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Abraham JR, Singh RP, Srivastava SK, Mammo DA. HAIR TRANSPLANTATION COMPLICATED BY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS SEPSIS AND ENDOGENOUS ENDOPHTHALMITIS. Retin Cases Brief Rep 2024; 18:301-304. [PMID: 36730419 DOI: 10.1097/icb.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/01/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe a case of endogenous endophthalmitis as a complication from hair transplantation. METHODS Case report of a 53-year-old man with a history of recent hair transplantation. RESULTS The patient presented with a febrile illness and blurry vision 1 week after hair transplantation. Infectious workup included blood cultures positive for methicillin-resistant Staphylococcus aureus, and he was treated with IV antibiotics. Initial ocular examination demonstrated 20/30 and hand motions in the right and left eyes, respectively, with significant vitritis. He underwent vitreous tap and injections of vancomycin and dexamethasone in both eyes and removal of purulent staple from the site of recently transplanted hair. His ocular and systemic symptoms improved. Approximately 3 months after initial clearing of the initial infection he had recurrence of bacteremia that prompted repeat intravitreal and systemic antibiotics. His vision returned to baseline with mild residual optic nerve pallor and atrophic retinal changes in the left eye. CONCLUSION Hair transplantation is associated with minimal systemic complications, but in rare cases, sepsis is possible and can result in intraocular seeding causing endophthalmitis. MRSA endogenous endophthalmitis frequently results in negative vitreous taps and treatment outcomes in the literature have been shown to vary widely including a return to baseline vision as in the described case.
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Affiliation(s)
- Joseph R Abraham
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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2
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Kourosh AS, Santiago Mangual KP, Farah RS, Rao M, Hordinsky MK, Arruda S, Sadick N. Platelet-Rich Plasma: Advances and Controversies in Hair Restoration and Skin Rejuvenation. Dermatol Surg 2024; 50:446-452. [PMID: 38376068 DOI: 10.1097/dss.0000000000004115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Platelet-rich plasma (PRP) and its combined therapeutic modalities have catalyzed new possibilities in dermatology; however, limitations in evidence and lack of consensus remain among clinicians regarding optimal composition, protocol, technique, and application. OBJECTIVE To provide an update and analysis of the evidence for PRP in hair restoration and skin rejuvenation through review of recent available data, highlighting controversies and expert insights to guide future studies, and stimulate discourse and innovations benefitting patients. METHODS A structured review and expert analysis of PubMed publications before October 2023, with a focus on recent literature from January 2020 through October 2023. RESULTS AND CONCLUSION Growing literature supports the utility and benefits of PRP and related autologous products for applications for skin and hair, with strongest evidence for androgenetic alopecia and skin rejuvenation. However, this is limited by lack of consensus regarding best practices and protocols. Randomized, controlled trials with uniform metrics comparing outcomes of various compositions of autologous blood products, preparation methods, dosimetry, and frequency of treatments are still required. This will allow the medical discourse to grow beyond the realm of expert opinion into consensus, standardization, and more wide spread adoption of best practices that will benefit patients.
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Affiliation(s)
- Arianne Shadi Kourosh
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kathyana P Santiago Mangual
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ronda S Farah
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
- Veteran's Affairs Medical Center, Minneapolis, Minnesota
| | - Medha Rao
- Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Maria K Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - Neil Sadick
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
- Sadick Dermatology, New York, New York
- Weill Cornell Medical College, New York, New York
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3
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Anastassakis K. Paradigm Shift from Linear Strip to Follicular Unit Excision in Hair Restoration Surgery. Facial Plast Surg 2024; 40:129-145. [PMID: 38092043 DOI: 10.1055/s-0043-1777311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Follicular unit excision (FUE) is a very effective and valuable modality for obtaining donor hair follicles using manual, motorized, or robotic devices to harvest individual donor follicular units in situ without a linear donor scar or visible scarring making it ideal for patients who wish to wear their hair short and hide signs of surgery. Over the past two decades, FUE has become increasingly popular, and the rising demand for FUE has driven the worldwide market size of hair restoration surgery (HRS) to an unprecedented height.FUE has revolutionized the HRS industry and offers excellent cosmesis and high patient satisfaction. Unfortunately, a large part of the favorable appeal of FUE is due to false claims that it is "minimally invasive," "scarless," or "not even surgery." Most patients opt-in for FUE due to these misconceptions, which are advertised by "black-market" clinics offering low-cost FUE surgery performed by amateur, nonprofessional technicians on unsuspected patients. The technique appears deceptively simple, and many neophyte surgeons falsely believe that the learning curve of FUE is short because the barrier of entry is low and no previous surgical skill is required. Nevertheless, injuries on grafts are extremely easy to occur since FUE is a blind technique and can be minimized only with excellent technique, which takes years to master.FUE actually presents unique challenges for the surgeon and carries potential long-term permanent side effects if not performed properly. The surgeon must have a thorough understanding of the nuances of the FUE surgical technique to ensure consistent graft quality and favorable cosmesis of both donor and recipient areas. Efficient FUE requires dexterity, training, dedication, devotion, enthusiasm, cognitive clarity, scientific knowledge, experience, and an extended learning curve.FUE is an invaluable addition to the armamentarium of a hair restoration surgeon but has to be judiciously performed.
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Konior RJ. Patient Selection for Follicular Unit Extraction versus Linear Strip Donor Harvesting. Facial Plast Surg 2024; 40:168-174. [PMID: 38016653 DOI: 10.1055/s-0043-1776993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Follicular unit grafts can be harvested using two methods: strip follicular unit transplantation and follicular unit excision. Each method can generate outstanding results, but both are uniquely different with respect to the advantages and disadvantages they offer. Devising a sound surgical plan is instrumental to assure that a patient's short-term and long-term goals can be met, but creating the best plan possible for the graft harvest process is not straightforward. This paper will review the various advantages and disadvantages of each graft harvest method, along with their short-term and long-term ramifications, so as to provide insight into the process by which a sound surgical plan can be developed for any patient seeking surgical hair restoration.
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5
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Keene SA, Susacasa A, Miranda P, Radwanski H. Follicular Unit Excision-Linear Ellipse Donor Harvesting Technique: Combining Standard Follicular Unit Excision with Follicular Unit Excision inside a Linear Strip (Modified Linear Strip Excision) to Optimize Graft Yield. Facial Plast Surg 2024; 40:205-213. [PMID: 37879352 DOI: 10.1055/a-2198-2703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Follicular unit excision (FUE) graft dissection has become the dominant method of donor harvesting globally, however, only a percentage of donor hair can be excised inside the safe donor area before visible donor thinning occurs. Compared to linear strip excision (LSE) where all follicular units inside the harvested ellipse of hair are used, FUE poses substantial limitations for lifetime graft yield and, therefore, cosmetic coverage in patients with advanced pattern hair loss. This paper reviews how combining the donor harvesting methods of FUE and LSE has been shown to optimize graft yield while minimizing the risk of donor depletion from overharvesting. It then describes a surgical technique called FUE-Linear Ellipse (FUE-LE) where FUE dissection of grafts inside a demarcated linear ellipse eliminates the need for a large dissection team which has posed a barrier for many new practices that offer both the donor harvesting methods. For practices that currently offer only FUE, the addition of the LSE method by the modified FUE-LE technique is possible without specialized staff training or associated equipment costs. In this paper, surgery practices that have adopted this technique will report on their experiences. Hair restoration surgeons are encouraged to provide both methods of donor harvesting (FUE and LSE using FUE-LE) in order to optimize graft yield for patients and avoid long-term donor depletion. Based on limited experience, it appears the technique of FUE-LE will help achieve this goal.
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Affiliation(s)
| | | | - Paulo Miranda
- Clinica Pelle, Nova Redentora, Sao Jose do Rio Preto, Brazil
| | - Henrique Radwanski
- International Society of Hair Restoration Surgeons (ISHRS), Rio de Janeiro, Brazil
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6
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Gabel S. Utility of Follicular Unit Excision Using Nonscalp Donor Hair. Facial Plast Surg 2024; 40:214-222. [PMID: 37984370 DOI: 10.1055/s-0043-1776401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
Nonscalp donor hair harvesting or body hair transplantation offers patients an additional source of donor hair in cases when the scalp does not have an adequate supply for the intended recipient area. The most common applications for nonscalp donor hair are for patients with advanced hair loss or to camouflage scarring from prior hair restoration procedures. For patients with available body hair, the beard is probably the best source followed by the chest and abdomen. Combined, these sources may be able to provide thousands of additional grafts for transplantation. Nonscalp hair donor harvesting is technically challenging and should be performed by those with extensive experience in follicular unit excision surgical techniques.
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Gupta AK, Polla Ravi S. Concepts, Terminology, and Innovations in Follicular Unit Excision Hair Restoration Surgery. Facial Plast Surg 2024; 40:146-157. [PMID: 37879351 DOI: 10.1055/a-2198-1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Follicular unit excision (FUE) has emerged as the preferred method for hair transplants. Standardized terms and definitions established by members of the International Society of Hair Restoration Surgery and prominent hair restoration surgeons have become the standard, enabling effective knowledge sharing. This chapter provides an overview of the terminology relating to the field.The historical evolution of FUE and its pivotal role in modern hair transplantation is summarized. Anatomical terminology and graft-related definitions follow, providing insights into the scalp's complex structures and graft characteristics. The subsequent sections detail the terminology associated with graft excision and extraction, shedding light on the precise techniques and procedures employed. An exploration of various FUE techniques and the evolving landscape of FUE devices underscores the continual refinement of hair restoration practices. The chapter proceeds to discuss the "safe'" scalp donor zones, donor assessment terminology, and elements in identifying the optimal donor area for a successful FUE procedure. Additionally, punch dynamics and technique characteristics are examined, emphasizing their pivotal role in achieving superior FUE outcomes. The chapter concludes by discussing the classification of punches and graft evaluation terms, offering insights into the tools, and criteria used to assess graft quality and viability.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
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Speranzini M, Souza SEG. Advancements in Graft Placement Techniques. Facial Plast Surg 2024; 40:223-233. [PMID: 37879353 DOI: 10.1055/a-2198-2782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
For decades, the placement of follicular units (FUs) into incisions in the recipient area was exclusively carried out using forceps. In 1992, Dr. Choi introduced an instrument known as the "implanter," which had the advantage of simultaneously creating incisions and placing FUs without damaging sensitive parts. Its initial popularity was greater in the East, primarily due to the characteristics of Asian hair. Asian hair is typically straight and thick, with FUs mostly consisting of just one or two hair.With the description of the follicular unit excision (FUE) technique in 2002 and its widespread adoption nearly a decade later, the advantages of using the implanter also gained popularity in the West. The uniformity in the size of FUs provided by the FUE technique and the possibility of delegating the placement were key attractions in the use of this placement tool. In addition to the traditional Korean implanter with a sharp needle, other implanters and inserters have been described.The choice of implantation technique depends on individual adaptation and the advantages and disadvantages offered by each instrument. Although forceps allow for safe placement in the hands of well-trained teams, the increased fragility of FUs obtained with the FUE technique has led to the growing acceptance of techniques that employ implanters and inserters.
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Krishnamurthy R, Jaganathan BK, Rangaswamy R, Jeganathan C. A Novel Method of Intraoperative Calculation in Follicular Unit Transplantation: 'The Sequential Strip and FUE Method'. Aesthetic Plast Surg 2024; 48:297-303. [PMID: 36928376 DOI: 10.1007/s00266-023-03300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/11/2023] [Indexed: 03/18/2023]
Abstract
Hair loss, in particular androgenetic alopecia, has troubled humans since the dawn of history. Treatment options for hair restoration have undergone massive transformation from punch grafting to follicular unit transplantation. Current surgical treatment options in hair restoration fall broadly under two categories, follicular unit transplantation most commonly known as strip method and follicular unit extraction (FUE). The strip method though widely used initially is not so common now due to its fair share of disadvantages ranging from linear donor scar, scar widening to strip overharvesting and wastage of grafts. Follicular unit excision (FUE) was introduced as an alternative method for extraction of grafts to combat the donor linear scar produced by strip method but the disadvantages of FUE include the number of grafts harvested in a single session, moth eaten appearance of donor area caused by over extraction of grafts and harvesting from outside the safe zone. Newer developments like extraction of axillary hair, body hair and pubic hair have been sought to overcome the limitations of number of grafts harvested in a single session of FUE. With more patients now affected by alopecia in their early 20s, there is an ever-increasing demand from the patients for the youthful hairline and hence the focus has shifted towards mega and giga sessions of hair transplantation which pose danger of over extraction of grafts leading to depletion of available donor sites. This article elaborates the combined sequential strip and FUE method along with an intraoperative calculation model to overcome the limitations of over extraction and wastage of grafts. (1) Combination of techniques Strip method with FUE. (2) An intraoperative calculation model that aids in limiting over extraction and wastage of grafts. (3) It is a real time model which can be applied in practice with ease.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 .
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Affiliation(s)
- Ramachandran Krishnamurthy
- Apollo Cosmetic Clinic, Apollo Spectra Hospitals, Sathya Dev Avenue, MRC Nagar, Chennai, Tamil Nadu, 600028, India
| | | | - Ravi Rangaswamy
- Apollo Cosmetic Clinic, Apollo Spectra Hospitals, Sathya Dev Avenue, MRC Nagar, Chennai, Tamil Nadu, 600028, India
| | - Charan Jeganathan
- Apollo Cosmetic Clinic, Apollo Spectra Hospitals, Sathya Dev Avenue, MRC Nagar, Chennai, Tamil Nadu, 600028, India
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10
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Liu C, Liu Q, Zhang Y, Zhang M, Zhang J, Wu W. A novel method to clean hair follicular grafts in hair transplantation. J Am Acad Dermatol 2024; 90:e58-e59. [PMID: 35398382 DOI: 10.1016/j.jaad.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Chi Liu
- Department of Medical Cosmetology, Shanghai PherriMed Clinic, Shanghai, China
| | - Qian Liu
- Department of Surgery, Sixth Hospital, Fuzhou, China
| | - Ying Zhang
- Department of Medical Cosmetology, Shanghai PherriMed Clinic, Shanghai, China
| | - Mei Zhang
- Department of Medical Cosmetology, Shanghai PherriMed Clinic, Shanghai, China
| | - Jiufu Zhang
- Department of Medical Cosmetology, Shanghai PherriMed Clinic, Shanghai, China
| | - Wei Wu
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital Affiliated to Medical School, Shanghai Jiao Tong University, Shanghai, China.
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Di M, Liu Q, Liu C, Zhu S, Jiang B, Wu W. Follicular unit extraction megasession treatment of high-grade androgenetic alopecia in Asians: Introducing novel principles for surgical design. J Cosmet Dermatol 2023; 22:3395-3404. [PMID: 37310421 DOI: 10.1111/jocd.15858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Male androgenetic alopecia (MAGA) has been one of the most common reasons for hair consultation, which affects more than half of men under the age of 50. Recently, follicular unit extraction (FUE) megasession has been an attractive treatment option for patients with severe AGA. However, compared with hair transplant surgery by traditional FUE or follicular unit transplantation (FUT), a megasession lacks a suitable surgical design solution for Asian high-grade AGA patients. Therefore, we introduced novel principles for surgical design into FUE megasession for Asians. OBJECTIVE The goal was to investigate the naturalness of hair, patient and doctor satisfaction level, and safety assessment of FUE megasession with the specific surgical design, to explore a novel technique for an efficient, satisfactory, and safe FUE megasession procedure. METHODS Thirty-six Asian male patients with AGA in Hamilton Grade V-VI were enrolled in the research. All participants underwent FUE megasession treatment with the specific surgical design. The investigators observed the patients' general conditions, surgical information, naturalness of hair, and patient and doctor satisfaction level and adverse reactions. RESULTS Before surgery, the average age of patients was 36.8 ± 9.6 years, and average duration of disease was 8.3 ± 3.8 years. During surgery, we harvested an average of 3705 ± 383 grafts. Recipient density ranged from 30 FUs/cm2 to 50 FUs/cm2 , and the total operation time was 10.6 ± 0.9 h. After surgery, patient-rated Likert score for naturalness of hair was as high as 4.72, and the doctor rated 4.61. Patient satisfaction score was up to 4.64, and the doctor scored 4.75. No serious side effects occurred in the study. CONCLUSION FUE megasession with the introduced surgical design is a satisfactory treatment option for patients with high-grade AGA in Asians, with few side effects. The application of the novel design method can effectively lead to relatively natural density and appearance in one operation. Due to its remarkable effect, high satisfaction level, and few postoperative complications, FUE megasession with the introduced surgical design has great potential for Asian high-grade AGA patients.
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Affiliation(s)
- Meihua Di
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital Affiliated to Medical School, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Liu
- Department of Surgery, Sixth Hospital, Fuzhou, China
| | - Chi Liu
- Department of Medical Aesthetics, General Hospital of Angang Group Corporation, Anshan, China
| | - Siyuan Zhu
- Department of Medical Aesthetics, Dongtai City Hospital of Traditional Chinese Medicine, Yancheng, China
| | - Bo Jiang
- Department of Plastic Surgery and Burns, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wei Wu
- Department of Surgery, Sixth Hospital, Fuzhou, China
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Balik O. Determination of Scalp Vascular Topography by Laser Doppler Flowmetry and Comparison of Vascular Damage by Different Blades in Hair Transplantation. J Craniofac Surg 2023; 34:e803-e806. [PMID: 37811982 DOI: 10.1097/scs.0000000000009765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/21/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Although necrosis is a rare complication in hair transplantation, it is extremely traumatic for both the patient and surgeon and also has potential medicolegal consequence. Studies have shown that ischemia in the recipient bed is related to tissue damage caused by the instruments used and the number of grafts per cm². OBJECTIVE We aimed to measure the effects of different instruments on circulation by dividing the recipient area of hair grafts of the same person into 2 sides as right and left. METHODS AND MATERIALS Sapphire percutaneous blade was used on the right side, and a handmade razor slit was used on the left side in 12 male patients with consent. Subsequently, vascularity was evaluated with laser Doppler flowmetry. RESULTS Scalp vascularity has so far only been evaluated with macroanatomic studies in the literature. First, the authors evaluated the effect of local anesthesia and adrenaline-containing swelling fluids on vascularity with a Laser Doppler Flowmeter. Afterward, the tissue damage caused by sapphire percutaneous blades and handmade blades (obtained from razor blades) were quantitatively analyzed and compared with each other. CONCLUSIONS Our results showed that handmade razor blades caused significantly less tissue damage.
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Umar S, Khanna R, Lohlun B, Maldonado JC, Zollinger M, Osei-Tutu A, Gonzales A, Chouhan K, Nusbaum A. Follicular Unit Excision in Patients of African Descent: A Skin-Responsive Technique. Dermatol Surg 2023; 49:949-955. [PMID: 37530735 PMCID: PMC10521773 DOI: 10.1097/dss.0000000000003881] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Follicular unit excision is a favored minimally invasive hair transplantation method. However, it is suboptimal for many patients of African descent because of wide variations in hair and skin characteristics. OBJECTIVE To evaluate the performance of a skin-responsive follicular unit excision device, which accommodates hair curliness, skin thickness, and firmness in patients of African descent. MATERIALS AND METHODS The authors retrospectively evaluated patients who underwent scalp follicular unit (FU) excision using a skin-responsive technique at 7 multinational clinics. The preoperative donor grading for the anticipated difficulty used a scale with Class V indicating the highest degree of hair curliness, skin thickness, and firmness. RESULTS Of 64 eligible patients (45 males and 19 females), 28 had Class V FU excision donor grades. The mean transection rate for all patients was 3%-6%, which was highest in class V patients. Skin thickness and firmness had a greater effect on the maximum transection rate than hair curliness. Only 19 or 18 G punches were used. CONCLUSION The authors report consistence success of a new skin-responsive FU excision device for all patients of African descent with a mean graft transection rate of less than 10%. The findings support skin thickness and firmness as major influencers of graft attrition rate.
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Affiliation(s)
- Sanusi Umar
- Dermatology Division, Department of Medicine, University of California, Los Angeles, California
- Division of Dermatology, Harbor-UCLA Medical Center, Torrance, California
- Dr. U Hair and Skin Clinic, Manhattan Beach, California
| | - Raveena Khanna
- Dr. U Hair and Skin Clinic, Manhattan Beach, California
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | | | | | | | | | | | - Kavish Chouhan
- Department of Dermatology, DermaClinix, Clinic, New Delhi, India
| | - Aron Nusbaum
- Hair Transplant Institute Miami, Coral Gables, Florida
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Li K, Sun P, Liu F, Hu Z, Miao Y. Frontal-Temporal Triangle Area Hair for Eyebrow Restoration in Asians: A Comparative Study With Periauricular and Occipital Hair. Dermatol Surg 2022; 48:731-736. [PMID: 35583985 DOI: 10.1097/dss.0000000000003469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The frontal-temporal triangle area (FTTA) hair has a slow growth rate and thin caliber, which are similar to those of eyebrow hair. However, a comparison of cosmetic outcomes between FTTA and other scalp hair grafts in eyebrow transplantation has not been performed. OBJECTIVE To compare the cosmetic outcomes of FTTA hair and periauricular and occipital area (POA) hair in eyebrow restoration. METHODS A retrospective analysis of 155 patients with FTTA or POA hair transplants was performed. Comparative variables included patient characteristics, hair density, diameter, percentage of one-hair follicular units (FUs), number of transplanted FUs, harvesting time, transection rate, hair survival rate, frequency of eyebrow trimming, and patient satisfaction. RESULTS There was a significant difference in hair density, diameter, percentage of one-hair FUs, and harvesting time between the FTTA and POA hair transplants. The FTTA hair grew significantly slower than the POA hair did. The patients in the FTTA group trimmed their postoperative eyebrows at a significantly longer interval than those in the POA group. The percentage of patients who were very satisfied with the surgery results was higher in the FTTA group. CONCLUSION The FTTA hair grafts can provide aesthetically pleasing cosmetic results in eyebrow restoration.
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Affiliation(s)
- Kaitao Li
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Pingping Sun
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Fang Liu
- Medical Cosmetic and Plastic Surgery Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiqi Hu
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yong Miao
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
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Abstract
BACKGROUND Limited information exists on the long-term risks to individuals undergoing procedures in hair restoration surgery. The short-term risks are well known and similar to other procedures in dermatologic surgery. The long-term risks of hair restoration surgery are seldom discussed between the physician and patient. OBJECTIVE The author sought to describe a classification system that can be used as a communication tool between physicians and patients to define the long-term risk involved with hair restoration surgery. METHODS The Progressive Loss (PL) Scale is an attempt at assessing the cosmesis because of future hair loss following a hair transplant procedure. The PL Risk Scale has designated 5 levels, 1 to 5, with each ascending level representing a higher level of risk. The PL Risk Scale can be assigned to an individual at the time of the assessment for hair restoration surgery. RESULTS Each patient can be assigned a risk level based on how future hair loss may affect the overall cosmetic result of their hair transplant. This risk is dependent on age, and specific for the area to be transplanted. The younger the age of the patient, the higher the risk. The larger the area to be transplanted, the higher the risk. It is not a static scale, because it will be affected by age, donor area, location of transplantation, and other mitigating factors. CONCLUSION Pattern baldness in men and women is progressive and unrelenting. The dichotomy of hair restoration surgery is that a satisfactory short-term outcome can evolve to disappointing results because of progressive hair loss. The PL Risk Scale can be assigned to every individual undergoing a hair restoration procedure. This scale assignment will convey to the patient their lifetime risk associated with any given surgical hair restoration procedure for that age and the specific area to be restored.
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Affiliation(s)
- Dow B Stough
- Burke Pharmaceutical Research, Hot Springs, Arkansas
- Department of Dermatology, UAMS, Little Rock, Arkansas
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Kash N, Roopani RB, Leavitt M, Leavitt A. Exploring the Reasons and Financial Implications of Same-Day Cancellations of Hair Restoration Surgery: A Single-Center Retrospective Study. Dermatol Surg 2021; 47:1678-1680. [PMID: 34750304 DOI: 10.1097/dss.0000000000003272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Natalie Kash
- Department of Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Program, Maitland, Florida
| | - Rahil B Roopani
- Hair Restoration Surgery Fellowship Program, Leavitt Medical Associates, Maitland, Florida
| | - Matt Leavitt
- Department of Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Program, Maitland, Florida
- Advanced Dermatology and Cosmetic Surgery, Maitland, Florida
- College of Medicine, University of Central Florida, Orlando, Florida
- Bosley Medical Group, Maitland, Florida
| | - Adam Leavitt
- Department of Dermatology, The University of Michigan, Ann Arbor, Michigan
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Nava-Castañeda Á, Tovilla-Canales JL, Solano-Leal P, Garnica-Hayashi L. Eyelash hair transplantation with strip composite eyebrow graft: an enhancing technique in tarsoconjunctival flap eyelid reconstruction procedure. Orbit 2019; 38:383-386. [PMID: 30482080 DOI: 10.1080/01676830.2018.1546324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/02/2018] [Indexed: 06/09/2023]
Abstract
Purpose: To describe and evaluate the eyelash transplantation with strip composite eyebrow graft to improve eyelid anatomy in tarsoconjunctival flap eyelid reconstruction procedure. Methods: Twenty two patients with eyelid tumors managed by local excision and reconstruction using tarsoconjunctival flap reconstruction procedure were included. Eyelash graft was performed during flap division by harvesting a graft from the eyebrow and creating a recipient pocket in the receptor eyelid. Patients had a 1-year follow up. Eyelash orientation and follicle survival rate were recorded. Demographic variables were analyzed with descriptive statistics. For eyelash follicles survival rate assessment, we evaluated the number of follicles found in the first postoperative day with the follicles found at the end of the study using the Wilcoxon signed rank test. P < 0.05 was considered statistically significant. Results: All eyelash grafts showed a good follicle orientation and no cases of eyelashes misdirection toward the eyeball were reported. No statistical differences (p > 0.05) were found in Wilcoxon signed rank test when comparing the number of follicles present at the first postoperative day and the number of follicles present at the 12th postoperative month, meaning that the vast majority of follicles survived at the end of the study. Graft ischemia, necrosis or infection were not observed. Conclusions: Tarsoconjunctival flap is an outstanding option for eyelid reconstruction and eyelash transplantation with an eyebrow composite graft is an excellent procedure to enhance and recreate a normal eyelid.
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Affiliation(s)
- Ángel Nava-Castañeda
- Oculoplastics Department, Instituto de Oftalmología Fundación Conde de Valenciana , Mexico City , Mexico
| | - José Luis Tovilla-Canales
- Oculoplastics Department, Instituto de Oftalmología Fundación Conde de Valenciana , Mexico City , Mexico
| | - Paolo Solano-Leal
- Oculoplastics Department, Instituto de Oftalmología Fundación Conde de Valenciana , Mexico City , Mexico
| | - Lilia Garnica-Hayashi
- Oculoplastics Department, Instituto de Oftalmología Fundación Conde de Valenciana , Mexico City , Mexico
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Abstract
For extensive irregular cicatricial alopecia after burn, effective and pleasing restoration of hair-bearing scalp remains challenging. In this article, the authors presented staged reconstructive treatment for extensive irregular cicatricial alopecia with the goal to achieve better and reliable results. A retrospective review of staged reconstructive treatment performed in 16 patients with extensive irregular cicatricial alopecia after burn was conducted. In stage 1, final flaps were designed at 1st. Tissue expanders were placed into the subgaleal plane and serially inflated with normal saline. In stage 2, scarring tissues were excised and the expanded hair-bearing flaps were advanced to the defect. Hair grafts were harvested from excessive hair-bearing scalps excised from the flaps and replanted. For patients with less satisfactory results, stage 3 was performed by hair transplantation. Cicatricial area, follicular unit density, survival rate of hair grafts, and patients' satisfaction were measured before and after each stage. Thirteen patients received 3-stage treatment, and 3 received 2-stage treatment. Significant improvements in aesthetics and patient satisfaction were achieved in all the patients. No flap necrosis, implant exposure or hematoma was observed. Ideal, aesthetic, and reliable results could be obtained using staged reconstructive treatment for patients with extensive irregular cicatricial alopecia after burn.
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Affiliation(s)
- Songjia Tang
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital
| | - Xiaoxin Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongxin Sun
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital
| | - Hanxiao Cheng
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital
| | - Haiyan Shen
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital
| | - Liang Tang
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital
| | - Jinghe Zhou
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital
| | - Ming Jia
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital
| | - Jinsheng Li
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital
| | - Jufang Zhang
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital
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Abstract
Introduction Androgenetic alopecia, also known as as male pattern baldness, affects up to 50% of men and 10% females worldwide. Patients with baldness seem to have a great impact on quality of life including their self-esteem, confidence, relationship as well as work. Methods This is a cross-sectional descriptive study on dermatology quality of life index in patients with androgenetic alopecia who came for hair transplantation surgery at Aavaran Skin Clinic Pvt Ltd, Battisputali, Kathmandu between 15th July 2017 to 15th February 2018. Ethical clearance was taken from ERB of Nepal Health Reasearch Council. All cases enrolled for transplant surgery during the study period and meeting the inclusive criteria were included. Results A total of 120 patients participated in the study. Age of the patients ranged from 19 to 49, mean age being 31.87±6.8. Maximum number of patients were in age group 25 to 34. Mean dermatology quality of life index score was 2.79. Maximum score was 14 & minimum score was 0. Maximum effect was seen in question number 2 of self-consciousness, which had impact on 58 (48.33%) patients at some level. Minimum impact on quality of life was seen in sexual activity where only 4 (3.33%) of patients were affected. Conclusions Androgenetic alopecia had a small effect on quality of life of our patients, but for some it had a great psychological impact not only with their personal feelings but also with the social response towards their problems.
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Affiliation(s)
- Rupak Bishwokarma Ghimire
- Department of Dermatology, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
- Correspondence: Dr. Rupak Bishwoka rma Ghimire, Department of Dermatology, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal. , Phone: +977-9802900007
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Au JK, Palma Diaz MF, Aghaloo T, St John MA. Scaffold-Assisted Artificial Hair Implantation in a Rat Model. JAMA FACIAL PLAST SU 2018; 20:230-237. [PMID: 29285533 PMCID: PMC6145790 DOI: 10.1001/jamafacial.2017.2186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/08/2017] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Current treatments for alopecia with autograft hair transplantation face limitations that may preclude complete hair restoration and leave patients with donor site scars. Scaffold assisted artificial hair implantation as demonstrated in a rat model may provide an adjunct for hair restoration without donor site morbidity. OBJECTIVE To design and create porous high-density polyethylene (PHDPE) and expanded polytetrafluoroethylene (ePTFE) hair-bearing scaffolds and evaluate their biocompatibility in a rat model. DESIGN, SETTING, AND PARTICIPANTS For this single-institution randomized prospective animal study, 34 Sprague Dawley rats were randomly selected into 2 groups: 24 rats for direct implantation and 10 rats for delayed implantation. The direct-implantation group was randomly divided into 3 subgroups of 8 rats, which were observed for 2, 12, and 24 week. INTERVENTIONS Each rat dorsum was implanted with 4 scaffolds-PHDPE and ePTFE with and without hair-in a randomized 4-quadrant manner. The rats in the direct-implantation group were observed to their selected time points of 2, 12, and 24 weeks. The rats in the delayed-implantation group were observed for 4 weeks at which, all well-healed scaffolds without hair were then percutaneously implanted with 2 follicular units of hair. These rats were then observed for another 4 weeks. MAIN OUTCOMES AND MEASURES During the clinical observation period, scaffolds were observed for signs of infection, extrusion, and persistence of follicular units. Following sacrifice, sagittal sections of scaffold and surrounding skin were fixed in formalin, stained with hematoxylin-eosin, and evaluated for degree of fibrovascular invasion and acute and chronic inflammation. RESULTS Overall 94.5% (86 of 91) of the scaffolds were well healed at time of evaluation (2 week, 100% [32 of 32]; 12 week, 96.3% [26 of 27]; 24 week, 87.5% [28 of 32]); while 85.6% of artificial hair follicular units were intact at time of evaluation (2 week, 93.8% [30 of 32]; 12 week, 86.7% [26 of 30]; 24 week, 75.0% [21 of 28]). Within the delayed implant group 100% (19 of 19) of the hair-implanted scaffolds were well healed at 8 weeks, with 94.7% (36 of 38) of the follicular units intact; 100% of the delayed-hair implant scaffolds were well healed with 86.1% (36 of 38) of the follicular units intact. Kaplan-Meier log-rank analysis showed no significant difference in survival between ePTFE and PHDPE scaffolds, as well as scaffolds with hair and scaffolds without hair. Upon histological analysis, overall scaffolds with hair were noted to have greater chronic inflammation (95% CI, -0.81 to -1.10; P = .01), and PHDPE was noted to have significantly great fibrovascular integration (95% CI, -11.42 to -1.96; P = .01) compared with ePTFE. CONCLUSIONS AND RELEVANCE Overall, PHDPE and ePTFE hair bearing scaffolds were well tolerated in a rat model. Progressive loss of artificial hair may be percutaneously implanted without significant increases in infection or extrusion. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Joshua K Au
- Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California
| | - Miguel Fernando Palma Diaz
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, California
- UCLA Head and Neck Cancer Program, UCLA David Geffen School of Medicine, Los Angeles, California
- Jonsson Comprehensive Cancer Center, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Tara Aghaloo
- Section of Oral & Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, California
| | - Maie A St John
- Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California
- UCLA Head and Neck Cancer Program, UCLA David Geffen School of Medicine, Los Angeles, California
- Jonsson Comprehensive Cancer Center, UCLA David Geffen School of Medicine, Los Angeles, California
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Anmad Shihadeh L, Couto Comba P, Hernández Carballo C. Purulent pericarditis by Staphylococcus Panton-Valentine secondary to hair implants. Med Clin (Barc) 2017; 148:525. [PMID: 28336116 DOI: 10.1016/j.medcli.2017.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Leydimar Anmad Shihadeh
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España.
| | - Patricia Couto Comba
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Carolina Hernández Carballo
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
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Pereira JOC, Pereira Filho JOC, Cabrera Pereira JOP. Megasessions for Robotic Hair Restoration. J Drugs Dermatol 2016; 15:1407-1412. [PMID: 28095555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A robotic system can select and remove individual hair follicles from the donor area with great precision and without fatigue. This report describes the use of the robotic system in a megasession for hair restoration. Patients were instructed to cut their hair to 1.0 to 1.2 mm before surgery. The robot selected and removed 600 to 800 grafts per hour so the follicular units (FU)s could be transplanted manually to recipient sites. The robot arm consists of a sharp inner punch and a blunt outer punch which together separate FUs from the sur- rounding tissue. Stereoscopic cameras controlled by image processing software allow the system to identify the angle and direction of hair growth. The physician and one assistant control the harvesting with a hand-held remote control and computer monitor while the patient is positioned in an adjustable chair. When the robot has harvested all the FUs they are removed by technicians with small forceps. Hairline design, creation of recipient sites, and graft placement are performed manually by the physician. Clinical photographs before and after surgery show that patients experience excellent outcomes with the robotic megasession. Phy- sician fatigue during graft extraction is reduced because the robot performs the repetitive movements without fatigue. Variability of graft extraction is minimized because the robot's optical system can be programmed to choose the best FUs. The transection rate is reduced because the robot's graft extraction system uses two needles, a sharp one to piece the skin and a blunt needle to dissect the root without trauma. A robotic megasession for hair restoration is minimally invasive, does not result in linear scars in the donor area, and is associated with minimal fatigue and discomfort for both patient and physician. Healing is rapid and patients experience a high level of satisfaction with the results. <em>J Drugs Dermatol. 2016;15(11):1407-1412.</em>.
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Umar S. Use of nape and peri-auricular hair by follicular unit extraction to create soft hairlines and temples: my experience with 128 patients. Aesthet Surg J 2015; 35:903-9. [PMID: 26399317 DOI: 10.1093/asj/sjv137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hairlines and temples can look unnatural due to coarseness of the safe donor area of transplanted scalp hair. Although the thinner caliber of nape and peri-auricular (NPA) hair would be ideal to create softer hairlines, they have not been used mainly because of concerns that they are nonpermanent. OBJECTIVE We assessed the outcome of NPA hair transplanted to hairlines and temples in selected patients. METHODS During November 2006 to November 2011, follicular unit extraction (FUE) transplantation using NPA hair was conducted in 128 patients following a shave test involving the visual evaluation of hair density and caliber of shaved head donor areas. The test was used to determine permanent versus nonpermanent donor areas. A questionnaire was sent to patients to assess satisfaction with their restored hairlines, with a follow-up questionnaire sent to those who initially responded. RESULTS Three-quarters of patients are good candidates for use of NPA hair to the hairlines and temples based on the shave test. Of 128 patients transplanted, 71% responded and reported a mean overall satisfaction of 8.3 (scale, 1-10). Patients saw full hair coverage at the recipient area at a mean of 9.6 months after surgery. Nineteen patients reported lost grafts. Thirty-three patients responded to a second survey and reported a mean overall satisfaction of 8.5 at an average of 4.6 years after surgery; only 5 (15%) new instances of graft loss were reported. CONCLUSIONS Soft, natural-looking hairlines can be created in select patients using NPA hair as a donor source by FUE hair transplantation. LEVEL OF EVIDENCE 4 Therapeutic.
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Affiliation(s)
- Sanusi Umar
- Dr Umar is a Clinical Instructor of Medicine, Division of Dermatology, Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA
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24
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Vogel JE. Commentary on: use of nape and peri-auricular hair by follicular unit extraction to create soft hairlines and temples: my experience with 128 patients. Aesthet Surg J 2015; 35:910-2. [PMID: 26399315 DOI: 10.1093/asj/sjv145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- James E Vogel
- Dr Vogel is an Associate Professor of Surgery, Department of Plastic Surgery, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD
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Cao W, Li L, Mii S, Amoh Y, Liu F, Hoffman RM. Long-Term Extensive Ectopic Hair Growth on the Spinal Cord of Mice from Transplanted Whisker Follicles. PLoS One 2015; 10:e0133475. [PMID: 26244638 PMCID: PMC4526646 DOI: 10.1371/journal.pone.0133475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/28/2015] [Indexed: 11/19/2022] Open
Abstract
We have previously demonstrated that hair follicles contain nestin-expressing pluripotent stem cells that can effect nerve and spinal cord repair upon transplantation. In the present study, isolated whisker follicles from nestin-driven green fluorescent protein (ND-GFP) mice were histocultured on Gelfoam for 3 weeks for the purpose of transplantation to the spinal cord to heal an induced injury. The hair shaft was cut off from Gelfoam-histocultured whisker follicles, and the remaining part of the whisker follicles containing GFP-nestin expressing pluripotent stem cells were transplanted into the injured spinal cord of nude mice, along with the Gelfoam. After 90 days, the mice were sacrificed and the spinal cord lesion was observed to have healed. ND-GFP expression was intense at the healed area of the spinal cord, as observed by fluorescence microscopy, demonstrating that the hair follicle stem cells were involved in healing the spinal cord. Unexpectedly, the transplanted whisker follicles sprouted out remarkably long hair shafts in the spinal cord during the 90 days after transplantation of Gelfoam whisker histocultures to the injured spine. The pigmented hair fibers, grown from the transplanted whisker histocultures, curved and enclosed the spinal cord. The unanticipated results demonstrate the great potential of hair growth after transplantation of Gelfoam hair follicle histocultures, even at an ectopic site.
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Affiliation(s)
- Wenluo Cao
- AntiCancer Inc., San Diego, CA, United States of America
- Department of Surgery, University of California San Diego, San Diego, CA, United States of America
- Department of Anatomy, Second Military Medical University, Shanghai, China
| | - Lingna Li
- AntiCancer Inc., San Diego, CA, United States of America
| | - Sumiyuki Mii
- Department of Dermatology, Kitasato University, Sagimahara, Japan
| | - Yasuyuki Amoh
- Department of Dermatology, Kitasato University, Sagimahara, Japan
| | - Fang Liu
- Department of Anatomy, Second Military Medical University, Shanghai, China
- * E-mail: (RH); (FL)
| | - Robert M. Hoffman
- Department of Surgery, University of California San Diego, San Diego, CA, United States of America
- Department of Anatomy, Second Military Medical University, Shanghai, China
- * E-mail: (RH); (FL)
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26
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Bernhardt M. Suppuration Following Hair Implantation. Skinmed 2015; 13:311. [PMID: 26861432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
Male baldness is the most common diagnosis in men that present with hair loss. It is a genetically determined condition that is clearly an androgen-dependent trait, mainly driven by dihydrotestosterone action on the hair follicles, leading to miniaturization. Although in general this condition is socially accepted as a natural process in a man's life, for some individuals it might significantly impact quality of life, reducing self-esteem and increasing stress. This chapter encompasses the most important aspects of the practical evaluation (clinical features, trichoscopy, trichogram, histopathology, relevant blood tests) and management of male baldness, diffuse baldness and senescent alopecia.
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Abstract
Female pattern hair loss, or female pattern androgenetic alopecia, is a nonscarring alopecia with a multi-factorial etiology that mostly affects postmenopausal women and is characterized by a reduction in hair density over the crown and frontal scalp. The clinical picture is characterized by a diffuse rarefaction of scalp hair over the mid-frontal scalp and a more-or-less intact frontal hairline without any signs of inflammation or scarring. Although the disease poses only a cosmetic concern, it is chronic and may have a significant negative psychological impact on the affected person. The aim of treating female pattern hair loss is to reduce hair loss and, to a certain extent, succeed in promoting hair regrowth. Various treatment methods are available, but it remains unclear which are the most effective. Early initiation of treatment and the combination of various modalities seem to be more efficacious than monotherapy.
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Yildiz H, Ercan E, Alhan D, Sezgin M. Recipient Site Necrosis After Tumescent Infiltration with Adrenaline in Hair Transplantation. Acta Dermatovenerol Croat 2015; 23:233-234. [PMID: 26476913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Hamza Yildiz
- Hamza Yildiz, MD, Department of Dermatology, Eskisehir Military Hospital , 26020 Eskisehir, Turkey;
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30
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Chen H, Zhang J, Li J, Jia M, Guo X, Wang Y, Shen H. [Application of soft tissue expansion combined with follicular unit extraction for burn cicatricial bald]. Zhonghua Zheng Xing Wai Ke Za Zhi 2015; 31:36-39. [PMID: 26040017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the therapeutic effect of soft tissue expansion combined with follicular unit extraction( FUE) for burn cicatricial bald. METHODS 48 patients with burn cicatricial bald (> 25 cm2) were treated in three stages. The expanders were implanted on the first stage. After expansion for 8 weeks, the expanders were taken out and local flaps were transferred. One year later, follicular unit extraction( FUE) was applied on the bald area. RESULTS 48 cases were followed up for 5 years with satisfactory cosmetic results. The VAS assessment of satisfaction on hair appearance after three-staged surgery was 8.2 ± 2.1. CONCLUSIONS Soft tissue expansion combined with FUE has a reliable effect for burn cicatricial bald.
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31
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Huang YL, Chang SL, Lee MC, Chang CH, Hu S, Gold MH. Measuring occipital scalp laxity before donor strip harvesting in hair transplantation. J Drugs Dermatol 2014; 13:1248-1252. [PMID: 25607560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Occipital scars from donor strip harvesting during hair transplantation are an important cosmetic concern. Scalp laxity has an important role, due to the more frequent use of dense packing and megasession transplantation, which requires more grafts and creates a wider, longer donor scar. OBJECTIVE To determine if the use of a simple, objective measurement of occipital scalp laxity could reduce scar length by allowing for adjustment of donor strip harvesting during hair transplantation. METHODS AND MATERIALS This retrospective study included data from 39 patients who underwent hair transplantation with >2000 follicular units: 25 patients underwent measurement of occipital scalp laxity (measurement group); the other 14 did not (control group). We measured and calculated preoperative scalp parameters for hair transplantation, including follicular unit density at occipital scalp, length and width of the donor strip, and estimated total number of grafts. All patients underwent standard follicular-unit hair transplantation, at which time the actual total number of grafts was determined. RESULTS Mean occipital follicular unit density in the measurement group was 74.16 follicles per cm2, which did not significantly differ from the controls (73.29; t=0.410, d.f.=37, P>0.05). The mean length of the occipital surgical wound was significantly shorter in the measurement group than in the controls (19.16 vs 27.50 cm, respectively; t=10.412, d.f.=37, P<0.05). The difference between the estimated and actual total number of grafts was significant in the measurement group (2139.44 vs 2397.64, respectively; paired t=3.095, d.f.=48, P<0.05) but not in the control group (2277.71 vs 2296.71, respectively; paired t=0.175, d.f.=26, P>0.05). Accuracy in estimating the total number of grafts was poor for the measurement group, as the number of actual grafts significantly exceeded estimates. CONCLUSION Use of data from a simple, objective method to measure occipital scalp laxity simplified adjustment of strip harvesting, allowed for use of wider strips, and resulted in smaller donor wounds and scars from hair transplantation; however, accuracy in estimating the total number of grafts was reduced.
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Gupta AK, Lyons DCA, Daigle D, Harris JA. Surgical hair restoration and the advent of a robotic-assisted extraction device. Skinmed 2014; 12:213-216. [PMID: 25335349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The number of surgical hair restorations performed worldwide is ever-increasing. Today's gold standard in surgical hair restoration is follicular unit transplantation (FUT). FUT refers to the transplantation of individual follicular units (FUs) from the donor region to the recipient region. Strip extraction and manual FU extraction (FUE) are the most common methods for FU production. While strip extraction and manual FUE both hold individual merits, they are also associated with a number of limitations. The introduction of a robotic surgical assistive device may circumvent many of the limitations associated with traditional strip and manual FUE methods. As with all new technologies, however, the robotic device will require further independently funded, peer-reviewed, clinical testing to establish its efficacy relative to existing hair restoration methods in clinical practice.
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Abstract
BACKGROUND Androgenetic alopecia (AGA) is one of the most common chronic problems seen by dermatologists worldwide. It is characterized by progressive hair loss, especially of scalp hair, and has distinctive patterns of loss in women versus men, but in both genders the central scalp is most severely affected. It often begins around puberty and is known to effect self-esteem and the individual's quality of life. In contrast to the high prevalence of AGA, approved therapeutic options are limited. In addition to the scarce pharmacologic treatments, there are numerous nonprescription products claimed to be effective in restoring hair in androgenetic alopecia. OBJECTIVES The purpose of this paper is to review published medical and non-medical treatments for male and female AGA using the American College of Physicians evidence assessment methods. MEDLINE, EMBASE and Cochrane Library were searched for systematic reviews, randomized controlled trials, open studies, case reports and relevant studies of the treatment of male and female AGA. The relevant articles were classified according to grade and level of evidence. RESULTS The medical treatments with the best level of evidence classification for efficacy and safety for male AGA are oral finasteride and topical minoxidil solution. For female AGA, topical minoxidil solution appears to be the most effective and safe treatment. The medical treatments corresponding to the next level of evidence quality are some commonly used therapeutic non-FDA-approved options including oral and topical anti-hormonal treatments. Surgical treatment of follicular unit hair transplantation is an option in cases that have failed medical treatment although there is high variation in outcomes. LIMITATIONS Some articles, especially those concerning traditional herbs claimed to promote hair regrowth, were published in non-English, local journals. CONCLUSIONS An assessment of the evidence quality of current publications indicates that oral finasteride (for men only) and topical minoxidil (for men and women) are the best treatments of AGA.
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Affiliation(s)
- Supenya Varothai
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sahin B. Reconstruction of large alopecia with old technique: V-Y-S plasty. Int Wound J 2014; 13:984-5. [PMID: 24698416 DOI: 10.1111/iwj.12259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 12/01/2022] Open
Abstract
Treatment of alopecia following burns, trauma or tumour surgery is challenging. Local flaps for small or medium sized defects and tissue expansion for larger defects is the common approach. Tissue expansion is a two-stage procedure and the inflation process causes difficulty for patients. V-Y-S plasty is safe and one-stage method of tissue reconstruction for scalp, face and other parts of the body. We performed this method safely for very large alopecia reconstructions in the scalp.
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Affiliation(s)
- Baris Sahin
- Plastic Reconstructive and Aesthetic Surgery Department, Afyon Park Hospital, Afyon, Turkey.
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Sehgal VN, Srivastava G, Aggarwal AK, Midha R. Hair biology and its comprehensive sequence in female pattern baldness: treatment modalities--part III. Skinmed 2013; 11:287-290. [PMID: 24340468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Virendra N Sehgal
- DermatoVenereology (Skin/VD) Center, Sehgal Neursing Home, Panchwati-Delhi.
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Baibergenova A, Donovan J. Lichen planopilaris: update on pathogenesis and treatment. Skinmed 2013; 11:161-165. [PMID: 23930355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Lichen planopilaris (LPP) is considered to be a follicular variant of lichen planus. Clinical variants include classic LPP, frontal fibrosing alopecia, and the Graham-Little-Piccardi-Lassueur syndrome. The pathogenesis of LPP remains to be fully elucidated, but like other cicatricial alopecias involves the irreversible destruction of hair follicle stem cells and loss of a hair follicle's capacity to regenerate itself In the early stages of LPP, patients may have scalp pruritus, burning, tenderness, and increased hair shedding. A scalp biopsy shows a lymphocytic infiltrate involving the isthmus and infundibulum. Apoptotic cells present in the external root sheath and concentric fibrosis surrounds the hair follicle. Treatment is prescribed with the goal to alleviate patient symptoms and to halt the progression of hair loss. Treatment involves use of potent topical corticosteroids and/or intralesional corticosteroids. Options for systemic treatment include anti-inflammatory agents such as hydroxychloroquine, tetracyclines, pioglitazones, and immunosuppressive medications such as cyclosporine, mycophenolate mofetil, or systemic corticosteroids. Hair transplantation may also be an option if the disease has been in clinical remission. The management of LPP can sometimes be challenging and additional research is needed to improve outcomes for patients.
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Affiliation(s)
- Akerke Baibergenova
- Division of Dermatology, University of Toronto Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Kim CK, Kim DY, Kim JY. Asymmetric dermal-subdermal suture in trichophytic closure for wide hair transplantation donor wound. Dermatol Surg 2013; 39:1124-7. [PMID: 23627870 DOI: 10.1111/dsu.12209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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Panchaprateep R, Pathomvanich D. Use of a special handle to control depth of recipient sites in hair transplantation. Dermatol Surg 2013; 39:790-1. [PMID: 23627809 DOI: 10.1111/dsu.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sreekar H, Lamba S, Gupta AK. Training young surgeons in sectioning scalp for hair transplantation; a simple method. An Bras Dermatol 2013; 88:317. [PMID: 23894759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Hair loss: it's not just for men. With most hair-loss therapies targeted to men, where can women turn for help? Harv Womens Health Watch 2013; 20:4-5. [PMID: 23757789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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McElwee KJ, Shapiro JS. Promising therapies for treating and/or preventing androgenic alopecia. Skin Therapy Lett 2012; 17:1-4. [PMID: 22735503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Androgenetic alopecia (AGA) may affect up to 70% of men and 40% of women at some point in their lifetime. While men typically present with a distinctive alopecia pattern involving hairline recession and vertex balding, women normally exhibit a diffuse hair thinning over the top of their scalps. The treatment standard in dermatology clinics continues to be minoxidil and finasteride with hair transplantation as a surgical option. Here we briefly review current therapeutic options and treatments under active investigation. Dutasteride and ketoconazole are also employed for AGA, while prostaglandin analogues latanoprost and bimatoprost are being investigated for their hair growth promoting potential. Laser treatment products available for home use and from cosmetic clinics are becoming popular. In the future, new cell mediated treatment approaches may be available for AGA. While there are a number of potential treatment options, good clinical trial data proving hair growth efficacy is limited.
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Affiliation(s)
- K J McElwee
- Department of Dermatology and Skin Science, The University of British Columbia, Vancouver, BC, Canada
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Rangwala S, Rashid RM. Alopecia: a review of laser and light therapies. Dermatol Online J 2012; 18:3. [PMID: 22398224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Since the 1980s, laser technology has become increasingly popular to treat a variety of cutaneous conditions. Its successful use as an epilator comes with the rare but interesting side effect of paradoxical hypertrichosis. In this review, we summarize cases describing hair growth after photoepilation, as well as studies testing laser and light sources as treatment for alopecia, particularly androgenetic alopecia and alopecia areata. We also discuss the possible biologic mechanisms by which phototherapy induces hair regeneration.
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Affiliation(s)
- Sophia Rangwala
- Department of Dermatology, MD Anderson Cancer Center, University of Texas, Houston, Houston, Texas, USA
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46
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Unger W. Re: Arteriovenous fistula following hair transplantation. Dermatol Surg 2011; 37:1816-7. [PMID: 22182237 DOI: 10.1111/j.1524-4725.2011.02193.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Meyer-Gonzalez T, Bisanga C. [Body-hair transplant for cicatricial alopecia]. Actas Dermosifiliogr 2011; 103:163-4. [PMID: 21872192 DOI: 10.1016/j.ad.2011.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 04/04/2011] [Accepted: 04/17/2011] [Indexed: 11/16/2022] Open
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Sun Y, Hu ZQ, Feng CB, Lu F, Liu G, Zhang ZD. [A hair prosthesis consisting of allogeneic hair and polypropylene mimicking follicular units: long-term result and histocompatibility in rabbits]. Nan Fang Yi Ke Da Xue Xue Bao 2011; 31:594-598. [PMID: 21515450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To develop a follicular unit-like construct with allogeneic hair, evaluate its histocompatibility and long-term stability after transplantation, and explore the possibility of its clinical application. METHODS Human hair and medical polypropylene was processed according to the structure of follicular units and prepared into hair prostheses for transplantation. The histocompatibility of polypropylene and human hair in New Zealand rabbits was observed by HE staining and scanning electron microscope, and the loss rate of the hair was recorded to evaluate the long-term result of transplantation. RESULTS Mild inflammatory cell infiltration around polypropylene and human hair was observed early after the transplantation, accompanied with local epithelial cell proliferation. The prosthesis mimicking the follicular units still showed good histocompatibility one year after the transplantation without degradation of the hair. The loss rate of the hair was averaged (4.1∓4.0)% at one year after the transplantation, and the total appearance of the prosthesis remained satisfactory. CONCLUSION Allogeneic human hair and polypropylene in the hair prosthesis show good histocompatibility in rabbits. The prosthesis allows good cosmetic effect after transplantation with low rate of hair loss, demonstrating its potential in clinical application.
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Affiliation(s)
- Yu Sun
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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Jiang WJ, Jing WM, Wang XP, Wang B, Tang ZY. [Aesthetic result of dense-packing single-hair autologous grafting for eyelash]. Zhonghua Zheng Xing Wai Ke Za Zhi 2011; 27:111-113. [PMID: 21774349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the aesthetic result of dense-packing single-hair grafting for eyelash. METHODS Twenty-six female cases were treated with the donor sites at the occipital safe area. The single-hair grafts were made with the hair of 4cm in length. The grafts were transplanted to the upper lid margin with needle technique, 30-40 grafts at each side. RESULTS The hair grafts survived very well with good growth direction. It looked even better when it had a permanent wave or the mascara was applied. The survival rate of hair grafts was more than 95%. CONCLUSIONS It is feasible to improve the shorter and thinner eyelash by dense-packing single-hair grafts.
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Affiliation(s)
- Wen-Jie Jiang
- Hair Transplantation Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
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50
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Gho CG, Neumann HAM. [Therapeutic options for androgenetic alopecia]. Ned Tijdschr Geneeskd 2011; 155:A2535. [PMID: 21382206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Androgenetic alopecia (AGA) is the most common type of hair loss. There are different treatment possibilities for the prevention of and as a remedy for AGA. The broad spectrum of possibilities varies from doing nothing to hair transplantation. Treating AGA is difficult because it is a natural, ongoing and personal process. The progression of AGA can be slowed down by medication. If one desires a full head of hair and immediate results, however, a hairpiece could be an option. A permanent result is only attainable by hair transplantation. In terms of cost effectiveness over the short term (1 year) and intermediate term (10 years), medication is the best option. Hair transplantation, however, remains the best solution for a permanent result over the long term (more than 10 years). Given the advantages of partial longitudinal follicle unit transplantation (PL-FUT) in comparison with traditional hair transplantation techniques, our preferences go out to PL-FUT and medicinal treatment.
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Affiliation(s)
- Coen G Gho
- Hair Science Institute, Maastricht, Nederland.
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