Scalp lifting. An 8-year experience with over 1,230 cases

Peripheral nerve blocks and trigger point injections in headache management - a systematic review and suggestions for future research

Interventional procedures such as peripheral nerve blocks (PNBs) and trigger point injections (TPIs) have long been used in the treatment of various headache disorders. There are, however, little data on their efficacy for the treatment of specific headache syndromes. Moreover, there is no widely accepted agreement among headache specialists as to the optimal technique of injection, type, and doses of the local anesthetics used, and injection regimens. The role of corticosteroids in this setting is also debated. We performed a PubMed search of the literature to find studies on PNBs and TPIs for headache treatment. We classified the abstracted studies based on the procedure performed and the treated condition. We found few controlled studies on the efficacy of PNBs for headaches, and virtually none on the use of TPIs for this indication. The most widely examined procedure in this setting was greater occipital nerve block, with the majority of studies being small and non-controlled. The techniques, as well as the type and doses of local anesthetics used for nerve blockade, varied greatly among studies. The specific conditions treated also varied, and included both primary (eg, migraine, cluster headache) and secondary (eg, cervicogenic, posttraumatic) headache disorders. Trigeminal (eg, supraorbital) nerve blocks were used in few studies. Results were generally positive, but should be taken with reservation given the methodological limitations of the available studies. The procedures were generally well tolerated. Evidently, there is a need to perform more rigorous clinical trials to clarify the role of PNBs and TPIs in the management of various headache disorders, and to aim at standardizing the techniques used for the various procedures in this setting.

An evaluation system to enhance patient selection for alopecia-reducing surgery

BACKGROUND

The author presents an evaluation system that helps optimize the chances of achieving good results with alopecia-reducing procedures.

OBJECTIVE

To help hair restoration surgeons select patients properly for alopecia-reducing procedures.

METHODS

Twenty criteria are scrutinized by the hair restoration surgeon during the initial consultation and given a score of one to five. The scores are added together and divided by 20. A patient with a score greater than four is considered a good candidate for alopecia reduction in most cases.

RESULTS

This evaluation method has significantly decreased the number of patients undergoing alopecia-reducing procedures while helping the author achieve consistently good results.

CONCLUSION

An evaluation system is presented that helps determine who is a good candidate for alopecia reduction and who is a poor candidate. This selection technique has helped the author achieve more consistently good results by eliminating poor and borderline candidates.

Chest hair used as donor material in hair restoration surgery

BACKGROUND

This article describes a technique for transplanting hair from the chest to the balding scalp.

OBJECTIVE

The objective is to describe an alternative route of harvesting donor hair in the situation when donor scalp hair is depleted.

METHOD

A fusiform donor harvest was removed from the sternal region. The tissue was divided into one- and two-haired micrografts and subsequently transplanted.

RESULTS

The technique worked extremely well with good take of the hair grafts. The donor site healed inconspicuously.

CONCLUSION

The technique of transplanting hair from the chest to the balding scalp can be a viable alternative when confronted with donor scalp hair depletion.

A comparison of the scalp kinetics in scalp-lifting with and without an intact occipital neurovascular bundle

BACKGROUND

This paper compares the scalp kinetics of the scalp-lifting procedures with and without an intact occipital neurovascular bundle.

OBJECTIVE

The objective of this paper is to perform lateral scalp-lifts and observe if an intact occipital neurovascular bundle hampers the amount of scalp advancement.

METHODS

Ten consecutive patients had lateral scalp-lifts performed without severing the occipital neurovascular bundle. Advancements were then measured at three points (mid-posterior, above the pinna, and at the temporal recession). The occipital neurovascular bundle was then divided, and the same measurements were made.

RESULTS

An intact occipital neurovascular bundle impeded the amount of advancement that could be accomplished with scalp-lifting. The anterior vector was primarily affected.

CONCLUSION

In light of the finding that an intact occipital neurovascular hampers the amount of advancement with scalp-lifting, the surgeon must weigh the advantages and disadvantages of both approaches (prior division of occipital neurovascular bundles versus leaving the bundles intact) when deciding upon the appropriate approach for the given patient.

The mathematics of hair restoration surgery

BACKGROUND

Mathematics is prevalent in almost all aspects of life, and so it is with hair restoration surgery. This article explores some of the mathematical relationships that exist in this quickly growing subspecialty of cosmetic surgery.

OBJECTIVE

The objective of this article is to demonstrate a few of the mathematical correlations that are present in hair restoration surgery.

METHODS

Several subdivisions of this subspecialty are analyzed from a mathematical perspective.

RESULTS

Mathematics pervades many of the aspects of hair restoration, from the donor site, to the recipient site, to scalp reduction, to scalp extension, and the list goes on.

CONCLUSION

To be able to perform hair restoration surgery in a very precise and accurate way, one should have a good grasp of the mathematical relationships that exist in this field.

Circumferential scalp reduction with a suture-in-place Silastic-Dacron extender

BACKGROUND

Circumferential scalp reduction combined with a suture-in-place Silastic-Dacron extender is described as a viable alternative for those surgeons wishing not to perform extensive scalp-lifting. The primary advantage of the Silastic-Dacron extender is that it allows the time interval between surgeries to be shortened to 1 month.

OBJECTIVE

To incur the benefits of circumferential scalp reduction (minimal stretch-back and decreased slot formation) and the decreased time between sessions offered by a suture-in-place Silastic-Dacron extender.

METHODS

A circumferential scalp reduction is first performed and a tunnel is made under the central bald peninsula. Once this is completed, a 4-cm-wide Silastic-Dacron strip is passed through the tunnel and is sutured to both lateral edges of the galea under tension. The way to determine the proper length of the strip is described.

RESULTS

The combination of circumferential scalp reduction with a suture-in-place Silastic-Dacron extender gives results that are comparable to scalp-lifting; however, more procedures are required and not as much upward movement into the crown is accomplished. The memory of the Silastic-Dacron extender has been found to eliminate stretch-back and quickly improve scalp laxity.

CONCLUSION

Circumferential scalp reduction combined with a suture-in-place Silastic-Dacron extender is an extremely viable method to treat patients with extensive baldness. The decrease in slot formation and minimal stretch-back afforded by circumferential scalp reduction and the shortened 1-month time interval between surgeries brought about by the Silastic-Dacron extender make this a procedure that hair replacement surgeons should have in their armamentarium.