No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Hair Follicle Transplantation on Scar Tissue
Abstract
Hair transplantation is a continuously evolving field. The procedure was originally developed by Dr. Orentreich in 1959, but he applied it only to the androgenic alopecia. Potential applications for hair grafting extend beyond treatment of hair loss.
Our study group consisted of 25 cases of 23 patients. The causes of scar resulting to hair loss were burns, operation, and trauma. The scalp strips or follicular unit extracts were harvested from occipital, posterior auricular, dog-eared scalp, adjacent scalp area, and nuchal area. The recipient sites were scalp, eyebrow, lip, and eyelid.
The follow-up cases over 6 months after operation were 18 among total 25 cases. The result after hair follicle transplantation was excellent (44.4%), good (38.9%), fair (11.1%), and poor (5.6%).
The hair follicle transplantation on the scar tissue is more difficult than grafting on normal tissue because the scar is accompanied by poor blood circulation and stiffness of tissue. The patients with burned scar achieved more favorable result than did others. Incision scars are deeper than burned scars, and their success rates are poor. We should recommend the patients that hair follicle transplantation on the scar may need secondary or more operations for the aesthetically better result.
... According to Unger, hairless lesions secondary to traumatic events (e.g., burns, radiation, prior surgeries, and traction injuries) that can cause permanent scarring in a hair-bearing region are specifically called "stable cicatricial alopecia (SCA)" [1]. Due to the general popularity of facial cosmetic surgeries, such as forehead lifts, forehead implants, and fat grafts, and the increasing numbers of complications involving scalp scars following these operations, there is an increased demand for the treatment of postsurgical alopecia [2][3][4][5]. ...
... Our study focused on surgically induced SCA. The traditional surgical treatment methods for such lesions include excision, local flap, and tissue expansion, which can result in additional scarring, an unfavorable hair growth direction, and vascular network compromises [1,5]. Some reports have described successful cases of camouflaging postsurgical scar alopecia with hair transplantation [14,25]. ...
... According to Shao, hair transplantation in 37 cicatricial alopecia patients with traumatic scars resulted in a 78% survival rate at an average of 13 months of follow-up [14]. Additionally, Jung showed that, among 18 patients who underwent hair follicle transplantation onto posttraumatic scar tissue, 15 showed more than 75% graft survival at the 6month follow-up visit [5]. ...
Background:
Although stable cicatricial alopecia (SCA) secondary to surgical events of the scalp can affect patients' psychosocial status, hair transplantation onto postsurgical scar tissue on the scalp is challenging because of tissue stiffness and poor blood circulation.
Objective:
In contrast to traditional surgical treatments, such as excision, local flap, and tissue expansion, follicular unit (FU) hair transplantation offers aesthetically pleasing results in the treatment of postsurgically induced SCA.
Materials and methods:
This study included 15 patients with SCA of the scalp due to postsurgical scarring. The patients underwent a single session of hair transplantation of approximately 35 units/cm2 density. The graft survival rate was evaluated 12 months after the procedure. The Patient and Observer Scar Assessment Scale (POSAS) was used to analyze the preoperative and postoperative satisfaction.
Results:
The FUE hair transplantation had a mean survival rate of 80.67% (range 70-90%). The patient and observer satisfaction significantly improved after the procedure; the POSAS scores were 24.47 (range 16-38) preoperatively and 11.60 (range 7-18) postoperatively.
Conclusion:
FU hair transplantation could be an effective method for managing scar tissue on the scalp and offers several advantages, including a high transplantation survival rate and satisfactory postoperative results.
... The eyelid represents another location in which hair transplantation remains a superior treatment option for patients who lack sufficient eyelashes. 2,8 The procedure of hair transplantation for eyelashes is similar to that of eyebrows, using the FUT technique most commonly. CGs can also be used, especially in patients demonstrating a complete loss of eyelashes. ...
... 2,[14][15][16][17][18][19][20][21] The occipital region is most commonly used because it is known to be the last area of the scalp to be affected by hair loss. 2,8,[15][16][17][18][21][22][23][24] Some studies have used skin from the contralateral eyebrow with similar success. 15,25 Once the skin strip has been excised, surgical assistants use stereomicroscopic dissection to remove individual follicular units. ...
... On the other hand, a unique benefit of FUE is the ability to extract hair follicles from regions beyond the occipital scalp, allowing for the ability to precisely match the density of the eyebrow. Studies have used a variety of donor regions for FUE including the occipital scalp, [3][4][5]8,[27][28][29] nape and periauricular area (NPA), 24 and leg hair. 30 Once harvesting is completed, recipient sites on the eyebrow are then created using a highgauge needle, with careful attention paid to the orientation of hair growth. ...
The objective of this systematic review was to investigate the etiologies of hair loss of the eyebrow and eyelash that required hair transplantation, the optimal surgical technique, patient outcomes, and common complications. A total of 67 articles including 354 patients from 18 countries were included in this study. Most patients were women with an average age of 29 years. The most common etiology requiring hair transplantation was burns, occurring in 57.6 percent of cases. Both eyebrow and eyelash transplantation use follicular unit transplantation techniques most commonly; however, other techniques involving composite grafts and skin flaps continue to be utilized effectively with minimal complication rates. In summary, many techniques have been developed for use in eyebrow/eyelash transplantation and the selection of technique depends upon the dermatologic surgeon's preferences and the unique presentations of their patients.
... fair (11.1%), and poor (5.6%). 49 Transplanting the hair follicles on a tissue with scar is so difficult, due to the poor blood supplement and tenacity of the scar tissue. Also, a higher rate of success and favorable results is seen in patients with burned scar rather than incision scars, due to the deeper depth of incision scars. ...
... Also, a higher rate of success and favorable results is seen in patients with burned scar rather than incision scars, due to the deeper depth of incision scars. 49 So, we should always warn the patients that choosing hair follicle transplantation procedure for scar management, can be accompanied by secondary (or more) operations, for better cosmetic result. ...
Key Clinical Message
Microcystic adnexal carcinoma (MAC) is a rare kind of cutaneous neoplasm with a very aggressive local infiltration that destructs the affected tissues. Its rate of recurrence is high and it mostly involves the face and scalp regions and most of the patients get affected in the fourth or fifth decades of their life. Here in, we report a 61‐year‐old woman with a right‐sided eyebrow MAC lesion with recurrency. Total excisional surgery was performed. A‐T Flap surgery was applied on the involved area, and after a 2‐year period of follow‐up, with no recurrency, hair transplantation with follicular unit transplantation method was successfully performed on the scarred area. Although microcystic adnexal carcinoma is an uncommon neoplasm; dermatologists and ophthalmologists should consider it as a differential diagnosis, due to its aggressive local infiltration. Complete surgical excision and long‐term follow‐up must be applied to manage the disease. Also, hair transplantation with follicular unit transplantation technique can be considered as a beneficial method for treating scars resulted from MAC excisional surgery.
... After a 6 months period of follow-up, satisfactory report from hair follicle transplantation procedure was as excellent (44.4%), good (38.9%), fair (11.1%), and poor (5.6%) (49). ...
... Transplanting the hair follicles on a tissue with scar is so difficult, due to the poor blood supplement and tenacity of the scar tissue. Also, a higher rate of success and favorable results is seen in patients with burned scar rather than incision scars, due to the deeper depth of incision scars (49). ...
... composite skin graft, and hair transplantation. [1][2][3][4][5][6] Use of a superficial temporal artery island scalp flap has several drawbacks, in that the restored hair is denser and thicker than before scarring, having a brush-like appearance with sharp boundaries. [7][8][9] In addition, these procedures require extensive dissection, which is complex and time-consuming. ...
... The average graft survival rate among patients was 85 percent-higher than the average 78 percent survival rate in patients with traumatic scars. 24 Jung et al. 1 reported that the survival rate of grafts that did not completely cover scars was less than 60 percent. The grafts in the current study completely covered previous scars. ...
Background:
Scarring that results in eyebrow loss is a serious psychological and cosmetic problem. Although hair transplantation is increasingly utilized for eyebrow restoration, graft loss may occur, preventing achievement of desired results. Single-hair follicle transplantation, however, may be effective. The present study describes outcomes of a standardized method of eyebrow reconstruction, involving single-hair follicle transplantation combined with follicular unit extraction (FUE), in patients with absent eyebrows due to scarring.
Methods:
This study was approved by the institutional ethics committee of Nanfang Hospital and all patients provided written informed consent before surgery. The medical records of patients who underwent eyebrow reconstruction from 2012-2019 for eyebrow loss caused by scar formation were retrospectively reviewed. Outcomes evaluated included satisfaction, graft survival rate and long-term complications. A nine-step standardized operating procedure was established for eyebrow reconstruction in patients with eyebrow absence due to scarring.
Results:
During the study period, 167 patients (205 eyebrows) underwent eyebrow reconstruction. Following the first stage of reconstruction, 95% of patients were highly satisfied with the density and natural appearance of their eyebrows. The average graft survival rate was 85% (range, 70-90%), significantly higher than the 75% survival rate previously reported. Fewer than 5% of patients underwent the take second stage of reconstruction, with these patients expressing satisfaction with their outcomes. No obvious complications were observed.
Conclusion:
This standardized method may optimize outcomes in patients with eyebrow absence due to scarring.
... Jung et al. reported their results in 23 patients with secondary cicatricial alopecia treated with FUE method. [19] They obtained 83.3% good and excellent results and concluded that burn scars are better ameliorated in comparison with incision scars as we do. We found that satisfaction of our patients was similar to this former report [18] and success rates of incision scars were worse than those of postburn scars as in the latter report. ...
... We found that satisfaction of our patients was similar to this former report [18] and success rates of incision scars were worse than those of postburn scars as in the latter report. [19] The limitations of our study include retrospective character; some patients could have been persuaded to undergo surgical scar excision before hair transplantation, and lack of scar biopsies to assess histological scar characteristics such as vascularity, collagen density, and thickness. ...
Background: Hair transplantation for the treatment of secondary cicatricial alopecia has recently become a more widely used technique. Objective: The aims of this study were to evaluate the results of use of hair transplantation surgery in patients with secondary cicatricial alopecia, to compare the results of the procedure with regard to different etiologies and to evaluate patient satisfaction. Patients and Methods: Forty-five patients with a definitive clinical diagnosis of secondary cicatricial alopecia were included in this retrospective study. Patients' characteristics were obtained retrospectively from medical records. The percentage of amelioration of cicatricial alopecia and patient satisfaction was obtained by interviewing patients. Results: Thirty-nine patients (86.7%) were satisfied and very satisfied with the procedure. While all patients who underwent hair transplantation for the treatment of facial cicatricial alopecic areas were satisfied, patients with hypertrophic scars were not satisfied significantly. Patient satisfaction was correlated to the percentage of amelioration of cicatricial alopecia. While patients with permanent alopecia as a result of developmental defects were satisfied the most, patients with postoperative and posttraumatic scars were satisfied the least. There was no difference between two different hair transplantation methods with regard to patient satisfaction. Conclusion: Hair transplantation done directly into scar tissue could be the first line treatment in selected cases with secondary cicatricial alopecia as this method is less traumatic and easier to perform in comparison with other surgical treatment methods.
... These surgical scars extended beyond the epidermis, reaching into the subcutaneous tissue, which hindered the normal development of hair follicles. 3,11 The scar tissue is notably firmer, with a texture tougher than normal scalp tissue, lacking healthy follicles and blood supply, thus limiting the ability for hair regeneration. 12 Previous studies have also found that the efficacy of hair transplantation in treating scarring alopecia caused by surgical incision scars is relatively poor, consistent with the results observed here. ...
Objective
To explore the efficacy of Follicular Unit Excision (FUE) in treating pediatric secondary cicatricial alopecia.
Methods
We selected 11 cases of patients under 18 years old who underwent treatment for secondary cicatricial alopecia at the Chengdu Hengmei Hair Medical Clinic from January 1, 2021, to December 31, 2022. Among them, there was 1 female and 10 males. All patients underwent FUE procedures. After 12 months, the assessment of the surgical efficacy was evaluated using the Global Aesthetic Improvement Scale (GAIS), and the incidence of complications was recorded.
Results
Among the 11 patients, none experienced complications such as infection, skin necrosis, significant hematoma, unnatural appearance, or temporary hair loss. 6 cases (54.5%) were rated as 1 on the GAIS, indicating extreme satisfaction. 2 cases (18.2%) were rated as 2, signifying satisfaction, resulting in an overall satisfaction rate of 72.7%. 1 case (9.1%) scored 3, showing limited improvement and dissatisfaction, and 2 cases (18.2%) scored 4, indicating no improvement.
Conclusion
FUE hair transplantation is a safe, minimally invasive, and effective method for treating stable cicatricial alopecia in children, leading to significant aesthetic improvements for the patients. Further studies with larger cohorts are needed to confirm these results and explore long-term outcomes.
... Particularly after the year 2011, which happens to be the year with the highest number of influential publications, we saw an emergence of articles discussing alternative uses and novel approaches for hair transplantation. Researchers began to expand the utility of hair transplantation for new applications such as scar concealment, wound healing, and burns treatment [11][12][13][14][15]. Three influential articles on the implementation of robotic-assisted follicular unit extraction for hair transplantation were published between 2014-2015 [16][17][18]. ...
Introduction
This bibliometric review aims to assess the impact of significant publications within the field of hair transplantation. Citation counts will serve as a primary influence indicator.
Methods
An exhaustive search was conducted using Clarivate’s Web of Science database, yielding 260 publications related to hair transplantation. These were evaluated and sorted based on citations, narrowing down to the 50 most highly cited works for analysis. Parameters including citation density, authorship, institutional affiliations, country of origin, year of publication, article topic, and the level of evidence for each publication were obtained.
Results
Analyzed publications were cited a total of 1341 times. Authorship analysis revealed that the most significant contributors regarding hair transplantation were Bernstein and Rassman. We also identified the leading institutions affiliated with these works, highlighting the primary academic and research centers driving the field. Geographical analysis exhibited the US' dominance in producing impactful publications. Most publications were also classified within Level IV and Level V according to the Oxford Levels of Evidence system.
Conclusion
This review provides a comprehensive snapshot of the pivotal publications shaping hair transplantation. Our findings underscore significant contributions within this field and may assist researchers and clinicians in understanding the evolution and the current state of the hair transplantation literature. This bibliometric analysis can serve as a roadmap for those seeking to delve into this rapidly evolving field, facilitating the identification of research gaps and formulating future research directions.
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 .
... We also conducted a study in one patient where scalp hair follicle grafts were transplanted into a STSG, and in this case only observed a transient remodelling effect of transplantation (see Supplementary Results). From our (FJ) experience, hair follicles transplanted into STSG scars have a survival rate of 70-90%, which is similar to that of secondary scarring alopecia [50][51][52] . This is also comparable to the survival rate (80-90%) of follicle grafts transplanted into strip scars 53 . ...
Despite the substantial impact of skin scarring on patients and the healthcare system, there is a lack of strategies to prevent scar formation, let alone methods to remodel mature scars. Here, we took a unique approach inspired by how healthy hairbearing skin undergoes physiological remodelling during the regular cycling of hair follicles. In this pilot clinical study, we tested if hair follicles transplanted into human scars can facilitate tissue regeneration and actively remodel fibrotic tissue, similar to how they remodel the healthy skin. We collected full-thickness skin biopsies and compared the morphology and transcriptional signature of fibrotic tissue before and after transplantation. We found that hair follicle tranplantation induced an increase in the epidermal thickness, interdigitation of the epidermal-dermal junction, dermal cell density, and blood vessel density. Remodelling of collagen type I fibres reduced the total collagen fraction, the proportion of thick fibres, and their alignment. Consistent with these morphological changes, we found a shift in the cytokine milieu of scars with a long-lasting inhibition of pro-fibrotic factors TGFβ1, IL13, and IL-6. Our results show that anagen hair follicles can attenuate the fibrotic phenotype, providing new insights for developing regenerative approaches to remodel mature scars.
... According to cause of injury among the studied cases there were nine (45%) due to trauma scar, one (5%) due to surgical scar, two (10%) due to post expander and eight (40%) due to burn and according to cause of injury among the studied cases there were five (25%) temporal, four (20%) parietal, two (10%) occipital, three (15%) frontal, three (15%) temp + parietal, two (10%) at occipital + sagittal and one (5%) frontal + temporal. The mean time since injury of studied cases was 11.45 (±6 SD) with range (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), Shao 11 carried their study on 37 patients suffering from secondary Cicatricial alopecia in duration of 5 years with mean age of 24.68 ± 5.88 and Radwanski 12 showed that the patients' average age was 44.9 years (range: 39-72 years). On each side, the average number of hair grafts transplanted was 223 (range: 178-357). ...
... Few studies have reported on hair transplantation on post burn scar area. 2,[5][6][7] The authors' anecdotal experience in more than 100 cases is that hair follicle graft survival in scar tissue can range from 0 to 90%. 2 An extensive form of cicatricial alopecia with thin and atrophic scar treated with hair micrografting on the freely transferred nonhair-bearing skin flap was reported with unsatisfactory results. 4 In most of these studies as in normal hair transplantation, the graft was taken from a healthy donor site and implanted in the scarred recipient area without any treatment of the scarred recipient area prior to hair transplantation. ...
Background
Burn scar and alopecia on hair bearing area can severely affect social life of the patients. Unlike healthy skin, poor biological and mechanical properties of scar tissue in the recipient area can reduce survival rate of hair graft following hair transplantation.
Objectives
Combined non-ablative fractional laser (NAFL) and microfat injection could improve survival rate of hair grafts on post burn scar.
Methods
Thirteen patients with alopecia resulting from burn scar in hair bearing area of the scalp and face were treated with combined NAFL and microfat graft and subsequently follicular unit extraction (FUE) hair transplantation. Cicatricial alopecia occurred on the scalp, eyebrow, mustache, and beard areas. Patients were treated with 3-6 sessions of NAFL, and-2-5 sessions of microfat graft injections, followed by one session of hair transplantation using FUE technique.
Results
Hair transplantation was successfully performed with good to excellent results. The survival rate of transplanted follicular units ranged from 76 to 95 percent (mean, 85.04%) and the density success rate per square centimeter ranged from 76.9 to 95.2 percent (mean, 84.54%). All patients expressed high satisfaction with the results and no complication was encountered.
Conclusions
Hair transplantation, after combined NAFL and microfat injection is a promising treatment for post burn alopecia.
... An alternative to hair transplant is tissue expansion of the hair bearing surface of the scalp, an approach that can be used even if 50% or more of the scalp suffers from alopecia. [40,41] Unfortunately, this method comes hand in hand with long periods of disfigurement, numerous clinical visits, and prolonged treatment. [40] In addition, the reduce density of hair follicles that result after tissue expansion in a large scalp defect compromises the aesthetic appearance. ...
Introduction:
Dissecting cellulitis of the scalp, or Hoffman disease, is described as an extremely rare condition. Clinically, it is represented by recurrent painful nodules, purulent drainage, interconnected sinus tracts and keloid formation, leading to scaring and cicatricial alopecia. Without a precise diagnosis and an adequate treatment, the repercussions consist of severe infectious complications along with psychological negative effects and serious aesthetic alterations. There is no standard treatment. In refractory cases, surgical management is reported.
Patient concerns:
We report a case of a 65-year-old Caucasian male patient, with a 5-year history of Hoffman disease, who presented with multiple abscesses and sinus tracts of the scalp and patches of alopecia. The lesions were non-responsive to medical treatment.
Diagnosis:
The diagnosis of DCS has been established on the basis of the clinical appearance and has been confirmed histopathologically.
Interventions:
The patient underwent wide excision of the scalp, followed by reconstruction using free latissimus dorsi flap and covered by meshed split-thickness skin graft.
Outcomes:
Eighteen-month follow-up revealed complete remission of symptoms and lesions along with satisfactory cosmetic result.
Conclusion:
The scope of this case report is to raise awareness of the following aspects: Hoffman disease has an extremely low occurrence rate, a difficult differential diagnosis and no standard therapeutical strategy. It also highlights the effectiveness of scalpectomy and free latissimus dorsi flap covered by meshed split-thickness skin graft in treating a very advanced stage of the disease together with providing a natural contouring of the scalp. Ultimately, it discusses the other treatment alternatives.
... Notably, there could be used not only distinctive for skin in steady state immune cells, such as T regs or γδT cells but also polymorphonuclear leukocytes (in particular, neutrophils) and macrophages. Thus, partial simulation of wound milieu may be helpful to reproduce WIH-A and WIHN microenvironment during hair transplantation into the scar, which is a promising method of its amelioration (Jung et al., 2013), or into the balding scalp. It may be proposed, that macrophages within the hair-bearing graft could improve hair growth by three ways: trough AKT/β-catenin activation ; via induction of Wnt-signaling by dint of growth factors release (Kasuya et al., 2018), or production of Wnt-ligands upon their apoptosis activation (Castellana et al., 2014). ...
There are many studies devoted to the role of hair follicle stem cells in wound healing as well as in follicle self-restoration. At the same time, the influence of the inflammatory cells on the hair follicle cycling in both injured and intact skin is well established. Immune cells of all wound healing stages, including macrophages, γδT cells, and Tregs, may activate epidermal stem cells to provide re-epithelization and wound-induced hair follicle neogenesis. In addition to the ability of epidermal cells to maintain epidermal morphogenesis through differentiation program, they can undergo de-differentiation and acquire stem features under the influence of inflammatory milieu. Simultaneously, a stem cell compartment may undergo re-programming to adopt another fate. The proportion of skin resident immune cells and wound-attracted inflammatory cells (e.g., neutrophils and macrophages) in wound-induced hair follicle anagen and plucking-induced anagen is still under discussion to date. Experimental data suggesting the role of reactive oxygen species and prostaglandins, which are uncharacteristic of the intact skin, in the hair follicle cycling indicates the role of neutrophils in injury-induced conditions. In this review, we discuss some of the hair follicles stem cell activities, such as wound-induced hair follicle neogenesis, hair follicle cycling, and re-epithelization, through the prism of inflammation. The plasticity of epidermal stem cells under the influence of inflammatory microenvironment is considered. The relationship between inflammation, scarring, and follicle neogenesis as an indicator of complete wound healing is also highlighted. Taking into consideration the available data, we also conclude that there may exist a presumptive interlink between the stem cell activation, inflammation and the components of programmed cell death pathways.
... 17,18 Hair transplantation has also shown success in patients with cicatricial alopecia secondary to burns and trauma. 19,20 Despite this promising therapeutic avenue, HT for primary scarring alopecia remains controversial given its mixed results. 21 The relapsing and remitting nature of unstable cicatricial diseases such as FFA and LPP often complicates surgical planning and management. ...
Objective: Evolving hair transplantation (HT) techniques have offered new possibilities for hair restoration. However, the role of HT in patients with frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) remains unclear. This study aims to evaluate the outcomes and temporal relationship of HT in this population.
Methods: A literature search of three databases was conducted. We reviewed 1) literature reporting outcomes of patients with LPP or FFA who received HT, and 2) studies reporting the development of LPP or FFA resulting from HT.
Results: Thirteen articles included 42 patients that provided data for evaluation. Fifteen patients had previously been diagnosed with FFA or LPP, and the remaining 27 patients developed disease after undergoing HT. Seven patients with FFA and eight patients with LPP received HT, with a mean sustained disease remission of 2.69 years prior to HT. In total, two of seven (29%) patients with FFA and five of eight (75%) patients with LPP experienced positive HT results over a follow‐up period of 8–72 months. Interestingly, 27 patients without evidence of previous disease developed FFA or LPP following HT after a median duration of 16 months.
Conclusions: HT for LPP and FFA is feasible but results may be less favorable compared to HT for other causes. Outcomes may be more favorable for LPP than FFA but this was not statistically significant and evidence is very limited. FFA and LPP can also develop following HT in patients without previous evidence of disease.
Level of Evidence: NA Laryngoscope, 131:59–66, 2021
... Cases of scalp wound closure using a skin-stretching device can develop marginal alopecia due to reduced blood flow in the sagittal scalp area [13]. Scalp scarring and alopecia can be alleviated with hair follicle transplantation [14]. ...
Full-thickness scalp burn secondary to hair coloring is rare. The defects can be large and may necessitate complex reconstruction of hair-bearing tissue. Many skin-stretching devices that use gradual traction have been applied to take advantage of the viscoelastic properties of the skin.
A 21-year-old female patient was seen with a burn defect on her occipital scalp leading to exposed subcutaneous tissue after chemical application of hair coloring in salon. The dimension of the wound was 10 cm x 5 cm and would have required a skin graft or flap for closure of the defect. Two long transfixing K- wires (1.4 mm) and paired three wires threads (23 gauge), which are readily available in most hospitals, were applied over a period of 12 days for trichophytic closure of the defect. Remaining scalp scars after primary trichophytic closure with this skin stretching method were refined with hair follicle transplantation.
This skin-stretching method is valuable in helping to close problematic areas of skin shortage that would otherwise require more complicated procedures as a solution. This method is simple in application. This case shows a relatively unknown complication of hair coloring and its treatment.
... Hair follicles were then implanted into the pork skin recipient sites created by 21-G needles. [5] We can simulate and recreate various methods of transplantation, grafts of different size, different angles, and different depths, satisfying a kind of training BGrand Slam.T his kind of comprehensive training just is not possible with actual patients, where one technique or method is favored or required. ...
A simple technique using pork skin and excess hair and epidermis harvested from anti-wrinkle surgeries was used to practice hair transplantation techniques. This allows inexperienced physicians to practice and perform the traditional steps of hair transplantation without involving an actual patient in the early stages of perfecting technique. The technique uses pork skin during the procedure, while performing real-time hair transplantation simulation. The surgical result of the procedure can then be visualized, and the training process can be repeated at will; peer evaluation is performed after completion. Results showed that residents that practiced this technique scored consistently better than those without the same training background. Every score increased with practice, and the length of time needed to complete the hair transplantation process decreased. A simple technique using pork skin for practicing hair transplantation technique is a valuable training tool, and gives residents a way to practice sound techniques along with more precise anatomical familiarity for hair transplantation surgery, without the risks associated with training on live patients.
... Hair restoration after full-or partial-thickness scalp injury is complicated and several options are available (1). Tissue expansion and flaps are the chief methods and hair transplant should be considered in available patients (2,3). Tissue expansion was reported by Neumann in 1957. ...
Treatment of alopecia following burns, trauma or tumour surgery is challenging. Local flaps for small or medium sized defects and tissue expansion for larger defects is the common approach. Tissue expansion is a two-stage procedure and the inflation process causes difficulty for patients. V-Y-S plasty is safe and one-stage method of tissue reconstruction for scalp, face and other parts of the body. We performed this method safely for very large alopecia reconstructions in the scalp.
Background and Rationale
Scarring alopecia significantly impacts patients’ appearance and psychological well-being. Surgery is a common cause of scarring alopecia, making positive treatment crucial for patients’ overall health.
Objective
To investigate the clinical efficacy of autologous follicular unit extraction (FUE) transplantation for postoperative secondary stable scarring alopecia and evaluate its effectiveness.
Methods
A retrospective descriptive study was conducted, including 14 patients with postoperative secondary scarring alopecia. All patients underwent initial autologous FUE hair transplantation, and postoperative complications were monitored. Patient satisfaction surveys were also conducted.
Results
Satisfaction assessments were performed for all 14 patients. Two patients (14.3%) reported being very satisfied, 6 patients expressed satisfaction (35.7%), 4 patients reported being somewhat satisfied (28.6%), and 3 patients were dissatisfied (21.4%). Aesthetic complications included low follicular density post-transplantation, uneven density, and unnatural appearance.
Conclusion
Solely using a single FUE hair transplantation for treating postoperative secondary scarring alopecia has limited effectiveness and may not always meet expectations, potentially requiring multiple transplantations. Further research is necessary to guide and improve follicular transplantation survival rates to ensure surgical efficacy.
Objective
To assess the clinical efficacy of combining autologous fat grafting with hair follicle unit transplantation.
Methods
The authors conducted a retrospective analysis involving 30 patients at the Department of Plastic Surgery, Second Affiliated Hospital of Nanchang University, between January 2021 and January 2023. Granular fat was harvested from the thigh’s posterior aspect using liposuction. The fat was then filtered through cotton pads, fascia was excised, and the fat was implanted into the scar tissue. Postoperatively, beyond the 3-month mark, hair follicle units were harvested from the posterior occipital region of the scalp using an electric device, and these units were transplanted into the scarred alopecic zones. At 1 year postoperatively, the authors evaluated the survival rate of the transplanted hair follicles and the cosmetic outcomes. In addition, patient satisfaction data were compiled.
Results
Among the 30 patients, 22 males and 8 females with an age range of 18 to 43 years and a mean age of 29 years were included. Complete coverage was achieved in 23 cases, and substantial coverage in 7 cases. High satisfaction was reported by 28 patients, whereas 2 expressed moderate satisfaction.
Conclusion
The integration of autologous fat grafting with hair follicle unit transplantation for the treatment of scar-related alopecia demonstrates significant efficacy and high patient satisfaction, recommending its broader clinical application.
Follicular unit hair transplantation has greatly elevated the results of eyebrow restoration. However, unnatural and unbeautiful-looking results are still often seen after the surgery.
This study focused on poor eyebrow transplantation, discussed its possible reasons, and offered refined proposals.
A retrospective analysis was performed on 100 patients who were dissatisfied with the results of eyebrow grafting and came to our department from 2011 to 2021. Demographic characteristics, primary disease, and clinical data were objectively summarized and analyzed for these patients.
The patients’ medical charts and photographs were analyzed and summarized into the following outcomes: Thirty-six patients (36%) had sparse eyebrows. Forty-one patients (41%) had eyebrows with inhomogeneous density and disordered growth direction. Eleven patients (11%) did not have single-hair grafting. Seven reconstructed eyebrows (7%) had a poor connection with the remaining eyebrows. Five new eyebrows (5%) had inconsistent hair characteristics with the original eyebrows. Lower hair survival rates, insufficient understanding of naturally beautiful eyebrows, and inadequate communication with patients were the main reasons for poor outcomes.
Good reconstructed eyebrows should have a high hair survival rate, and hair growth direction and characteristics should also be consistent with the natural eyebrow to achieve ideal surgical effects.
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.
Scars are the final result of many different traumas. Irrespective of their cause they can not only disturb aesthetic harmony but also interfere with functional requirements. Both can mandate the need for surgical scar improvement. Surgical scar therapy can either be targeted on removing, improving, or modifying a scar for a better aesthetic and/or functional outcome.
There are various surgical options for scar therapy. Since not every method is suitable for every scar, making the right choice is essential. Extensive experience and a broad knowledge of the different techniques and their effects, risks, and limitations is crucial. This chapter focuses on different surgical therapeutic options in scar reconstructive therapy, such as serial excision, dermabrasion, local flap surgery, pedicled regional flaps, microvascular free flaps, use of tissue expanders, lipofilling, split-thickness skin grafting, full-thickness skin grafting, and hair transplantation. The importance of the relaxed skin tension lines (RSTLs) and the consecutive planning of the surgery is emphasized.
We developed a narrative literature review on the association of fat grafting and
hair transplantation using the Follicular Unit Extraction (FUE) technique in
scalp scars. Data were collected from studies found in Medline, Lilacs, and
IBECS databases. Bibliographical records of several authors who researched
mesenchymal cells in adipose tissue were cited, describing the techniques
used.The conclusion was that the two-stage hair transplantation technique, with
previous fat transplantation, is effective, according to the reviewed
articles.
Secondary soft tissue defects in patients with clefts include aesthetically displeasing scars, asymmetry of anatomical boundaries, incongruencies of the vermilion and white roll, nasal deformities, and an overall deficiency of soft tissue volume. Children with clefts undergo multiple surgeries before skeletal maturity, which may result in the disruption of facial growth. This chapter reviews the array of residual defects that may affect the lip, as well as the surgical management of these conditions. Patients with bilateral cleft lip may present an additional set of specific secondary lip deformities in addition to those commonly seen in unilateral cleft lip. Postoperative palate deformities can occur because of a failure of the normal wound‐healing process after palatal repair. Adjunctive aesthetic procedures to correct soft tissue deformities are extremely important and can be applied to supplement secondary cleft deformities.
Testosterone creates several characteristic changes in the upper face. These changes include elevating and squaring the hairline, flattening the central forehead, and increasing the anterior projection of the brow bone and orbital rims. When present, these changes will give a strong masculine characteristic to the face overall. Several techniques will be described here to restore the feminine characteristics of the upper face.
Background:
Follicular unit extraction (FUE) is a minimally invasive surgery that is becoming popular in hair restoration in cicatricial alopecia (CA).
Aim:
Evaluation of FUE with or without platelet rich plasma (PRP) in scarring alopecia PATIENTS AND METHODS: Twenty patients with CA were randomized into two groups. Group A (10 patients) underwent FUE, group B (10 patients) underwent FUE+PRP. PRP was injected one week before surgery, then monthly after surgery for 3 months. Follow up was done after 3,6 and 12 months by calculating the density of surviving follicular units and the survival rate.
Results:
In group A, there was statistically significant increase in mean survival rate which was 30.30% At 3 months, 67.26% at 6 months and 78.15% at 12 months. In group B, there was a significant increase in mean survival rate being 30.14% at 3 months, 58.75% at 6 months and 69.74% at 12 months. There was no significant difference between both groups at anytime during follow up period.
Conclusion:
FUE is a preferred procedure for hair restoration in CA with few side effects. The role of PRP in HT is controversial. In the present study, PRP does not significantly affect the survival rate of hair grafts.
Eyebrow is one of the most important features of the face; the absence of eyebrows will cause a heavy psychological burden to patients. Existing brow reconstruction techniques are not perfect for every case of eyebrow defect. In this study, a patient who suffered from eyebrows loss after radiotherapy for hemangioma underwent eyebrow reconstruction with the relay transfer of a temporal hairline flap. The entire procedure was performed in the outpatient operating room. The temporal hairline flap was transferred to the eyebrow region in a relay and survived well without necrosis. In the 2-month follow-up, the shape and density of the reconstructed eyebrows were satisfactory. The operation showed this technique was innovative, economic, and recommended as a suitable choice for eyebrow reconstruction, especially in those patients with poor hair transplantation recipient area.
Soft tissue wounds in the scalp are a common occurrence after trauma or resection of a malignancy. The reconstructive surgeon should strive to use the simplest reconstructive technique while optimizing aesthetic outcomes. In general, large defects with infection, previous irradiation (or require postoperative radiation), or with calvarial defects usually require reconstruction with vascularized tissue (ie, microvascular free tissue transfer). Smaller defects greater than 3 cm that are not amenable to primary closure can be treated with local flap reconstruction. In all cases, the reconstruction method will need be tailored to the patient's health status, desires, and aesthetic considerations.
Modern hair restoration surgery is based on a technique known as follicular unit transplantation in which follicular units (FUs) are the exclusive structures used as hair grafts. In Part 1 of this two-part review, we describe how the techniques employed in hair transplantation have evolved into their present forms. Anatomic concepts of specific relevance for dermatologists are discussed, including the distribution and ex-vivo morphology of scalp FUs. Male androgenetic alopecia and female pattern hair loss are the most common reasons for hair loss consultations with dermatologists and will be the primary focus of this review. However, as not all hair disorders are suitable for transplantation, this review will also describe which scalp conditions are amenable to surgery and which are not. In addition, guidelines are provided to help dermatologists better define good or bad candidates for hair transplantation. Finally, other conditions for which hair transplantation surgery is indicated are reviewed.
FREQUENCY OF ABNORMAL PARATHYROID HORMONE IN PATIENTS OF RENAL FAILURE PLANNED TO UNDERGO HEMODIALYSIS
Nephrology department, Liaquat National Hospital, Karachi
Abstract
Background: Chronic renal failure (CRF) is commonly found condition and its prevalence is more in the population of old patients. Hyperparathyroidism is among the pathologic signs of CRF which may cause the greater danger of cardiovascular disease (CVD). Hyperparathyroidism with hoisted serum parathyroid hormone (PTH) is related with greater cardiovascular mortality in last stage of renal disease and this relation is ambiguous in moderate CRF.
Objective: To define the frequency distribution of abnormal parathyroid hormone in patients of renal failure planned to undergo hemodialysis, at a tertiary care center at Karachi
Methods: This single center, cross sectional study was carried out in Department of Nephrology, Liaquat National Hospital Karachi from April 2013 to March 2014. There were 90 patients with diagnosis of CRF planned to undergo hemodialysis included. Before dialysis blood sample was obtained and sent to the laboratory of the hospital for assessment of PTH level. Then patients underwent haemodialysis. Dialysis was done as per hospital protocol. All the data was collected using the proforma
Study design: Cross sectional study
Results: - Patients` mean age was computed to be 53.79±6.51 years. Frequency of abnormal parathyroid was observed in 71.11% (64/90), in which hypoparathyroidism was 44.44% (40/90) and 26.67% (24/90) had hyperparathyroidism.
Conclusion: We found high frequency of abnormal parathyroid hormone in patients of renal failure planned to undergo hemodialysis. Derangement of Parathyroid hormone is progressive and it prevalence is found in the patients with chronic kidney disease (CKD) and with serious outcomes for the health of patients. If it is poorly overcome, this imbalance can result in the bone disease, calcification of soft tissue and vascular calcification, all of these are found to be influential on mortality and morbidity.
Key Words: Chronic renal failure, Hemodialysis, Hypoparathyroidism, Hyperparathyroidism.
ABSTRACT:
Objective:
Aim of this study is to evaluate the ambiguities regarding online course of medical sciences from the faculty point of view at Al-Tibri medical college and hospital Karachi.
Methods:
A cross sectional study conducted in Al-Tibri medical college and hospital Karachi from month 2020 to month 2020. Both genders of basic and clinical sciences were included by non-probability convenient sampling. The faculty was asked to fill the questionnaire. For that a valid questionnaire was adopted, that is based on various questions related with ambiguities of faculty members during online classes.
Results:
Out of total 50 faculty members (lecturer, assistance professor, associate professor and professor), 58.7% were male and 41.3 females. Most common barriers in Personal obstacles to faculty members' participation in online education were Anxiety regarding excessive workload and insufficient time for other academic activities (68%) in basic and (72%) clinical faculty. Attitudinal and Contextual obstacles to faculty members' participation in online education were facing are anxiety regarding online teaching because of direct proportional effect on quality of education that is due to lack of direct interaction with students (62%) agreed basic (72%) clinical faculty.
Conclusion: In present study it was noticed that high percentage of faculty was concerns regarding deficiencies of important equipment like software, internet sources) and inadequate information in online teaching. Thus to implement on new educational environment, need support and training regarding online teaching.
Key words: Online teaching, Barriers, Ambiguities
Abstract
Objective: To analyze the pre and post hands-on workshop analysis of faculty members related to medical sciences regarding scientific writing
Study Design: Cross sectional analytical study
Place and Duration of the study: Al-Tibri Medical College and Hospital, between January 2020 to May 2020
Materials and Methodology: After taken an ethical approval, total 50 number of faculty members of medical sciences were enrolled in research based work shop on the basis of convenient sampling. The workshop was conducted in three different phases and equally divides the faculty into groups. Before the workshop, the participants were given verbal consent and fill the pre-workshop questionnaire and after completion of hands-on workshop the similar questionnaire was filled by the participants. Now the pre and post workshop data was collected and presented in the form of frequency and percentage of response given by the participants and Chi-square test was applied to draw the significant difference between pre and post analysis. The level of significance was taken P=<0.05
Results: The significant difference (P value <0.01) were analyzed through pre and post workshop analysis in all component of the questionnaire
Conclusion: The study results revealed the significant difference in pre and post analysis of faculty members, they are lacking in quality when it comes to knowledge and writing skills in scientific writing, however, if workshops are conducted regularly they will develop skills necessary to write better literature and submit their work in different publications for appraisal. Research excellence department should be established for the faculty development
Key word: Scientific writing, workshop, medical sciences
Background:
Skin tattooing and cosmetic eyebrow definition and reshaping (micropigmentation) have been growing exponentially in popularity. The pigment used in these procedures can activate the skin's inflammatory response, promoting the formation of pathologic scars.
Objective:
To carry out a systematic review of the literature on this topic and report a case of pathologic scarring on the eyebrows after micropigmentation.
Methods:
A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline in the MEDLINE, Lilacs, and SciELO databases using the keywords "scar; scar, hypertrophic; eyebrows; pigmentation; skin pigmentation; coloring agents; tattooing" and their synonyms.
Results:
The systematic literature review did not identify any study reporting pathologic scarring on eyebrows after micropigmentation. This is likely because eyebrow pathology is uncommon, although these results are limited by the comprehensiveness of the systematic review. The case of a 50-year-old woman undergoing eyebrow micropigmentation who presented with hypertrophic scarring after the procedure is also reported.
Conclusions:
Eyebrow micropigmentation may be a risk factor for pathologic scarring, but further research is needed.
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.
Objective
To review the application and research progress of transcutaneous oxygen pressure (TcPO 2) in scar assessment.
Methods
The original articles about scar and TcPO 2 were reviewed and analyzed.
Results
Hypoxia environment plays an important role in the progression of scar tissue. TcPO 2 can accurately reflect the oxygen tension of scar tissue, which is of great significance in the assessment of scar maturity, the guidance of scar treatment, and the study of correlations between hypoxia and the progression of scar.
Conclusion
TcPO 2 measurement is important in the study of scar evaluation, treatment, and correlation between hypoxia and scar formation.
Las secuelas de quemaduras faciales se deben a quemaduras profundas o tratadas de forma insuficiente en el estadio inicial; su repercusión estética suele ser predominante, pero las secuelas funcionales pueden ser graves, sobre todo al nivel palpebral y labial. La reparación de las secuelas de quemaduras de la cara es un proceso largo y complejo, que requiere respetar las unidades estéticas de la cara y aportar piel sana de calidad y de color equivalente a la piel facial. Por tanto, en ella se utiliza casi siempre la expansión cutánea, en forma de injertos de piel total o de colgajos cutáneos expandidos, movilizados si es posible por encima de las regiones claviculares. Las técnicas más complejas de reparación, colgajos libres o alotrasplante de cara, dan resultados a menudo poco satisfactorios y sus indicaciones son excepcionales.
Le sequele delle ustioni facciali sono dovute a ustioni profonde o insufficientemente trattate allo stadio iniziale; il loro impatto estetico è spesso predominante, ma le sequele funzionali possono essere maggiori, specialmente a livello palpebrale e labiale. La riparazione delle sequele delle ustioni facciali è un processo lungo e complesso, che richiede il rispetto delle unità estetiche del volto e l’apporto di pelle sana di qualità e colore equivalenti alla pelle del viso. Fa, quindi, appello in quasi tutti i casi all’espansione cutanea, sotto forma di innesti cutanei a tutto spessore o di lembi cutanei espansi, prelevati, se possibile, al di sopra delle regioni claveari. Le tecniche più complesse di riparazione, lembi liberi o allotrapianti di faccia, danno dei risultati spesso più soddisfacenti e hanno solo indicazioni eccezionali.
The scalp presents many challenges to the reconstructive surgeon given its visible nature and the various considerations that must be given for optimal reconstruction. In this article, we review the anatomy of the scalp, the various options for reconstruction, and important considerations for improving the chances of optimal reconstruction of scalp defects.
Eyebrows, eyelashes, and eyelids are cosmetically and functionally important periocular landmarks that offer insights into a patient's emotional state. Several pathologies exist with respect to the eyebrows, eyelashes, and eyelids. Madarosis refers to loss of the eyebrows or eyelashes; milphosis refers specifically to eyelash loss. Excess growth of eyelash hair is termed trichomegaly. Excess skin in the upper or lower eyelids is called dermatochalasis. Pathology of these important structures can be reflective of important local and systemic disease processes.
Copyright © 2015. Published by Elsevier Inc.
To present the case of an 18-year-old boy with a cleft lip scar and an obligatory need for facial hair who underwent single-follicular-unit graft hair transplantation that resulted in significant moustache hair restoration in a single procedure.
The surgery was performed in an outpatient private practice setting using oral sedation and local anesthesia.
Advances in instrumentation technology and an increased understanding of the anatomical clustering of hair follicles into so-called "follicular units" containing one to six hairs per unit has resulted in a rapid expansion of hair restoration surgery into new areas including female-pattern alopecia, scarring alopecias, and cosmetic surgery scars. These new techniques can be employed to create natural-looking hair lines in front of artificial hair replacement systems; to improve unnatural looking, old "large-plug" hair transplants; and to correct discontinuity of eyebrows and hairlines in patients with congenital facial clefts. Increased awareness is needed to incorporate follicular-unit graft hair transplant surgery into the family of corrective surgery subspecialties.
Objective
To present the case of an 18-year-old boy with a cleft lip scar and an obligatory need for facial hair who underwent single–follicular-unit graft hair transplantation that resulted in significant moustache hair restoration in a single procedure.
Setting
The surgery was performed in an outpatient private practice setting using oral sedation and local anesthesia.
Results
Advances in instrumentation technology and an increased understanding of the anatomical clustering of hair follicles into so-called “follicular units” containing one to six hairs per unit has resulted in a rapid expansion of hair restoration surgery into new areas including female–pattern alopecia, scarring alopecias, and cosmetic surgery scars. These new techniques can be employed to create natural-looking hair lines in front of artificial hair replacement systems; to improve unnatural looking, old “large-plug” hair transplants; and to correct discontinuity of eyebrows and hairlines in patients with congenital facial clefts. Increased awareness is needed to incorporate follicular-unit graft hair transplant surgery into the family of corrective surgery subspecialties.
Follicular Unit Transplantation (FUT) is performed using large numbers of naturally occuring individual follicular units obtained by single-strip harvesting and stereo-microscopic dissection. Donor wound scarring from strip excision, although an infrequent complication, still concerns enough patients that an alternative solution is warranted.
The purpose of this paper is to introduce Follicular Unit Extraction (The FOX Procedure), in which individual follicular units are removed directly from the donor region through very small punch excisions, and to describe a test (The FOX Test) that determines which patients are candidates for this procedure. This paper explores the nuances, limitations, and practical aspects of Follicular Unit Extraction (FUE).
FUE was performed using 1-mm punches to separate follicular units from the surrounding tissue down to the level of the mid dermis. This was followed by extraction of the follicular units with forceps. The FOX test was developed to determine which patients would be good candidates for the procedure. The test was performed on 200 patients. Representative patients who were FOX-positive and FOX-negative were studied histologically.
The FOX Test can determine which patients are suitable candidates for FUE. Approximately 25% of the patients biopsied were ideal candidates for FUE and 35% of the patients biopsied were good candidates for extraction.
FUE is a minimally invasive approach to hair transplantation that obviates the need for a linear donor incision. This technique can serve as an important alternative to traditional hair transplantation in certain patients.
Subject
The eyebrow reconstruction should restore an eyebrow with a natural shape and with matching hair direction.
Method
We describe the micrograft hair technique for eyebrow reconstruction, using either hair from the opposite eyebrow or hair from the scalp. We illustrate our technique with three clinical cases: a traumatic eyebrow injury, a burn scar and a progressive hair loss.
Discussion
We insist on the advantages of this technique which is simple, “taylor-made” and which allows to choose the hair direction according to the eyebrow topography. The micrograft hair technique has many advantages in comparison with scalp strip grafting or hair-bearing island scalp flap techniques.
Conclusion
The eyebrow reconstruction using micrograft hair technique is a simple effective technique offering a better cosmetic result than usual techniques by achieving a natural hair direction and density.
Loss of hair-bearing tissue in the head and neck area can result from surgery, trauma, burns, tumors, and infection, as well as a diversity of inflammatory conditions, and the resulting defect can present a challenging problem for the reconstructive surgeon. Hair transplantation can be used as a reconstructive method alone or in conjunction with other techniques. The current method of using follicular unit grafts has led to natural restorations for a variety of areas including not only the scalp but also eyebrows, eyelashes, and beard areas. Camouflage provided by hair grafts can provide restoration not obtainable with other methods.
The advent of tissue expansion started a new era of aesthetically reconstructed scalp alopecia by providing a large hair-bearing scalp area with acceptable hair density. However, residual scalp alopecia and wide visible scars still raised aesthetic problems. The hair follicle transplantation carries the possibility of producing a more natural scalp because both the desired hair density and the natural direction of the hair can be reproduced using this procedure. Our study group consisted of 62 patients (41 males and 21 females) with a mean age of 26.3 years. The median age of suffering a burn to the scalp was 3 years. The causes of burn resulting to scalp alopecia were flame (n = 28), scald (n = 18), contact (n = 7), and electrical (n = 9) injuries. The first reconstruction for all patients was the expanded flap coverage. Three patients used 2-stage expanded flaps. Five patients underwent hair follicle transplantation after they had undergone the expanded flap coverage. Expanders (n = 86) were placed in 62 patients with a total of 9 major (9.3%) and 3 minor (3.5%) complications. The overall results after expanded flap reconstruction and hair follicle transplantation were excellent (43 patients, 69.4%), good (18 patients, 29%), and bad (1 patient, 1.6%). Postburn scalp alopecia can be reconstructed by 1-stage or multiple-stage expanded flap procedures. The visible remaining alopecia and marginal scar after the procedure, especially on the anterior hairline of the forehead and the sideburns, can be refined by hair follicle transplantation. This report also suggests the possibility that cicatrical scalp alopecia with intact deep tissue can be restored by hair follicle transplantations using hair transplanter.
The eyebrow reconstruction should restore an eyebrow with a natural shape and with matching hair direction.
We describe the micrograft hair technique for eyebrow reconstruction, using either hair from the opposite eyebrow or hair from the scalp. We illustrate our technique with three clinical cases: a traumatic eyebrow injury, a burn scar and a progressive hair loss.
We insist on the advantages of this technique which is simple, "taylor-made" and which allows to choose the hair direction according to the eyebrow topography. The micrograft hair technique has many advantages in comparison with scalp strip grafting or hair-bearing island scalp flap techniques.
The eyebrow reconstruction using micrograft hair technique is a simple effective technique offering a better cosmetic result than usual techniques by achieving a natural hair direction and density.
Multiple surgical methods are currently used for hair transplantation. Each method has a specific technique, morbidity, and relatively predictable cosmetic result.
To describe a methodology that combines elliptical excision of donor tissue and dissection under stereoscopic magnification into small grafts to obtain an improved final cosmetic result. For the purposes of this paper, any graft small enough to be easily inserted into a 16-, 18-, or 20-gauge needle tunnel will be referred to as a micrograft.
Three hundred thirty patients underwent transplantation by this method over a 6-year period. All patients were photographed before, during, and upon completion to monitor results.
Cosmetic results as documented by examination and photography represent a further refinement due to the large number and small size of grafts placed.
The author considers the method described as a viable alternative technique in hair transplantation for both limited and extensive androgenetic alopecia.
Hair on a man's head is an important emblem of health, youth, and vitality. As in all areas of cosmetic surgery, the refinements of surgical technique and instrumentation have improved the results of hair transplantation. The state of the art in hair grafting today produces a result that is undetectable as being a surgical hair transplant. Many earlier techniques of plug hair transplantation are not aesthetically acceptable by today's standards. This is especially true in the face of progressive hair loss, which can unmask previously camouflaged cornrow plugs. A technique to reduce the plugs and recycle the grafts into smaller grafts is described. The recycled hair grafts can be combined with scalp lifting, scalp reductions, and occipital harvesting of grafts to improve the results of cornrow appearing hair transplants and other problems of surgical hair restoration.
The use of a micrograft to camouflage upper lip scars is a simple and effective method. The authors used a microhair graft to camouflage upper lip scars in one patient. Unlike other methods of scar revision, additional tissue is not killed and new incision lines are not created.
Not Available Bibtex entry for this abstract Preferred format for this abstract (see Preferences) Find Similar Abstracts: Use: Authors Title Return: Query Results Return items starting with number Query Form Database: Astronomy Physics arXiv e-prints
Scarring eyebrow loss is usually repaired with a hair-bearing island scalp flap or scalp strip grafting technique. The results, however, are usually not desirable with regard to appearance. In this article, a one- or two-hair graft with a dense-packing technique was developed for cicatricial eyebrow reconstruction. It was carried out by harvesting a scalp strip close to the hairline of the back, then dividing it into a series of one- or two-hair grafts, and finally implanting the grafts into the prepared recipient holes of the eyebrow with a desired hair direction. With the authors' experience in treating 96 patients (154 eyebrows) in cases of burn, skin grafting, traumatic scarring, and chemical peeling scar after tattoo removal, the eyebrows could be restored in only one session. In general, 150 to 200 grafts with 200 to 250 hairs were needed for a complete male eyebrow reconstruction and 100 to 150 grafts with 150 to 200 hairs were needed for a complete female eyebrow reconstruction. The maximal hair density was 91.5 hairs/cm per session. Over a 6-month follow-up period, the mean graft survival rate reached 98.1 percent. All of the patients achieved satisfactory results, with a very natural appearance. These results indicate that the above-mentioned technique could be a practical, effective, and probably ideal method for cicatricial eyebrow reconstruction.
Follicular unit extraction: minimally invasive surgery for hair transplantation
- W R Rassman
- R M Bernstein
- R Mxclellan
Rassman WR, Bernstein RM, Mxclellan R, et al. Follicular unit
extraction: minimally invasive surgery for hair transplantation.
Dermatol Surg 2002;28:720Y728