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Niu Y, Ren C, Jin Z, Qiao M, Wang X, Zhang J, Zhu L. Autologous follicular unit extraction transplant for postburn cicatricial alopecia: A single-center's retrospective case series. J Cosmet Dermatol 2024; 23:2209-2214. [PMID: 38369852 DOI: 10.1111/jocd.16237] [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: 11/20/2023] [Revised: 01/05/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND RATIONALE Cicatricial alopecia not only affects patients' appearance but also has negative effects on their physical and mental well-being, as well as their daily lives. Therefore, it is essential to provide proactive treatment to patients. OBJECTIVE To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of secondary scarring alopecia caused by burn, and to evaluate its effectiveness. METHODS A retrospective observational study has been conducted, which included 41 patients with secondary scarring alopecia caused by burn. All patients underwent initial autologous FUE hair transplantation surgery, and the occurrence of postoperative complications was monitored. Patient satisfaction was evaluated after 12 months post-surgery. RESULTS Satisfaction assessments were conducted for all 41 patients. Out of the total, 31 individuals expressed being very satisfied, 7 individuals reported being satisfied, and 3 individuals indicated being not very satisfied. Among the patients, 3 experienced complications, including herpes in the donor area for one patient, temporary hair loss for another patient, and thick scab for the third patient. CONCLUSION FUE hair transplantation yields positive results for secondary scarring alopecia caused by burn. It offers natural hair growth patterns, minimal trauma, quick recovery, high patient satisfaction, and few complications.
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Affiliation(s)
- Yanchao Niu
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Ci Ren
- Department of Dermatological Surgery, Shenyang Seventh People's Hospital, Shenyang, Liaoning, China
| | - Zhoufeng Jin
- Department of Plastic Surgery, Shenyang Mingliu Plastic Surgery and Aesthetics Hospital, Shenyang, Liaoning, China
| | - Min Qiao
- Medical Technology Department, Sichuan Nursing Vocational College, Chengdu, Sichuan, China
| | - Xiaoxu Wang
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Jian Zhang
- Department of Dermatological Surgery, Shenyang Seventh People's Hospital, Shenyang, Liaoning, China
| | - Ling Zhu
- Medical Technology Department, Sichuan Nursing Vocational College, Chengdu, Sichuan, China
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2
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Maletic A, Dumic-Cule I, Zic R, Milosevic M. Impact of Hair Transplantation on Quality of Life. Aesthetic Plast Surg 2024; 48:1825-1830. [PMID: 38123846 DOI: 10.1007/s00266-023-03781-6] [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: 09/06/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Alopecia is defined as partial or complete hair loss. The most common form is androgenetic alopecia, which occurs in both men and women. Despite the nonsurgical options available for treatment, the only permanent solution is hair transplantation. Hair loss has been shown to have significant psychological consequences associated with loss of self-confidence, poor self-image and difficulties in social functioning. We aim to examine the effect of hair transplantation on quality of life and psychosocial functioning. METHODS Forty-eight patients with androgenetic alopecia were enrolled in this two-center prospective study and underwent hair transplantation by the Follicular Unit Extraction method. Different questionnaires were used to assess their quality of life and other psychosocial parameters before and after hair transplantation. RESULTS According to SF-36 Physical and Mental Health Score patients showed significant improvement in life quality after hair transplantation. Diener's Life Satisfaction Scale (DASS-21) revealed increased life satisfaction after the procedure. Stress and anxiety DASS-21 subscales showed significantly reduced results; while, the DASS-21 depression scale and MSPSS were not significantly changed. CONCLUSION Taken together, quality of life and psychosocial functioning increased after hair transplantation. Structured abstract is required. Please provide.I insert name of paragraphs within abstract as follows: background, methods, results, conclusion Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Ivo Dumic-Cule
- University North, 104 brigade 3, 42000, Varaždin, Croatia.
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Rado Zic
- Department of Plastic Surgery, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Salata 3, 10000, Zagreb, Croatia
| | - Milan Milosevic
- School of Medicine, University of Zagreb, Salata 3, 10000, Zagreb, Croatia
- Department of Environmental Health and Occupational and Sports Medicine, Andrija Stampar School of Public Health, Rockfellerova 4, 10000, Zagreb, Croatia
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3
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Carman TP, Rassman W. Follicular Unit Excision Donor Area Management and Considerations of the Scalp. Facial Plast Surg 2024; 40:195-204. [PMID: 38049108 DOI: 10.1055/s-0043-1777074] [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: 12/06/2023] Open
Abstract
Over the last several years, follicular unit excision (FUE) donor harvesting has become the predominant donor harvest method, surpassing the traditional method of linear strip excision donor harvesting. While this may offer advantages in specific clinical settings, the reality of ongoing losses with the natural evolution of male patterned hair loss places a premium on obtaining as much lifetime donor hair as possible to address this clinical reality. This lifetime demand requirement must be weighed against the possibility of a detrimental cosmetic appearance of the donor area with serial donor harvests utilizing FUE. This chapter will examine the important technical and artistic considerations critical for hair restoration surgeons to appreciate in order to maintain cosmetically high-quality donor area outcomes in patients choosing to undergo FUE harvesting for hair transplantation surgery.
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Affiliation(s)
| | - William Rassman
- La Jolla Hair Restoration Medical Center, La Jolla, California
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4
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Gabel S. Follicular Unit Excision in Hair Restoration Surgery. Facial Plast Surg 2024; 40:127-128. [PMID: 38016652 DOI: 10.1055/s-0043-1776873] [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: 11/30/2023] Open
Affiliation(s)
- Steven Gabel
- Department of Hair Restoration Surgery, Gabel Hair Restoration Center, Portland, Oregon
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5
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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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6
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Lam SM. Follicular Unit Excision (FUE) Basics. Facial Plast Surg 2024; 40:158-167. [PMID: 37734402 DOI: 10.1055/a-2179-4729] [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: 09/23/2023] Open
Abstract
Follicular unit excision (FUE) has risen to the forefront as the world's most popular hair transplant procedure. However, most writing on this subject has catered to the advanced practitioner. The goal of this article will be to focus on safe planning and decision making along with key technical steps that will guide the beginner surgeon to harvest a graft safely and to harvest the donor area in a uniform way to avoid overharvesting. Topics covered in this article also include instrumentation and decision making between FUE versus linear strip excision.
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Affiliation(s)
- Samuel M Lam
- Lam Institute for Hair Restoration, Plano, Texas
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7
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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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8
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Josephitis DS. Instrumentation and Devices Specific to Follicular Unit Excision. Facial Plast Surg 2024; 40:180-194. [PMID: 37884033 DOI: 10.1055/a-2198-8686] [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: 10/28/2023] Open
Abstract
The volume of hair transplantation procedures done via the follicular unit excision (FUE) harvesting technique has increased tremendously over the last few years. With this growth, new advances in technology have come along. The wide variety of instrumentation and devices can be overwhelming, especially for a novice surgeon. This chapter aims to discuss the relevant aspects of FUE and its relationship to the devices that are used to harvest grafts. The development and overview of all the major types of instrumentation will be reviewed.
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9
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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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10
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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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11
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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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12
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Juhasz MLW, Csuka E, Kincaid C, Atanaskova Mesinkovska N. The Challenge of Regrowing Hair With Lasers in Androgenetic Alopecia. Dermatol Surg 2024; 50:303-306. [PMID: 38427446 DOI: 10.1097/dss.0000000000004030] [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: 03/03/2024]
Affiliation(s)
- Margit L W Juhasz
- Department of Dermatology, Cedars-Sinai Medical Center, Beverly Hills, California
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Ella Csuka
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Colin Kincaid
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Natasha Atanaskova Mesinkovska
- Department of Dermatology, University of California, Irvine, Irvine, California
- Beckman Laser Institute, University of California, Irvine, Irvine, California
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13
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Pittella F, Castro CG, Trivellini R, Sethi P, La Padula S, Sanabria B, Paes CQ, Palmieri MGS, Pittella F. PRECISE Scale: a quantitative classification for androgenetic alopecia and its application to hair transplantation. Aesthetic Plast Surg 2024; 48:775-784. [PMID: 37365308 PMCID: PMC10980655 DOI: 10.1007/s00266-023-03462-4] [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: 05/01/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Androgenetic alopecia (AGA) is a prevalent genetic condition that can affect both male and female, and is considered the most frequent form of hair loss. Traditional scales and methods of classifying AGA are basically qualitative. OBJECTIVE This work aims to propose a quantitative scale to classify AGA in order to assist hair transplantation surgery. METHODS Based on whole hairless and thinning areas that needs to receive follicular units in a hair transplantation procedure, basic equations to support the scale are proposed. Additionally, the study involves simulations that apply the classification system and compare its results with those of qualitative methods. RESULTS The PRECISE scale utilizes a range of 0-10, using 30 cm2 as the measured standard of a bald area. For hair transplantation, 1500 follicular units (FU) are recommended for each score in the PRECISE scale. Technological and manual methods to measure the hairless and thinning areas are presented and discussed. This new quantitative classification, combined with different and complementary methods of measurement of hairless and thinning areas endorse the understanding of the clinical condition by the patient and the planning of a surgery procedure. CONCLUSION The developed PRECISE scale brings a different way of classifying Androgenetic alopecia (AGA), through an essentially quantitative evaluation. It can be used to elaborate the best strategy for the hair transplantation surgery and to improve the outcomes. LEVEL OF EVIDENCE V 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)
- Felipe Pittella
- Pittella Day Hospital - Hair Restoration and Plastic Surgery, Vitoria, ES, 29050-300, Brazil
| | - Carlo G Castro
- Pittella Day Hospital - Hair Restoration and Plastic Surgery, Vitoria, ES, 29050-300, Brazil
| | | | | | - Simone La Padula
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, 80131, Naples, Italy
- Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 94000, Paris, France
| | | | - Camila Q Paes
- Faculdade de Enfermagem, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, 36036-900, Brazil
| | - Miguel G S Palmieri
- Faculdade de Farmácia, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, 36036-900, Brazil
| | - Frederico Pittella
- Faculdade de Farmácia, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, 36036-900, Brazil.
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14
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Palmieri B, Vadalà M, Al Bzour BM, Di Carmine M, Scarano A. A new easy technique to identify the correct artificial hair implantation site: A case series and preliminary results. J Cosmet Dermatol 2024; 23:614-621. [PMID: 37991104 DOI: 10.1111/jocd.16015] [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: 06/07/2023] [Revised: 08/01/2023] [Accepted: 09/19/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The implantation of artificial hair is a successful standardized procedure to restore bald areas or scarred alopecic surfaces of the scalp in both sexes. MATERIALS AND METHODS Sebometric measurements were taken, pre, 1, 3, and 6 months postimplant in two symmetric frontotemporal areas of the scalp of seven volunteers to be implanted with 50 units of artificial hair. The artificial hair used in this study are Biofibre 4.0 produced by Medicap srl, Italy. RESULTS The dermaroller assisted procedure was performed only on one side, and the plain random implant contralaterally for comparison. A marked downregulation of the sebum concentration was observed in the dermaroller treated area 1, 3, and 6 months later in respect to the control side. CONCLUSION The dermaroller assisted procedure is safe and effective in reducing the foreign body reaction by the sebaceous glands and the vascular axis injured by the implanting needle; a longer standing success of the implanted hair can thus be achieved reducing the burden of inflammatory reaction.
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Affiliation(s)
- Beniamino Palmieri
- Second Opinion Medical Network, Modena, Italy
- Medico Cura Te Stesso Onlus, Modena, Italy
| | - Maria Vadalà
- Second Opinion Medical Network, Modena, Italy
- Medico Cura Te Stesso Onlus, Modena, Italy
| | | | - Mariastella Di Carmine
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Chieti, Italy
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Chieti, Italy
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15
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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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16
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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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17
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Niu Y, Ren C, Liao H, Jin Z, Zhu L. Clinical effects of autologous follicular unit extraction transplantation in the treatment of secondary cicatricial alopecia after infections. J Cosmet Dermatol 2024; 23:585-590. [PMID: 37735949 DOI: 10.1111/jocd.15996] [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: 07/21/2023] [Revised: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of secondary scarring alopecia caused by infections, and to evaluate its effectiveness. METHODS A retrospective observational study has been conducted, which included nine patients with secondary scarring alopecia caused by infections. All patients underwent initial autologous FUE hair transplantation surgery, and the occurrence of postoperative complications was monitored. Patient satisfaction was evaluated after 12 months post-surgery. RESULTS At the follow-up, postoperative satisfaction was 88.9% in nine patients, with only one case of postoperative infection and no incidence of skin necrosis, significant bruising and swelling, unnatural appearance or temporary hair loss. CONCLUSIONS Autologous FUE hair transplantation is an effective method for treating secondary scarring alopecia caused by infections. This procedure is minimally invasive, resulting in high patient satisfaction and minimal complications postoperatively.
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Affiliation(s)
- Yanchao Niu
- Department of Dermatovenereology, Chengdu Second People's Hospital, Sichuan, Chengdu, China
| | - Ci Ren
- Department of Dermatological Surgery, Shenyang Seventh People's Hospital, Liaoning, Shenyang, China
| | - Hengli Liao
- Department of Dermatology, Chengdu Hengmei Hair Medical Clinic, Chengdu, Sichuan, China
| | - Zhoufeng Jin
- Department of Plastic Surgery, Shenyang Mingliu Plastic Surgery and Aesthetics Hospital, Liaoning, Shenyang, China
| | - Ling Zhu
- Medical Technology Department, Sichuan Nursing Vocational College, Sichuan, Chengdu, China
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18
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Jedlowski PM, Anthony M. Use of fractionated laser therapy for the treatment of androgenetic alopecia: a systematic review and meta-analysis. Lasers Med Sci 2023; 39:4. [PMID: 38087122 DOI: 10.1007/s10103-023-03946-4] [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: 04/05/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
Procedural management, including fractionated laser therapy, has been increasingly investigated for the management of androgenetic alopecia (AGA). However, no comprehensive resources exist detailing the efficacy of fractionated laser therapies used for the treatment of AGA. A systematic review investigating fractionated laser use for AGA was performed, separated into each distinct fractionated laser modality. A meta-analysis was performed to examine improvement in hair counts and hair shaft diameter. Fourteen studies were included for systematic review, which identified the use of erbium-glass, thulium, erbium-ytrrium:aluminum garnet (YAG), and carbon dioxide (CO2) fractionated laser for the treatment of AGA. In the meta-analysis, fractionated laser combination therapy showed significant improvement in hair shaft diameter (2.51, 95% CI 2.37-2.65, I2 = 90.54). Fractionated laser monotherapy alone significantly improved hair shaft diameter (2.28 95% CI 2.03-2.52, I2 = 91.20%). This effect was durable on subgroup analysis for both erbium-glass (2.36 95% CI 2.01-2.71, I2 = 92.05%) and thulium (1.61 95% CI 1.08-2.15, I2 = < 0.00%). There was no improvement in hair shaft count for any laser modality. Erbium-glass laser is an effective modality as either monotherapy or combination with topical/injectable therapies to improve hair shaft diameter in AGA.
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Affiliation(s)
- Patrick M Jedlowski
- Division of Dermatology, Banner University Medical Center, University of Arizona College of Medicine - Tucson, 1765 N Pima Canyon Dr, Tucson, AZ, 85718, USA.
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19
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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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20
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Othman S, Glat P. Surgical Management for Hair Restoration: A Review of Contemporary Techniques. Aesthetic Plast Surg 2023; 47:2415-2424. [PMID: 37193885 DOI: 10.1007/s00266-023-03391-2] [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: 03/11/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Hair loss can cause psychological distress for patients, regardless of the etiology or extent of the defect. Many conservative and pharmacological approaches are successful in management, but refractory or severe cases often mandate surgical treatment. Surgical techniques have been refined over the course of a century, and we aim to review the most contemporary strategies. METHODS A review of the literature was performed using the databases PubMed, Web of Science, and Embase, in May 2020. Articles were included if they discussed techniques used within the past 10 years, in search of more contemporary strategies and the most widely used approaches. RESULTS The use of local flaps, scalp reduction surgery, and hair transplantation techniques are all used for various indications. Modern hair transplantation can be further divided into follicular unit excision and follicular unit transplantation, each with its own advantages. Local flaps are most often used for post-traumatic and reconstructive indication, while hair transplantation can be used for smaller cosmetic lesions or in combination with a variety of other reconstructive techniques. CONCLUSION Hair loss continues to be a challenging pathology for both patients and physicians, regardless of etiology. When conservative treatment is inadequate, there exist multiple surgical techniques that can feasibly restore hair, though the exact degree of success may vary between patients. The proper technique is dependent upon etiology, patient specific factors, as well as surgeon experience and comfort. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sammy Othman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New York, NY, USA
| | - Paul Glat
- Section of Plastic Surgery, Department of Surgery, St. Christopher's Hospital for Children, Philadelphia, PA, 19134, USA.
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21
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Harada K, Ohyama M, Niiyama S, Irisawa R, Mae K, Mori M, Wakimoto H, Kinoshita-Ise M, Fukuyama M, Hayakawa R, Takagi M, Yamazaki M, Miyoshi M, Nishikawa S, Sato S, Nakazawa Y, Sugimoto T, Ogo M, Tsuboi R. Efficacy of autologous dermal sheath cup cell transplantation in male and female pattern hair loss: A Single-Arm, Multi-Center, phase III equivalent clinical study. J Dermatol 2023; 50:1539-1549. [PMID: 37752738 DOI: 10.1111/1346-8138.16957] [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: 06/06/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023]
Abstract
A previous, proof-of-concept clinical study suggested that dermal sheath cup cell injections into the affected areas of male/female pattern hair loss (PHL) may have some amelioratory effects, the clinical efficacy of which needs further examination. A phase III equivalent clinical study was conducted to further probe the therapeutic potential of this novel approach and verify its safety and efficacy in improving the appearance of PHL. Thirty-six participants with PHL were injected with dermal sheath cup cell harvested from non-affected occipital hair follicles twice in quarterly intervals. Global photographic assessment and phototrichogram were performed in a blinded manner. Patient-reported outcomes were assessed for 12 months. On global photographic assessment, 30% of the participants showed improvement. The analysis of phototricogram data detected the increases in the cumulative hair diameter, hair cross-sectional area, and mean hair diameter of 107.6 ± 152.6 μm/cm2 , 13069.1 ± 10960.7 μm2 /cm2 , and 0.9 ± 0.9 μm (ratios vs. baseline: +1.4%, +3.4%, and +2.2%), respectively. The female and high terminal hair ratio groups achieved better improvement. Of the total participants, 62.9% noted some degree of improvement. No serious adverse events were detected. This novel approach exhibited visible effects while ensuring safety and patient satisfaction. Therefore, it holds promise as a possible therapeutic option for treating PHL, especially in women.
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Affiliation(s)
- Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Shiro Niiyama
- Department of Dermatology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Ryokichi Irisawa
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Kenichiro Mae
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Miho Mori
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Hiroko Wakimoto
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | | | - Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Reina Hayakawa
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masaya Takagi
- Regenerative Medicine Research & Business. Development Department, Yokohama, Japan
| | - Masako Yamazaki
- Regenerative Medicine Research & Business. Development Department, Yokohama, Japan
| | - Mami Miyoshi
- Regenerative Medicine Research & Business. Development Department, Yokohama, Japan
| | - Saori Nishikawa
- Regenerative Medicine Research & Business. Development Department, Yokohama, Japan
| | - Seiji Sato
- Regenerative Medicine Research & Business. Development Department, Yokohama, Japan
| | - Yosuke Nakazawa
- Regenerative Medicine Research & Business. Development Department, Yokohama, Japan
| | - Takaki Sugimoto
- Regenerative Medicine Research & Business. Development Department, Yokohama, Japan
| | - Masashi Ogo
- Regenerative Medicine Research & Business. Development Department, Yokohama, Japan
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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22
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Vañó-Galván S, Bisanga CN, Bouhanna P, Farjo B, Gambino V, Meyer-González T, Silyuk T. An international expert consensus statement focusing on pre and post hair transplantation care. J DERMATOL TREAT 2023; 34:2232065. [PMID: 37477225 DOI: 10.1080/09546634.2023.2232065] [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: 05/01/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023]
Abstract
AIM To achieve international expert consensus and give recommendations on best practices in hair transplantation surgery, focusing on pre- and post-transplantation care. METHODS A modified Delphi method was used to reach consensus. An international scientific committee developed an 81-statement questionnaire. A panel of 38 experts in hair transplantation from 17 countries across 4 continents assessed the questionnaire. RESULTS Two consensus rounds were carried out, with 59 out of 81 statements (73%) reaching consensus. Expert recommendations emphasize the correct selection of candidates for hair transplantation and the need for patients to have received adequate medical treatment for alopecia before transplant. Comorbidities should be assessed and considered while planning surgery, and an individualized plan for perioperative care should be drawn up before transplant. Certain medications associated with increased risk of bleeding should be withdrawn before surgery. Specific recommendations for post-transplantation care are given. After transplantation, patients should gradually resume their normal haircare regimen. Close follow-up should be carried out during the first year after transplant. CONCLUSIONS This study presents numerous consensus-based recommendations on general aspects of hair transplantation, including candidate selection, medical therapy prior to transplantation, anesthesia, and resuming haircare after transplantation.
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Affiliation(s)
- S Vañó-Galván
- Hair Disorders Unit, Ramon y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
- Hair Disorders and Hair Transplantation Unit, Grupo Pedro Jaen Clinic, Madrid, Spain
| | | | - P Bouhanna
- Hair Surgery Service Department, Sabouraud Hospital Saint-Louis, Paris, France
| | - B Farjo
- Farjo Hair Institute, Manchester, UK
| | - V Gambino
- Department of Dermatology and Aesthetic Dermatology, San Raffaele University Hospital, Milan, Italy
| | - T Meyer-González
- Trichology and Hair transplantation Unit, Hospital HM Dr. Gálvez, Meyer&Alcaide Group, Málaga, Spain
| | - T Silyuk
- Hair Treatment and Transplantation Center, Saint Petersburg, Russian Federation
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23
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Hyakutake Y, Shibahara I, Toyoda M, Shigeeda R, Handa H, Saruta W, Sato S, Hide T, Kumabe T. Frontotemporal craniotomy with skin incision along the superior temporal line outside the hairline in bald male patients with temporal gliomas. Neurosurg Rev 2023; 46:296. [PMID: 37950043 DOI: 10.1007/s10143-023-02212-z] [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: 08/10/2023] [Revised: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
A head skin incision is inevitable in neurosurgical procedures and is usually concealed within the hairline. Androgenetic alopecia (AGA) is a progressive hair loss disorder or baldness highly prevalent in men. Therefore, if bald male patients require neurosurgical procedures, skin incisions cannot be concealed, but this subject is yet to be discussed in the literature. This study presents a frontotemporal craniotomy using a skin incision along the superior temporal line, ignoring the hairline in bald male patients. Thirty-three patients with temporal gliomas underwent surgical removal between 2015 and 2022. They were divided into three groups: bald male patients with skin incisions not concealed in the hairline (minimum group, n = 13), bald and non-bald male patients with skin incisions concealed in the hairline (male group, n = 11), and female patients with skin incisions concealed in the hairline (female group, n = 9). In the minimum group, patients had no complaints regarding the incision scar. Cosmetic outcome was excellent, and no cases showed surgical site infection or peripheral facial nerve palsy. Compared with the male and female groups, the minimum group had the shortest skin incision length; however, the craniotomy size and extent of resection were similar. Skin incision for frontotemporal craniotomy cannot be hidden in bald male patients, and the preferred location for the incision is unknown. The skin incision along the superior temporal line is a cosmetically favorable, feasible, and safe procedure.
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Affiliation(s)
- Yuri Hyakutake
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Mariko Toyoda
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Ryota Shigeeda
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hajime Handa
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Wakiko Saruta
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Sumito Sato
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takuichiro Hide
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
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24
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Villavisanis DF, Chatterjee A, Taylor JA. Hairline Correction by Hair Transplantation for Reducing Apparent Face Length in Long-Face Women. Plast Reconstr Surg 2023; 152:962e-963e. [PMID: 37871270 DOI: 10.1097/prs.0000000000010728] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Dillan F Villavisanis
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, Penn Center for Neuroaesthetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Anjan Chatterjee
- Penn Center for Neuroaesthetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, Penn Center for Neuroaesthetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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25
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Xia CD, Xue JD, Xing PP, Di HP, Shi JJ, Zhang J, Cao DY, Xiao HT, Liu L, Ma C. [Clinical effects of scalp flaps pedicled with superficial temporal artery parietal branch in repairing facial destructive burn wounds]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:919-925. [PMID: 37899556 DOI: 10.3760/cma.j.cn501225-20230312-00077] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Objective: To explore the clinical effects of scalp flaps pedicled with superficial temporal artery parietal branch in repairing facial destructive burn wounds. Methods: A retrospective observational study was conducted. From January 2016 to December 2021, 15 patients with facial destructive burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 11 males and 4 females, aged 22 to 79 years. Two patients were complicated with unilateral eyeball destructive burns, two patients were complicated with unilateral auricle defects, eight patients were complicated with lip and cheek defects, and three patients were complicated with lip, cheek, and unilateral nasal alar defects. The burn wound areas ranged from 9 cm×6 cm to 13 cm×10 cm. The scalp flaps pedicled with superficial temporal artery parietal branch, with the area of 10 cm×7 cm to 15 cm×11 cm, were designed, excised, and transferred for repairing burn wounds. The secondary wounds at the donor sites were repaired with medium-thickness scalp grafts. According to patient's needs, the hairs grew at the facial transplanted flap were removed by laser at 2 weeks after the flap was completely viable, or the expanded scalp flap was used to treat the secondary alopecia in the flap donor area of the head at 3 months after the primary wound repair. The survival of the flap/skin graft and the wound healing of the donor and recipient areas after the primary wound repair were recorded. During the follow-up, the appearance of the flap, the scar hyperplasia at the suture site, the repair effect of facial functional parts, the treatment effects of laser hair removal and secondary alopecia treatment at the flap donor site were observed; the patient's satisfaction with the overall repair effect was inquired. Results: After the primary wound repair, all the flaps transplanted to the burn wounds and the skin grafts transplanted to the secondary wounds of the flap donor sites survived well, and the wounds at the donor and recipient sites of flap healed well. The color, texture, and thickness of flap were basically the same as those of normal facial skin, and the scar at the suture site was slight during 3 to 18 months of follow-up period after the primary wound repair. In 11 patients complicated with lip defects, the oral integrity, and the opening and closing functions of mouth were restored with the mouth opening being 2.0-2.5 cm and no microstomia; all the patients could carry out basic language communication, 8 of them could take regular food, and 3 of them could take soft food. The wounds in two patients with unilateral eyeball destructive burns were repaired. In 2 patients complicated with auricle defects, the wounds were repaired, and the external auditory canals were normal. In 3 patients complicated with unilateral nasal alar defects, their noses had poor appearance with reduced nostrils. No hair growth was observed in the facial flap sites after treatment of laser hair removal in 8 patients. Five patients were successfully treated with expanded scalp flaps for secondary alopecia in the flap donor area of the head. The patients were all satisfied with the overall repair effect. Conclusions: The scalp flap pedicled with superficial temporal artery parietal branch has abundant blood supply and is suitable for repairing the wounds in facial destructive burns. It is easy to transfer and can better restore the appearance and function of the recipient area with minimal damage to the flap donor area, which is worthy of clinical promotion.
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Affiliation(s)
- C D Xia
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - J D Xue
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - P P Xing
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - H P Di
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - J J Shi
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - J Zhang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - D Y Cao
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - H T Xiao
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - L Liu
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - C Ma
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
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26
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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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27
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Shehan JN, Spiegel JH. Hair Restoration Techniques. Facial Plast Surg 2023; 39:512-516. [PMID: 37506740 DOI: 10.1055/s-0043-1771291] [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: 07/30/2023] Open
Abstract
Hair restoration is an essential topic in the current management of facial plastic surgery concerns and queries. Advances in hair restoration include oral and topical medications and compounded preparations, injections including platelet-rich plasma, light therapy, and follicular unit extraction methods. This article provides a review of current techniques.
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Affiliation(s)
- Jennifer Nicole Shehan
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Boston University School of Medicine, Boston, Massachusetts
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28
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Wang J, Liu J, Chen J, Wang Y. Application of Autologous Hair Transplantation Technique in Children with Cicatricial Alopecia. Adv Ther 2023; 40:4024-4031. [PMID: 37430139 PMCID: PMC10427550 DOI: 10.1007/s12325-023-02581-3] [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: 04/25/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Cicatricial alopecia not only affects the appearance of children's heads and faces but also their mental health in the long term. This study aims to explore the therapeutic characteristics and clinical effects of autologous hair transplantation technology in children with cicatricial alopecia. METHODS Children in our department who received autologous hair transplantation technology for cicatricial baldness of the scalp from February 2019 to October 2022 were collected. Their basic information was analyzed, and postoperative follow-up was conducted, including calculation of hair follicle survival rate, hair growth, complications, and an efficacy satisfaction survey given to the children's family members. RESULTS Thirteen children were included in this study (10 males and 3 females), aged from 4 years 1 month to 12 years 10 months, with an average age of 7 years 5 months. Two hundred to 2500 hair follicular units were extracted, with an average recipient area of 22.7 cm2, an average hair follicle unit density of 55.3 ± 9.1 per cm2, and an average hair/follicular unit (hair/FU) ratio of 1.75 ± 0.07. Thirteen children in this group were followed up for 6-12 months with the following treatment options: FUE (follicular unit extraction, 9 cases), FUT (follicular unit transplantation, 3 cases), and FUT combined with FUE (1 case). The average hair survival rate was 85.3%. Except for one child with temporary folliculitis, there were no complications. The GAIS score is divided into five levels: complete improvement (2 cases), obvious improvement (10 cases), partial improvement (1 case), no improvement (0 cases), and deterioration (0 cases). The patient satisfaction results included very satisfied (2 cases), mostly satisfied (10 cases), and dissatisfied (1 case). CONCLUSION Autologous hair transplantation technology is a safe and effective method for children with cicatricial alopecia.
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Affiliation(s)
- Jiping Wang
- Department of Burn and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Rd, Xicheng, Beijing, 100045, China
| | - Jing Liu
- Department of Burn and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Rd, Xicheng, Beijing, 100045, China
| | - Jigang Chen
- Department of Burn and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Rd, Xicheng, Beijing, 100045, China
| | - Yanni Wang
- Department of Burn and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Rd, Xicheng, Beijing, 100045, China.
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Cheng CY. Needle holder fixation technique for assisting non-shaven follicular unit extraction hair transplantation. Indian J Dermatol Venereol Leprol 2023; 89:786. [PMID: 37067148 DOI: 10.25259/ijdvl_29_2022] [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] [Received: 01/01/2022] [Accepted: 10/01/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Chun-Yu Cheng
- Department of Dermatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Yang Y, Wang G, Yang Q, Diao B. [Effect study of Sonic hedgehog overexpressed hair follicle stem cells in hair follicle regeneration]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:868-878. [PMID: 37460185 DOI: 10.7507/1002-1892.202304008] [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] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Objective To determine the expression level of Sonic hedgehog (Shh) in the passage of hair follicle stem cells (HFSCs), analyze the effect of Shh overexpression on the proliferation activity of HFSCs, and explore the survival of HFSCs after Shh overexpression and its effect on hair follicle regeneration. Methods Hair follicles from the normal area (H1 group) and alopecia area (H2 group) of the scalp donated by 20 female alopecia patients aged 40-50 years old were taken, and the middle part of the hair follicle was cut under the microscope to culture, and the primary HFSCs were obtained and passaged; the positive markers (CD29, CD71) and negative marker (CD34) on the surface of the fourth generation HFSCs were identified by flow cytometry. The two groups of HFSCs were transfected with Shh-overexpressed lentivirus. Flow cytometry and cell counting kit 8 assay were used to detect the cell cycle changes and cell proliferation of HFSCs before and after transfection, respectively. Then the HFSCs transfected with Shh lentivirus were transplanted subcutaneously into the back of nude mice as the experimental group, and the same amount of saline was injected as the control group. At 5 weeks after cell transplantation, the expression of Shh protein in the back skin tissue of nude mice was detected by Western blot. HE staining and immunofluorescence staining were used to compare the number of hair follicles and the survival of HFSCs between groups. Results The isolated and cultured cells were fusiform and firmly attached to the wall; flow cytometry showed that CD29 and CD71 were highly expressed on the surface of the cells, while CD34 was lowly expressed, suggesting that the cultured cells were HFSCs. The results of real-time fluorescence quantitative PCR and Western blot showed that the expression levels of Shh protein and gene in the 4th, 7th, and 10th passages of cells in H1 and H2 groups decreased gradually with the prolongation of culture time in vitro. After overexpression of Shh, the proliferation activity of HFSCs in the two groups was significantly higher than that in the blank group (not transfected with lentivirus) and the negative control group (transfected with negative control lentivirus), and the proliferation activity of HFSCs in H1 group was significantly higher than that in H2 group before and after transfection, showing significant differences ( P<0.05). At 5 weeks after cell transplantation, Shh protein was stably expressed in the dorsal skin of each experimental group; the number of hair follicles and the expression levels of HFSCs markers (CD71, cytokeratin 15) in each experimental group were significantly higher than those in the control group, and the number of hair follicles and the expression levels of HFSCs markers in H1 group were significantly higher than those in H2 group, and the differences were significant ( P<0.05). Conclusion Lentivirus-mediated Shh can be successfully transfected into HFSCs, the proliferation activity of HFSCs significantly increase after overexpression of Shh, which can secrete and express Shh continuously and stably, and promote hair follicle regeneration by combining the advantages of stem cells and Shh.
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Affiliation(s)
- Yingying Yang
- Medical College, Wuhan University of Science and Technology, Wuhan Hubei, 430081, P. R. China
| | - Gang Wang
- Basic Medical Laboratory, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430081, P. R. China
| | - Qian Yang
- Basic Medical Laboratory, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430081, P. R. China
| | - Bo Diao
- Basic Medical Laboratory, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430081, P. R. China
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AboShaban MS, Ghareeb FM, Alkashty SM. The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients. Ann Plast Surg 2023; 90:437-443. [PMID: 36975119 DOI: 10.1097/sap.0000000000003433] [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: 03/29/2023]
Abstract
BACKGROUND Scalp expansion is an optimal treatment for alopecia resulting from burn injuries, especially in the pediatric population through providing highly vascularized adjacent local tissues with optimal hair density, color matching, texture, and hair-bearing characteristics. The aim of this study was to evaluate the efficacy of anterior capsulotomy and basal capsulectomy adherent to expanded scalp flap during alopecia reconstruction with scalp expansion in pediatric burned patients. METHODS The study was conducted on 127 patients with an age range of 5 to 19 years who presented with postburn alopecia accompanied by hairline loss. The patients were divided into 2 groups: group I consisted of 58 patients who were operated on using conventional technique, and group II consisted of 69 patients who were operated using modified technique including basal capsulectomy on the skull side and anterior capsulotomy on the expanded scalp flap. RESULTS The Hairdex, a validated questionnaire of Hair-Specific Health-Related Quality of Life measures, showed that percentage of satisfaction concerning outcomes was 91.50%, psychological well-being was 95%, and self-confidence was 84.30% in group II, compared with 63%, 55.70%, and 66.20%, respectively, in group I. This significant values had a great positive effect on patient satisfaction, changing child's behavior and self-confidence. CONCLUSION Although physiological background of tissue expansion is the same, proper flap design with anterior capsulotomy on flap undersurface and basal capsulectomy on the skull side improve results of the traditional method significantly and minimize the complication rate. These surgical modifications provide maximum benefits from expanded tissue, with restoration of the hairline and a uniform hair direction. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Mohammed Saad AboShaban
- From the Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
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Rousso DE, Klimczak JA. Reducing Surgical Risks for Hair Replacement Surgery. Facial Plast Surg Clin North Am 2023; 31:263-274. [PMID: 37001929 DOI: 10.1016/j.fsc.2023.01.009] [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: 03/02/2023]
Abstract
Hair loss is a common problem among men and women. Hair replacement surgery (HRS) has become increasingly popular as technological advancements have been made producing remarkably natural results when performed by a skilled surgeon. Although complications from HRS are low compared with other esthetic surgeries, they can still occur even with the best-trained and qualified surgeon or staff. The process of hair restoration can be a long road for some patients and active patient participation and education is key for successful results. In this article, we seek to discuss the surgical risks of HRS and discuss methods to prevent them in your practice.
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Affiliation(s)
- Daniel E Rousso
- Rousso Adams Facial Plastic Surgery, 2700 Highway 280, Suite 300W, Birmingham, AL 35223, USA
| | - Jaclyn A Klimczak
- Rousso Adams Facial Plastic Surgery, 2700 Highway 280, Suite 300W, Birmingham, AL 35223, USA; Nose and Sinus Institute of Boca Raton, 1601 Clint Moore Road #170, Boca Raton, FL 33487, USA.
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Avram MR. Commentary on "The Progressive Loss Risk Scale for Hair Restoration Surgery". Dermatol Surg 2022; 48:730. [PMID: 35583990 DOI: 10.1097/dss.0000000000003454] [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: 11/26/2022]
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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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Dai JJ, Wang L, Qiu HY, Huang XY, Tian YX, Peng Q, Liu Y, Guan H. [Clinical effects of autologous follicular unit extraction transplantation in the treatment of small area secondary cicatricial alopecia after burns]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2022; 38:532-537. [PMID: 35764578 DOI: 10.3760/cma.j.cn501120-20210224-00064] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of small area secondary cicatricial alopecia (hereinafter referred to as cicatricial alopecia) after burns. Methods: A retrospective observational study was carried out. According to the adopted treatment methods, 18 patients (12 males and 6 females, aged (29±6) years) who received autologous FUE transplantation for small area cicatricial alopecia after burns from March 2017 to November 2019 in the First Affiliated Hospital of Air Force Medical University were included in FUE transplantation group, and 18 patients (13 males and 5 females, aged (33±5) years) who were treated with expanded flap transplantation for small area cicatricial alopecia after burns by the same surgery team during the same period in the same hospital were included in expanded flap transplantation group. All the patients were followed up for more than 1 year. At the last follow-up, the follicular unit density in the transplanted area was measured by Folliscope hair detection system and the hair survival rate was calculated; the visual analogue scale (VAS) method was adopted to evaluate the treatment effect; patients were asked their satisfaction with the treatment effect and the occurrence of complications during follow-up; the hair growth and the scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area were recorded. Data were statistically analyzed with Fisher's exact probability test and independent sample t test. Results: At the last follow-up, the follicular unit density in the transplanted area of patients in FUE transplantation group was (46.8±2.0)/cm2, which was significantly higher than (42.5±4.3)/cm2 in expanded flap transplantation group (t=3.84, P<0.01); the hair survival rates of patients were similar between the two groups (P>0.05). At the last follow-up, VAS scores evaluating the treatment effect of patients were similar between the two groups (P>0.05); the satisfaction score of patients toward the treatment effect in FUE transplantation group was 8.6±1.1, which was significantly higher than 7.6±0.8 in expanded flap transplantation group (t=2.89, P<0.01). During the follow-up, no inflammation or infection occurred in patients of the two groups, but only 2 patients in expanded flap transplantation group had postoperative pain. At the last follow-up, the transplanted area of patients in the two groups was covered with new hair, and the hair growth direction was basically consistent with the surrounding normal hair; scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area of patients were similar between the two groups (P>0.05). Conclusions: Autologous FUE transplantation has better long-term follicular unit density and patients' satisfaction than expanded flap transplantation in the treatment of small area cicatricial alopecia after burns, showing better postoperative effect and a good prospect of clinical application.
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Affiliation(s)
- J J Dai
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - L Wang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - H Y Qiu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - X Y Huang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - Y X Tian
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - Q Peng
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - Y Liu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - H Guan
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
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Arasu A, Meah N, Marzola M, Sinclair R. Scalp reduction surgery does not reactivate frontal fibrosing alopecia: A case report. Dermatol Ther 2022; 35:e15451. [PMID: 35293086 DOI: 10.1111/dth.15451] [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] [Received: 02/16/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Alexis Arasu
- Sinclair Dermatology, East Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Nekma Meah
- Sinclair Dermatology, East Melbourne, Victoria, Australia
- University of Manchester, Manchester, UK
| | - Mario Marzola
- Sinclair Dermatology, East Melbourne, Victoria, Australia
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Tang KN, Chen XL, Zhang WH, Yang K, Liu K, Jiang W, Chen XZ, Hu JK. [Comparison of postoperative mid-term and long-term quality of life between Billroth-I gastroduodenostomy and Billroth-II gastrojejunostomy after radical distal gastrectomy in patients with gastric cancer: a cohort study based on a case registry database]. Zhonghua Wei Chang Wai Ke Za Zhi 2022; 25:401-411. [PMID: 35599395 DOI: 10.3760/cma.j.cn441530-20220304-00081] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: The pattern of digestive tract reconstruction in radical gastrectomy for gastric cancer is still inconclusive. This study aims to compare mid-term and long-term quality of life after radical gastrectomy for distal gastric cancer between Billroth-I (B-I) and Billroth-II (B-II) reconstruction. Methods: A retrospective cohort study was conducted.Clinicopathological and follow-up data of 859 gastric cancer patients were colected cellected from the surgical case registry database of Gastrointestinal Surgery Center of Sichuan University West China Hospital, who underwent radical distal gastric cancer resection between January 2016 and December 2020. Inclusion criteria: (1) gastric cancer confirmed by preoperative gastroscopy and biopsy; (2) elective radical distal major gastrectomy performed according to the Japanese Society for Gastric Cancer treatment guidelines for gastric cancer; (3) TNM staging referenced to the American Cancer Society 8th edition criteria and exclusion of patients with stage IV by postoperative pathology; (4) combined organ resection only involving the gallbladder or appendix; (5) gastrointestinal tract reconstruction modality of B-I or B-II; (6) complete clinicopathological data; (7) survivor during the last follow-up period from December 15, 2021 to January 15, 2022. Exclusion criteria: (1) poor compliance to follow-up; (2) incomplete information on questionnaire evaluation; (3) survivors with tumors; (4) concurrent malignancies in other systems; (5) concurrent psychiatric and neurological disorders that seriously affected the objectivity of the questionnaire or interfered with patient's cognition. Telephone follow-up was conducted by a single investigator from December 2021 to January 2022, and the standardized questionnaire EORTC QLQ-C30 scale (symptom domains, functional domains and general health status) and EORTC QLQ-STO22 scale (5 symptoms of dysphagia, pain, reflux, restricted eating, anxiety; 4 single items of dry mouth, taste, body image, hair loss) were applied to evaluate postoperative quality of life. In 859 patients, 271 were females and 588 were males; the median age was 57.0 (49.5, 66.0) years. The included cases were divided into the postoperative follow-up first year group (202 cases), the second year group (236 cases), the third year group (148 cases), the fourth year group (129 cases) and the fifth year group (144 cases) according to the number of years of postoperative follow-up. Each group was then divided into B-I reconstruction group and B-II reconstruction group according to procedure of digestive tract reconstruction. Except for T-stage in the fourth year group, and age, tumor T-stage and tumor TNM-stage in the fifth year group, whose differences were statistically significant between the B-I and B-II reconstruction groups (all P<0.05), the differences between the B-I and B-II reconstruction groups in terms of demographics, body mass index (BMI), tumor TNM-stage and tumor pathological grading in postoperative follow-up each year group were not statistically significant (all P>0.05), suggesting that the baseline information between B-I reconstruction group and the B-II reconstruction group in postoperative each year group was comparable. Evaluation indicators of quality of life (EORTC QLQ-C30 and EORTC QLQ-STO22 scales) and nutrition-related laboratory tests (serum hemoglobin, albumin, total protein, triglycerides) between the B-I reconstruction group and B-II reconstruction group in each year group were compared. Non-normally distributed continuous variables were presented as median (Q(1),Q(3)), and compared by using the Wilcoxon rank sum test (paired=False). The χ(2) test or Fisher's exact test was used for comparison of categorical variables between groups. Results: There were no statistically significant differences in all indexes EORTC QLQ-30 scale between the B-I reconstruction group and the B-II reconstruction group among all postoperative follow-up year groups (all P>0.05). The EORTC QLQ-STO22 scale showed that significant differences in pain and eating scores between the B-I reconstruction group and the B-II reconstruction group were found in the second year group, and significant differences in eating, body and hair loss scores between the B-I reconstruction group and the B-II reconstruction group were found in the third year group (all P<0.05), while no significant differences of other item scores between the B-I reconstruction group and the B-II reconstruction group were found in postoperative follow-up of all year groups (P>0.05). Triglyceride level was higher in the B-II reconstruction group than that in the B-I reconstruction group (W=2 060.5, P=0.038), and the proportion of patients with hyperlipidemia (triglycerides >1.85 mmol/L) was also higher in the B-II reconstruction group (19/168, 11.3%) than that in the B-I reconstruction group (0/34) (χ(2)=0.047, P=0.030) in the first year group with significant difference. Albumin level was lower in the B-II reconstruction group than that in the B-I reconstruction group (W=482.5, P=0.036), and the proportion of patients with hypoproteinemia (albumin <40 g/L) was also higher in the B-II reconstruction group (19/125, 15.2%) than that in the B-I reconstruction group (0/19) in the fifth year group, but the difference was not statistically significant (χ(2)=0.341, P=0.164). Other nutrition-related clinical laboratory tests were not statistically different between the B-I reconstruction and the B-II reconstruction in each year group (all P>0.05). Conclusions: The effects of both B-I and B-II reconstruction methods on postoperative mid-term and long-term quality of life are comparable. The choice of reconstruction method after radical resection of distal gastric cancer can be based on a combination of patients' condition, sugenos' eoperience and operational convenience.
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Affiliation(s)
- K N Tang
- Department of Gastrointestinal Surgery and Gastric Cancer Laboratory, West China Hospital, Sichuan University, Chengdu 610041, China University of Electronic Science and Technology of China Hospital, Chengdu 611731, China
| | - X L Chen
- Department of Gastrointestinal Surgery and Gastric Cancer Laboratory, West China Hospital, Sichuan University, Chengdu 610041, China
| | - W H Zhang
- Department of Gastrointestinal Surgery and Gastric Cancer Laboratory, West China Hospital, Sichuan University, Chengdu 610041, China
| | - K Yang
- Department of Gastrointestinal Surgery and Gastric Cancer Laboratory, West China Hospital, Sichuan University, Chengdu 610041, China
| | - K Liu
- Department of Gastrointestinal Surgery and Gastric Cancer Laboratory, West China Hospital, Sichuan University, Chengdu 610041, China
| | - W Jiang
- University of Electronic Science and Technology of China Hospital, Chengdu 611731, China
| | - X Z Chen
- Department of Gastrointestinal Surgery and Gastric Cancer Laboratory, West China Hospital, Sichuan University, Chengdu 610041, China The Second People's hospital of Yibin, Yibin 644000, China
| | - J K Hu
- Department of Gastrointestinal Surgery and Gastric Cancer Laboratory, West China Hospital, Sichuan University, Chengdu 610041, China
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Barrera A. Invited Discussion on: New Donor Excision Design for Better Hair Alignment in Hair Restoration Surgery. Aesthetic Plast Surg 2022; 46:229-230. [PMID: 34608516 DOI: 10.1007/s00266-021-02514-x] [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] [Received: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Alfonso Barrera
- West Houston Plastic Surgery Clinic, PA, Baylor College of Medicine, 915 Gessner Dr, Suite #825, Houston, TX, 77024, USA.
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Kanayama K, Kato H, Mori M, Sakae Y, Okazaki M. Robotically Assisted Recipient Site Preparation in Hair Restoration Surgery: Surgical Safety and Clinical Outcomes in 31 Consecutive Patients. Dermatol Surg 2021; 47:1365-1370. [PMID: 34417387 DOI: 10.1097/dss.0000000000003152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/26/2022]
Abstract
BACKGROUND Recent advances in robotic surgery have extended to hair restoration surgery, using a robotic recipient site creation device. OBJECTIVE This study aimed to assess the surgical safety and postoperative clinical outcomes of using this robotic system. MATERIALS AND METHODS Thirty-one men diagnosed with androgenetic alopecia, who underwent hair transplantation with robotic recipient site creation, were retrospectively reviewed. Their mean age was 38.7 ± 9.5 (range, 22‒67) years. RESULTS The total number of robotically created recipient sites was 36,273. The average site creation speed was 1,593 ± 544 sites per hour. Postoperative crusting (54.8%) was the most frequent complication in the recipient area, followed by pruritus (12.9%), asymmetry (6.5%), and folliculitis (6.5%). The mean score of cosmetic outcomes and patient satisfaction, scored on a 5-point scale, was 4.10 ± 0.54 and 4.13 ± 0.85, respectively. No significant differences in cosmetic outcomes and patient satisfaction were found between 3 operators. CONCLUSION The current device can automatically make slit incisions in the recipient area with speed and consistency noninferior to manual site creation. It is both safe and reliable for clinical use, and it is also easily managed by different hair surgeons without a long learning curve.
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Affiliation(s)
- Koji Kanayama
- Crown Clinic Ginza, Tokyo, Japan
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo, Tokyo, Japan
| | | | | | | | - Mutsumi Okazaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo, Tokyo, Japan
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40
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Sharma AA, Kim DJ, Avram MR, Lee PK. Ergonomics in Dermatologic Procedures Part 4: Hair Transplantation. Dermatol Surg 2021; 47:1414-1416. [PMID: 34334616 DOI: 10.1097/dss.0000000000003170] [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: 11/26/2022]
Affiliation(s)
- Aditi A Sharma
- Department of Dermatology, University of California, Irvine, California
| | - Dong Joo Kim
- Department of Dermatology, University of California, Irvine, California
| | - Marc R Avram
- Private Practice, New York, New York
- Department of Dermatology, Weill Medical College at Cornell Medical Center, New York Presbyterian Hospital, New York City, New York
| | - Patrick K Lee
- Department of Dermatology, University of California, Irvine, California
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Stoneburner J, Shauly O, Carey J, Patel KM, Stevens WG, Gould DJ. Contemporary Management of Alopecia: A Systematic Review and Meta-analysis for Surgeons. Aesthetic Plast Surg 2020; 44:97-113. [PMID: 31667549 DOI: 10.1007/s00266-019-01529-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/08/2019] [Accepted: 10/14/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The decision of surgical approach for hair restoration often involves evaluation of the type of alopecia; however, the impact of surgical hair restoration from existing techniques in specific population subsets has not been comprehensively investigated. OBJECTIVES The authors sought to systematically review the literature on micrografts, minigrafts, mini-micrografts, tissue grafts, tissue flaps and expanders, as well as evaluate graft survival and satisfaction within specific populations in a meta-analysis. METHODS PubMed and Scopus literature searches between 1980 and 2018 yielded 57 articles for systematic review and 34 articles for meta-analysis. Study design, mean patient age and gender, patient alopecia type, surgical hair restoration technique, number of treatment areas, mean follow-up, graft survival rate and satisfaction rate were extracted from each study, and a meta-analysis was performed. RESULTS The pooled rates of graft survival were 84.98% (95% CI 78.90-91.06) using micrografts and 93.11% (95% CI 91.93-94.29) using micrografts and minigrafts in nonscarring alopecia patients, as well as 88.66% (95% CI 80.12-97.20) using micrografts and 86.25% (95% CI 74.00-98.50) using micrografts and minigrafts in scarring alopecia patients. The pooled rates of satisfaction were 89.70% (95% CI 82.64-96.76) using micrografts and 97.00% (95% CI 92.48-100.0) using micrografts and minigrafts in nonscarring alopecia patients, as well as 97.80% (95% CI 94.59-100.0) using micrografts and 88.70% (95% CI 66.49-100.0) using micrografts and minigrafts in scarring alopecia patients. Dot plots depict rates of graft survival rate from micrografts and satisfaction from micrografts and minigrafts. CONCLUSION Surgical hair restoration for nonscarring and scarring alopecia yields high graft survival and satisfaction rates. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Jacqueline Stoneburner
- Keck School of Medicine of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA
| | - Orr Shauly
- Keck School of Medicine of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA
| | - Joseph Carey
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA
| | - W Grant Stevens
- Marina Plastic Surgery, Marina Plastic Surgery Associates, 4644 Lincoln Blvd., Suite 552, Marina Del Rey, CA, 90292, USA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA.
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Pathania V, Bhatt S. Creating slits to the right depth: Innovative use of micropore tape for depth control on an 18-gauge needle in hair restoration surgery. J Am Acad Dermatol 2019; 84:e79-e80. [PMID: 31415836 DOI: 10.1016/j.jaad.2019.08.021] [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: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Vikas Pathania
- Armed Forces Medical College and Command Hospital (SC), Pune, India.
| | - Siddharth Bhatt
- Armed Forces Medical College and Command Hospital (SC), Pune, India
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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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Ishak A, Mat Saad AZ, Azman WS, Halim AS. Alopecia secondary to repaired occipital encephalocele - role of tissue expander in hair restoration. Med J Malaysia 2018; 73:172-174. [PMID: 29962502] [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: 06/08/2023]
Abstract
Partial scalp alopecia is a common problem that can lead to severe social and psychological problems. Tissue expansion, although an old concept, provides a surgical alternative to manage areas of alopecia. We describe a case of alopecia secondary to repaired occipital encephalocele that was successfully treated using tissue expansion technique.
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Affiliation(s)
- A Ishak
- Universiti Sains Malaysia, School of Medical Sciences, Reconstructive Sciences Unit, Health Campus, Kubang Kerian, Malaysia.
| | - A Z Mat Saad
- Universiti Sains Malaysia, School of Medical Sciences, Reconstructive Sciences Unit, Health Campus, Kubang Kerian, Malaysia
| | - W S Azman
- Universiti Sains Malaysia, School of Medical Sciences, Reconstructive Sciences Unit, Health Campus, Kubang Kerian, Malaysia
| | - A S Halim
- Universiti Sains Malaysia, School of Medical Sciences, Reconstructive Sciences Unit, Health Campus, Kubang Kerian, Malaysia
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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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Abstract
Background Body hair shafts from the beard, trunk, and extremities can be used to treat baldness when patients have inadequate amounts of scalp donor hair, but reports in the literature concerning use of body hair to treat baldness are confined to case reports. Objectives This study aimed to assess the outcome of body hair transplanted to bald areas of the scalp in selected patients. Methods From 2005 through 2011, 122 patients preselected for adequate body hair had donor hair transplanted from the beard, trunk, and the extremities to the scalp by follicular unit extraction (FUE) by the author at a single center. All patients were emailed surveys to assess surgical outcomes and overall satisfaction. Results Seventy-nine patients (64.8%) responded with a mean time of 2.9 years between date of last surgery and time of survey. Patients were generally very satisfied with results of their procedure, giving mean scores of at least a 7.8 on a Likert-like scale of 0 to 10 for their healing status, hair growth in recipient areas, and overall satisfaction with their surgeries. These scores were comparable to mean scores provided by patients whose transplants included scalp donor sources. Conclusions FUE using body hair can be an effective hair transplantation method for a select patient population of hirsute individuals who suffer from severe baldness or have inadequate scalp donor reserve. Level of Evidence: 4
Therapeutic
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Affiliation(s)
- Sanusi Umar
- Dr Umar is a Clinical Instructor of Medicine, Department of Medicine, Division of Dermatology, University of California at Los Angeles, Los Angeles, CA
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Chen L, Xi J, Liu D, Zhang X, Lü Y, Li J, Wang J, Zhou J, Nan X, Yue W, Pei X. [CO-TRANSPLANTATION OF MOUSE EPIDERMIS AND DERMIS CELLS IN INDUCING HAIR FOLLICLE REGENERATION]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2016; 30:485-490. [PMID: 27411280] [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: 06/06/2023]
Abstract
OBJECTIVE To investigate the co-transplantation of C57-green fluorescent protein (GFP) mouse epidermis and dermis cells subcutaneously to induce the hair follicle regeneration. METHODS C57-GFP mouse epidermis and dermis were harvested for isolation the mouse epidermis and dermis cells. The morphology of epidermis and dermis mixed cells at ratio of 1:1 of adult mouse, dermis cells of adult mouse, cultured 3rd generation dermis cells were observed by fluorescence microscope. Immunocytochemistry staining was used to detect hair follicle stem cells markers in cultured 3rd generation dermis cells from new born C57-GFP mouse. And then the epidermis and dermis mixed cells of adult mouse (group A), dermis cells of adult mouse (group B), cultured 3rd generation dermis cells of new born mouse (group C), and saline (group D) were transplanted subcutaneously into Balb/c nude mice. The skin surface of nude mice were observed at 4, 5, 6 weeks of transplantation and hair follicle formation were detected at 6 weeks by immunohistochemistry staining. RESULTS The isolated C57-GFP mouse epidermis and dermis cells strongly expressed the GFP under the fluorescence microscope. Immunocytochemistry staining for hair follicle stem cells markers in cultured 3rd generation dermis cells showed strong expression of Vimentin and α-smooth muscle actin, indicating that the cells were dermal sheath cells; some cells expressed CD133, Versican, and cytokeratin 15. After transplanted for 4-6 weeks, the skin became black at the injection site in group A, indicating new hair follicle formation. However, no color change was observed in groups B, C, and D. Immunohistochemical staining showed that new complete hair follicles structures formed in group A. GFP expression could be only observed in the hair follicle dermal sheath and outer root sheath in group B, and it could also be observed in the hair follicle dermal sheath, outer root sheath, dermal papilla cells, and sweat gland in group C. The expression of GFP was negative in group D. CONCLUSION Co-transplantation of mouse epidermis and dermis cells can induce the hair follicle regeneration by means of interaction of each other. And transplantation of isolated dermis cells or cultured dermis cells individually only partly involved in the hair follicles formation.
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Ramos O, Tchernev G, Chokoeva AA, Wollina U, Maximov GK, Patterson JW, Fioranelli M, Roccia MG, Ananiev J, Lotti T. Biofibre hair implant impact on the quality of life. J BIOL REG HOMEOS AG 2016; 30:21-25. [PMID: 27373130] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Body image refers to how we feel about our bodies. It does not refer to what we actually look like, but rather to our perceptions, opinions and ways of thinking about our appearance. How we feel about our appearance is part of our body image and self-image. The hair is a significant part of this image. The problem of alopecia affects both sexes and all ages with significant sequelae. Along with androgenetic alopecia, there are forms of alopecia of various origins: traumatic, surgical, pharmacological and others. Polyamide artificial hair implant (Biofibre®) is one of the current techniques used to treat this problem.
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Affiliation(s)
- O Ramos
- Clinica Dermatologica Tavizon y Torres, Coyoacan, Distrito Federal, Mexico
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical faculty, Plovdiv, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - G K Maximov
- Department Medicinal Information and Non-interventional studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - J W Patterson
- University of Virginia Health System, Department of Pathology, Charlottesville, VA USA
| | - M Fioranelli
- History Department, G. Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - J Ananiev
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Trakia University, Armeiska str.11, Stara Zagora, Bulgaria
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
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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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