-up for 3-12 months averaged 6 months revealed that 81 areas undergoing the expander insertion healed well and the hair grew well, too. Eight areas undergoing the expander insertions had complications, including expander exposure in 2 patients, infection in 2, hematoma in 1, expander rupture in 1, necrosis of the flap tip in I, and scar necrosis at the injection port in 1. The results also revealed that there was a significantly increased rate of complications in the patients aged 5-10 years and the patients older than 50 years (P<0. 05). The complication rate in the patients who received 2 expanders at one time was significantly higher than that in the patients who received only 1 expander (P<0. 05). However, there was no significant difference in the complication rate in the other kinds of patients. All the complications were effectively treated with a satisfactory therapeutic result.

CONCLUSION

The skin soft tissue expansion for scar alopecia can effectively prevent and treat postoperative complications. If the complications are identified early and treated properly, the therapeutic results will be satisfactory.

The Role of Platelet Plasma Growth Factors in Male Pattern Baldness Surgery

BACKGROUND

Follicular units are commonly used in baldness surgery, and they have become a global procedure for both male and female patients. The yield from micrografts varies between 70 and 85 percent. Yield is determined by factors such as quality of the harvested donor area, preparation of the units, care taken during the implantation procedure, and follicular apoptosis. To improve hair density and stimulate follicular unit growth, an experimental study was designed using platelet plasma growth factors obtained from the patient's autologous plasma.

METHODS

The author established a protocol within a group of 20 patients with male pattern baldness. The data showed a gaussian distribution; to compare the two procedures involved in this clinical trial, the paired t test was used.

RESULTS

The author observed a significant difference in the yield of follicular units when comparing the experimental with the control areas of the scalp (p < 0.001). The areas treated with platelet plasma growth factors demonstrated a yield of 18.7 follicular units per cm2, whereas the control areas yielded 16.4 follicular units per cm2, an increase in follicular density of 15.1 percent. Among patients who used the experimental protocol, some experienced only 3 percent and others experienced a 52 percent increase in density.

CONCLUSIONS

This study provides a new perspective and contribution to baldness surgery with follicular unit megasessions, and demonstrates an improvement that can be introduced into baldness surgery clinics with less morbidity and a low cost-to-benefit ratio. Further studies may improve the efficiency of the technique and allow digital programs to better evaluate the increase in hair density.

Moustache Reconstruction in Patients With Cleft Lip

Men with clefts often have limited or even missing moustache growth in scar areas or in the upper lip prolabium. However the histological testing showed the absence or at least the inactive form of androgenic receptor in hair follicle of cleft site, transplantation of autologous grafts harvested from hair was successful in all six cases either into scars or the prolabium. A more natural effect was achieved by using micrografts. The positive reaction of patients proved there is a need for detailed treatment in highly outgoing individuals.

The triple rotation scalp flap revisited: a case of reconstruction of cicatricial pressure alopecia

Rotation flaps constitute a time-honoured method for repair of small-to-moderate scalp defects, in effect even in the era of microsurgical reconstruction. A case of cicatricial pressure alopecia that was successfully repaired using the Bardach modification of the curved tripod flap confirms the value of this flap in scalp reconstruction. The main advantages of this method are the natural appearance of the final result due to preservation of hair orientation, and the uniform distribution of the wound-closure tension over a wide peripheral area of the scalp, although extensive undermining is generally required.

Survival rate according to grafted density of Korean one-hair follicular units with a hair transplant implanter: Experience with four patients

BACKGROUND

The survival rate of grafted hairs in hair transplantation has been frequently discussed by many hair-transplant surgeons. Several factors, including skill of doctors and assistants and the amount of perifollicular connective tissue, are suggested to have predictive values in foretelling the eventual quantity of hair growth.

OBJECTIVE

The purpose of this study is to determine survival rate according to density of Korean one-hair follicular units grafted with a KNU implanter.

METHODS

We designed four templates of 1 cm2 made by tattooing two templates on each side of empty frontoparietal recesses in four Korean patients with male pattern alopecia (beyond Norwood-Hamilton-Type IIIa). One-hair follicular units were prepared from occiput and we grafted 20, 30, 40, and 50 one-hair follicular units using a KNU implanter on each template, respectively, and counted the number of surviving hairs after 10 months.

RESULTS

The survival rate of 20 and 30 grafts per template was higher than that of 40 and 50 grafts.

CONCLUSION

We think that 30 one-hair follicular units grafted with a KNU implanter is the proper density for better survival in Korean hair transplantation, and repeated sessions will be necessary for a better final result. However, we need further evaluation with a larger number of participants to overcome the small sample size and limitation of one-hair follicular unit grafts. The authors have indicated no significant interest with commercial supporters.

Supragaleal placement of tissue expander for post-burn alopecia

Supragaleal placement of tissue expander for management of alopecia of scalp excludes tough galeal layer so that easier and faster expansion of scalp may be achieved.

Follicular unit transplantation for male-pattern hair loss: Evaluation of 120 patients

The main aim in surgical hair restoration is to restore hair, making the scalp look natural. Interviews with earlier patients who received hair transplants revealed that their complaints were - a straight anterior hairline that looked unnatural, and hair that looked like 'sprouted grass'. The use of follicular unit transplantation (FUT) technique, where hair roots are harvested under magnification, is becoming widespread. In this technique, hair roots are harvested into natural follicular units that contain 1-4 hair roots. In this article, we present our results related to hair transplantation by FUT technique, performed on 120 patients between the ages of 21 and 75 years with male-pattern hair loss. We made simple yet useful interventions to avoid the occurrence of the above-mentioned problems. Initially, drawings based on the middle line and the two temporal regression points were made for a natural-looking anterior hairline. Following this, irregular seeding was done instead of seeding in rows, to obtain a natural hairline. To avoid the 'sprouted grass' look, single hair roots were placed on the anterior hairline taking into consideration the direction of hair growth. However, the FUT technique is not adequate on its own for natural-looking hair restoration. Good planning and creation of an anterior hairline suited to the individual's forehead structure is fundamental for successful results. In addition, we believe that hair texture is very important in hair transplantation and additional care should be given particularly to patients with dark-coloured and hard hair.

Changing trends in hair restoration surgery

Androgenetic alopecia is an important and common cause for baldness. Despite recent advances, the drug therapy of this condition remains unsatisfactory. Surgical hair restoration is the only permanent method of treating this condition. Introduction of recent techniques such as follicular unit transplantation have improved the cosmetic results and patient satisfaction. This article discusses the latest trends in hair restoration surgery.