Enxerto de Gordura Prévio e Transplante pela Técnica FUE em Cicatrizes do Couro Cabeludo: Atualização / Previous fat grafting and hair transplantation using the FUE technique on scalp scars: Update

Foi realizada uma revisão de literatura narrativa, sobre a associação de enxerto de gordura e transplante de cabelos com a técnica FUE (Follicular Unit Extraction) em cicatrizes do couro cabeludo. Os dados foram coletados a partir de estudos encontrados nas bases Medline, Lilacs e IBECS. Foram citados registros bibliográficos de vários autores que pesquisaram as células mesenquimais do tecido gorduroso, com descrição das técnicas utilizadas. A conclusão foi de que a técnica de transplante capilar em duas etapas, com transplante prévio de gordura é eficaz, segundo os artigos revisados.

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.

Clinical outcome of hair transplantation combined with SVF GEL assisted fat transplantation in cicatricial alopecia / 中华医学美学美容杂志

Objective:To explore the clinical effects of hair transplantation combined with SVF GEL assisted fat transplantation in treating cicatricial alopecia.Methods:Eleven patients (5 males and 6 females, ranging from 22 to 41 years old) with cicatricial alopecia caused by burn or tumor excision in Shanghai Mylike Cosmetic Hospital from October 2017 to August 2019. All patients were treated with hair transplantation combined with SVF GEL assisted fat transplantation according to their scar areas.Results:Patients were followed up for 11 months on average, their hair grew well, with significantly improved appearances and no obvious complications. Hair follicle detection system was used to analyze the hair density after transplantation. The average survival rate reached 90.26% in accompany with desirable patients＇ satisfactory rates.Conclusions:Excellent results can be achieved by conducting hair transplantation combined with SVF GEL assisted fat transplantation in treating cicatricial alopecia, which is worth clinical application.

The Application and Effect of the Clinical Nursing Pathway in the Autologous Hair Transplantation / 昆明医科大学学报

Objective To analyze the nursing effect of the standardized CNP (Clinical nursing pathway) in the hair transplantation surgery during the perioperative period. Method The nursing process of 48 autologous hair transplantation cases in our center would be retrospective analyzed from September 2016 to September 2017. The patients were divided into the control group (24 cases) and experimental group (24 cases), which the former with conventional nursing, the latter with CNP. Afterwards, to study the effect of standardized CNP on hair transplantation according to the statistical analysis of data including the patients'basic information;patient satisfaction;doctors' satisfaction;unit operation time and unit area planting density. Result The results indicated the experimental group with CNP improved the satisfaction of both patients and doctors,meanwhile reducing the opera-tion time and improve the unit area planting density. The application of CNP can improve the nursing process and op-erating results effectively as well as the satisfaction of patients and doctors. It is worthy to be promoted and generalized in clinical treatment.Conclusion The application of CPN could effectively improve the nursing process, as well as the satisfaction of patients and doctors,and improve the overall surgical efficiency. It's worth to be applied in the clinical therapy.

Localized Telogen Effluvium Following Hair Transplantation

Telogen effluvium is categorized in nonscarring alopecia, which shows scalp hair thinning and shedding diffusely resulting from inducing factors such as physiological stressful events and several acute or chronic diseases. It usually appears in female patients following parturition, as well as after febrile disease, major surgery, emotional stress, abrupt diet, chronic illness, or the taking of certain medication pills. Two patients who both recalled an operational history of hair transplantation visited our department with their frontal and both temporal hair loss. Physical examination of the both patients showed localized but diffuse hair loss, especially in the frontal and temporal scalp. Histopathological examination of biopsy specimen taken from their temporal scalp revealed normal follicular density and increased numbers of telogen hair follicles without any inflammatory cell infiltration around follicles. These clinical and histopathological findings were consistent with telogen effluvium. Both of them were reassured and placed on close follow-up without any treatment. From these cases, we demonstrate that localized telogen effluvium could be a cause of hair loss after hair transplantation.

Transplante capilar de unidades foliculares: experiência de 15 casos / Hair transplant of follicular units: a 15-case experience

Introdução: O transplante capilar de unidades foliculares (UFs) é a técnica que permite a obtenção dos resultados mais naturais. A implantação de 20 a 25 UF/cm2 possui baixo risco de dano aos folículos e tem resultado satisfatório com duas sessões. Densidade superior a 30-35 UF/cm2 permite resultado com uma única sessão, mas aumenta os riscos de dano ao folículo e perda de crescimento dos fios. O objetivo do estudo foi relatar a experiência de 15 casos de transplante capilar com implantação de 30 ou mais UF/cm2, com incisões previamente realizadas e utilizando um instrumento cirúrgico modificado para facilitar a implantação. Método: Foi realizado estudo retrospectivo de 15 pacientes submetidos em sequência a um total de 17 cirurgias, no período de julho de 2008 a junho de 2012, com tempo de seguimento de 1 ano. Resultados: Foi implantada uma quantidade média de 1433,3 UF e 3019,8 fios por cirurgia. O tempo médio de duração das cirurgias foi de 10 horas e 23 minutos. Ocorreu crescimento satisfatório dos fios com resultado visível a partir de 6 meses, com poucas complicações. Dos 15 pacientes, dois necessitaram de uma segunda sessão. Conclusões: A técnica empregada possibilitou manipulação delicada das UFs e permitiu implantação com alta densidade, obtendo bom resultado com uma sessão, mas requer tempo de execução acima da média, devendo ter uso restrito a áreas pequenas com necessidade de maior densidade.

Introduction: The transplant of follicular units (FUs) for hair restoration yields the most natural results. The implantation of 20-25 FU/cm2 has a low risk of follicular damage and yields satisfactory results within two sessions. A density greater than 30-35 FU/cm2 yields the same results within a single session but increases the risk of follicular damage and hair growth loss. We report our experience with 15 cases of hair transplantation, with an implantation density of ≥ 30 FU/cm2 and with incisions made previously using a surgical instrument modified to facilitate implantation. Method: A retrospective study of 15 patients who consecutively underwent 17 surgeries between July 2008 and June 2012 and were followed up for 1 year. Results: A mean of 1433.3 FUs and 3019.8 hairs were implanted per surgery. The mean surgical duration was 10 hours and 23 minutes. Satisfactory hair growth occurred, and results were visible at 6 months onward with few complications. Of the 15 patients, two required a second session. Conclusions: The technique used here enabled delicate manipulation of the FUs and high-density implantation that achieved good results within one session but required an above-average execution time and should be restricted to small areas requiring greater density.

Application of transplanting different diameter single hair in treatment of part eyebrow defect / 中华医学美学美容杂志

Objective To explore the effects of implanting different diameter single hair in treatment of part eyebrow defect.Methods 49 patients with part eyebrow defect,including 37 congenital sparse eyebrows and 12 traumatic eyebrow detect,were performed hair transplantation.Single-hair grafts were harvested from the scalp behind ear or the inferior part of the occiput.Single-hair grafts were implanted according to directions of normal eyebrow.22G or 23G needle was used for stick-andplace insertion.The thick and thin hairs were divided.The thin hairs were implanted into the medial and distal ends and the upper edge,the thick hairs were implanted into the center.Results After 3-10 months follow-up.The reconstructed eyebrows growed slowly,about every 5-7 days needed be trimmed.Two sides eyebrows were symmetry.Because a small amount of transplanted hairs were not alive,twelve patients were performed the second operation for thicker eyebrow.All patients were satisfied with the results.Conclusions In treatment of part eyebrow defect,the results of implanting different diameter single hair are natural and vivid.

Asian Female Hairline Surgery Using Follicular Unit Extraction

BACKGROUND: Asian female hairline surgery is unique part among hair transplantation surgerys. Most of Asian female hairline surgery had been done by single strip harvesting technique which leave noticeable linear scar. As follicualr unit extraction is introduced1, female hairline surgery can take advantage of the Follicular Unit Extraction technique;leaving no linear donor scar. There has been a belief among surgeons who are somewhat reluctant to use follicular unit extraction for female hairline surgery that the inspection of the naturally occurring curl direction of hair, which is believed one of the critical steps for appropriate operative result in Asian female hairline surgery, is impossible in follicular unit extraction. So follicular unit extraction has to be 'plan B' in respect of Asian female hairline surgery. But author thought differently about this belief. METHODS: From December 2012 to May 2013, 78 consecutive cases of female hairline surgerys were done by follicular unit extraction. The ages of patients were 18 to 57 and mean was 34.5. The cases can be categorized in 3 groups; 1) Correction of fronttemporal recession only. 2) Whole hairline correction (including fronto-temporal recession, temporal recession and lowering of the central hairline). 3) Correction of the hairline with scar by previous aesthetic surgery just like forehead lift or forehead reduction surgery. Donor hair was harvested by follicular unit extraction and preparation of donor area was done by micro-strip shave pattern, by which no short haircut window was needed. Follow up periods were 4 months to 8 months. RESULTS: Aesthetic results of the all cases were satisfactory. There were three cases which needed small session (less than 100 hairs) for relatively less survival area (all of these areas were the anterior part of hair part) and two cases of small 'moth-eaten pattern' on donor area which need no treatment or another session for aesthetic improvement. There was no lumpy graft which can be look unnatural or literal wall of plug graft in anterior part of corrected hairline. There was no linear harvesting scar, which is in-evitable in single strip harvesting, on donor area. CONCLUSIONS: Follucualr unit extraction can be versatile technique for hair restoration surgery and also hold good for Asian female hairline surgery.

The Influence of Implanter Bevel Direction during Insertion on Transplanted Hair Survival Rate: Bevel-up or Bevel-down? / 대한피부과학회지

No abstract available.

Correction of Temporal Triangular Alopecia with Follicular Unit Hair Transplantation / 이화의대지

Temporal triangular alopecia is a triangular or oval shaped non-scarring alopecia, occurring on the temporal side of a scalp. Although surgical excision or hair transplantation has been known to be an effective therapy for this condition, so far only a few case reports have proved their usefulness. A 27-year-old male patient presented with a history of congenital hair loss affecting left frontotemporal area which persisted after simple excision done 10 years ago. We transplanted 270 follicular units into the alopecic patch using follicular unit hair transplantation method. About 75% of alopecic patch was covered with newly grown hairs 15 months after hair transplantation and the patient was satisfied with the result. Herein, we report a case of temporal triangular alopecia which underwent both simple excision and hair transplantation, which provides information about the benefit and loss for each procedure.

The Shape and the Location of Forehead Hairline of Korean Males in Their 20s & 30s

PURPOSE: It is generally believed that alopecia is caused by various factors such as scars, stress, genetical factors, androgens, etc. Androgenic alopecia is one of the most common cause of alopecia and found mainly in males. Propecia(Merck & Co., USA) and Minoxidil(McNEIL-PPC, Inc, USA) were the drugs approved from FDA for treatment of androgenic alopecia. Surgical treatments such as flap, tissue expansion, scalp reduction and hair transplantation can be considered if necessary. Hair micrograft techniques were developed for natural hair shapes and minimal adverse effect. There were attempts to measure the length of the forehead of the Korean young adults. However attempts to classify the shape and location of forehead hairline were rare. This study attempted to find out standard hairlines of young adults in their 20s & 30s and the result would be the guideline of the hairline in hair replacement surgery of male patients in their 40s & 50s. METHODS: 200 male adults in 20s and 30s were photographed and measured the length of 11 vertical index lines to determine hairline. The indexes are the distances from hairline to intercanthal midpoint(A), to medial canthus (B), to upper eyelid fissure(C), to lower eyelid fissure(D), to lateral canthus(E) and distance from lateral highest point to medial lowest point, if the hairline is M-shape(F). Additionally, we classified the hairlines into 4 groups, M, horizontal, inverted U and irregular shapes. RESULTS: The most common hairline of male adults in their 20s is inverted U-shape(53.3%), followed by horizontal-shape, M-shape, irregular-shape. In their 30s, inverted U-shape(59%) is followed by irregular-shape, M-shape, horizontal-shape. The M-shape is more frequently found in males in 30s than those in 20s. The mean values of the indexes in their 20s are as follows: A(76.14mm), B(Rt: 75.78mm, Lt:76.41mm), C(Rt: 69.43mm, Lt: 69.92mm), D(Rt: 76.92mm, Lt:77.46mm), E(Rt: 64.16mm, Lt: 64.73 mm), F(4.09mm). Those in their 30s are as follows: A(76.13mm), B(Rt: 76.114mm, Lt: 76.02mm), C(Rt: 69.87 mm, Lt: 70.37mm), D(Rt: 77.37 mm, Lt: 77.58mm), E(Rt: 69.63mm, Lt: 69.85mm), F(6.14 mm). CONCLUSION: The knowledge about human body measurement is indispensable to plastic surgeons. In this study, inverted U shape is the most common type of hairline in 30s, and similar distribution is found in 20s. The percentage of M shape in their 30s is elevated more than 10% compared to that in their 20s. The study of hairline shapes and 11 indexes of hairlines can be useful for planning of the hair transplantation and postoperative evaluation. This study being based on photogrammetry, there may be differences between actual distance of curved face and projected distance on flat photographs.

Conduta pessoal em cirurgia da calvície / Personal procedures for baldness surgery

O autor apresenta um modelo pessoal de sistematização emcirurgia do transplante capilar para tratamento da calvícieandrogenética, avaliando os resultados conseguidos com novastécnicas, táticas, materiais cirúrgicos, videomicroscopia emedidas pós-operatórias que visam a maximizar os resultadosobtidos com tecnologia de ponta. São discutidos aspectosrelacionados às unidades foliculares, linha anterior, técnicaapurada e uma nova abordagem à área doadora, tanto nadissecção e retirada da faixa quanto na sutura tricofíticautilizada para repará-la.

A personal approach to the treatment of baldness is performedthrough a simple and efficient technique set on new principlessuch as the dissection of the follicular units, just single-hair-graftsfor the front hair lines, precise technique and a non traumaticapproach to the donator site where a new kind of dissection andsuture is introduced.

Single Hair Transplantation for Cicatrical Eyebrow Alopecia

PURPOSE: Single hair transplantation for eyebrow loss has been considered as a good method of achieving natural appearance of eyebrow. To date, however, no study has reported the survival rate following single hair transplantation for cicatricial eyebrow alopecia. METHODS: We performed single hair transplantation using Choi hair transplanter for 49 cases of scarring eyebrow loss from March 2003 to March 2006. Of these cases, 33 could be under a follow-up postoperatively for more than seven months. These 33 cases comprised 20 men and 13 women. Mean follow-up period was 12 months (7-36 months). In 17 patients(51.5%), 100 to 200 hairs were unilaterally transplanted. RESULTS: Following initial hair transplantation, the surgical outcome was excellent in 11 cases(33.3%), good in 12 cases(36.4%), fair or poor in the remaining ten cases(30.3%). All procedures were done under intravenous sedation and local or regional block anesthesia. It took about one and a half hours for us to transplant 200 hairs. The shape of eyebrow was aesthetically acceptable with a good direction and an ideal inclination of hairs. No patients developed notable complications, while 30 percent had a low survival rate. CONCLUSION: Single hair transplantation using Choi hair transplanter is a safe, effective surgical method for scarring eyebrow loss.

Eyebrow Reconstruction with Single Hair Transplantation

People who have thin eyebrows seek to enhance the density of their eyebrows. Eyebrow reconstruction could be accomplished by tattooing, pedicled flap, composite graft and hair transplantation. However, tattooing is neither permanent nor natural. The pedicled flap or the composite graft leaves an unsightly scar and unnatural results. High level skill and long operation time is the only disadvantage of eyebrow hair transplantation reconstruction but this problem can be overcome by having a well trained operation team. The authors present 130 cases of single eyebrow hair transplantation in one stage with pure cosmetic aims. The majority of patients had congenital thin eyebrows and no definite cause of thinning was found. The results were adequate and almost all of the patients were satisfied with their newly grown dense eyebrow hair.

Dermtosurgical Treatment of Hypotrichosis of Pubis and Atrichia Pubis with the Additive Effect of Testosterone Cream / 대한피부과학회지

BACKGROUND: The incidence of hypotrichosis of pubis and atrichia pubis is relatively higher in oriental countries including Korea. OBJECTIVE: The aim of this study was to develop a treatment method to increase the density and to improve the distribution pattern of pubic hair in these patients. METHODS: Testosterone cream(5%) was applied to ten patients for six months. Then, the individual hair transplantation from the parietotemporal region of the scalp with the specially devised mini-punch was performed. Around the mons pubis, transplantation with 2-3mm punch was done. Postoperatively, the application of testosterone cream was done twice a day. RESULTS: Nine of ten patients were satisfied with the final results. Testosterone cream helped to increase the density of pubic hair. Transplanted hairs showed curling to some extent and did not grow like as it were at donor site. CONCLUSION: The advantage of this method is to make the appearance of pubic hairs more natural by controlling the direction and numbers of transplanting hairs at the time of operation and by making the hair denser with pre- and post-operative application of testosterone cream. The authors hope many dermatologic surgeons to use this new treatment approach for atrichia pubis and hypotrichosis of pubis.

Distribution and Density of Pubic Hair of the Korean Adult Female

'Pubic atrichosis or hypotrichosis' is defined as the agenesis or the insufficient amount of pubic hair nevertheless the presence of other secondary sexual characteristics are normal. Such females may suffer from low self-esteem and psychological problem in addition to the aesthetic problem. In past, the treatment of atrichosis or hypotrichosis was done mainly with such medical therapeutics as hormonal drug therapy, but treatment tends toward the single hair transplantation in these days. Therefore, the importance of preoperative design have been emphasized to obtain more natural appearances and satisfactory results. We have studied for the pattern, hair line, distribution, density, direction, and angle to skin surface of pubic hair in 50 adult females. In pattern of pubic hair, the most common type was the horizontal type(64%) and the acuminate, the dispersed, the few type followed in order. But, the sagittal type was not observed. In the horizontal type, the upper border of line of pubic hair was located at 3/6-4/6(53%) or 4/6-5/6(47%) point of the distance from junctional point of both inguinal ligaments to the horizontal line passing both anterior superior iliac spines. In the acuminate type, most of them(75%) were located at 4/6-5/6 point of the distance from junctional point of both inguinal ligaments. In the horizontal and the acuminate type, the most lateral points of pubic hair were located, between right and left symmetrically, at 2/6-3/6 point of distance between both anterior superior iliac spines. The density of pubic hair at mons pubis, superior and lateral region of labium major didn't have no statistical difference and the central region had higher density than peripheral region. The direction of pubic hair was equal to Langer's line, angle of hair shaft to skin surface was about 60 degrees at central region and it was more acute angle at the peripheral region. In transplantation of pubic hair, it is important to know anatomical shape of pubic hair in normal adult female. If a surgeon considers the pattern, hair line, distribution, density, direction, and angle of hair shaft to skin in preoperative design and hair transplantation, one can obtain more natural-appearing and satisfactory results.

The Effects of Dehydration, Preservation Temperature and Time on the Hair Grafts

BACKGROUND: Careful manipulation of hair grafts is essential for a good yield of transplanted hair. OBJECTIVE: The aim of this study was to evaluate some of the factors responsible for poor graft yield, such as dehydration of the graft and the temperature and duration of preservation. METHODS: First, for the dehydration study, isolated single hair follicles were left on dry gauze for 0, 5, 10, 20, and 30 minutes at room temperature. Secondly, to evaluate the effect of preservation temperature and time on the hair graft, follicles were preserved in saline for 5 minutes as a control, then for 6, 24, and 48 hours both at room temperature and at 4℃, respectively. Viability of preserved follicles was judged based on organ culture. RESULTS: Elongation of hair folliciles was seen in 96%, 94%, 94%, 83%, and 68% for 0-, 5-, 10-, 20-, and 30-minute air-exposed groups, respectively. Survival was seen in 95%, 92%, 40% and 34% at room temperature and 96%, 94%, 76% and 50% at 4℃ for follicles preserved in saline for 5 min (control), then for 6, 24, and 48 hours, respectively. CONCLUSION: We suggest that, alone with careful manipulation of hair units, high survival can be achieved with the avoidance of graft dehydration and preservation of the grafts at low temperatures if the operation time extends for more than 6 hours.

A Case of Pubic Hair Transplantation in Male Pseudohermaphroditism / 대한피부과학회지

Sex identification may be described in terms of some characteristics. Any individual with testicular formation and contraindiction of any of the anatomical criteria of sex may be considered as a male pseudohermaphrodite. Most of them have genitalia that are more feminine than masculine, are best raised as females. We report a 26-year-old male pseudohermaphrodite who was phenotypically female with amenorrhea, little breast development and little sexual hair. For treatment, multidisciplinary team approach including pubic hair transplantation is needed to enhance self-image and confidence in intersexuality.

HAIR TRANSPLANTATION FOR MALE PATTERN BALDNESS AND OTHER ALOPECIAS

The increasingly successful results of hair restoration surgery in the last years have developed the interest and the confidence of patients and it is the most frequently performed esthetic surgery among male patients. Currently, various kinds of techniques for hair restoration surgery including hair transplantation, scalp reduction, and scalp flaps are performed in our clinic. Among these, hair transplantation is the basic and the most popular procedure, which can be performed not only by itself but also in conjunction with other procedures. 123 consecutive cases of hair transplantations were peformed from Jan. 1995 to Feb. 1996 for male pattern baldness, traumatic alopecia, and female pattern baldness under out patient base. The authors introduced a new classification for male pattern baldness, which are the type M, O, C, U, M-O, and C-O after alphabet to make simple and easy for clinical application. The ancillary procedures were scalp reduction, preauricular flap, and scalp expansion. An ellipsis of hair bearing scalp taken from the occipital area was sliced into slit-, mega-, mini-, and micro-grafts. The survival rate of the grafts was over 90% with minimal complications. This hair transplantation technique enabled us to achieve a good density and more natural looking hair with avoidance of cobble stoning and apparent scar.

Total Micrografting Hair Transplantation Using a New Hair Implanter

BACKGROUND: Hair transplantation is a continuously evolving era towards a more natural style and micrografting in greater quantities is becoming an unmistakable trend. OBJECTIVE: A rapid, simple method to make a micrograft implanter with low cost and a case of total micrografting using this new hair implanter are presented. METHODS: We devised a simple method to make a micrograft hair implanter using a spinal tap-ping needle and did total micrografting with this device 3 times on 1 patient. RESULTS: Cosmetically, hair transplantation using our device produces hair that is slightly less dense in a normal individual. However, our technique gives a good balance in distribution of hair with no scarring which contribute to a natural style appearance. CONCLUSIONS: Total Micrografting with our new implanter produces a natural appearance without the artificial look and scars typical of the minigrafts or punch grafts in Koreans. So we consider this device as a another alternative device in hair transplantation.