New Donor Excision Design for Better Hair Alignment in Hair Restoration Surgery.

BACKGROUND: The linear scar and misalignment of hair follicles are disadvantages of the follicular unit transplantation (FUT) or strip technique. The most common misalignment is at the end of the strip. Although most surgeons try to match hair direction to achieve optimal hair alignment, their attempts are often unsuccessful. OBJECTIVES: We aimed to assess strip designs to improve hair alignment during hair transplantation. METHODS: We conducted a retrospective study of 157 patients who underwent hair transplantation with either the commonly used elliptical incision or our novel triangular flag-shaped designed incision on the donor strip tip. Two blind evaluators assessed the outcome of hair alignment using a 5-point visual analog scale. RESULTS: In total, 303 wounds on 157 patients were assessed. Overall, our triangular flag-shaped design (TFD) achieved better hair alignment than the common elliptical design (CED) (p=0.01). Patients with hair direction straight on the upper wound edge and hair direction inward on the lower wound edge showed improved outcomes with TFD, whereas patients with hair direction inward on both upper and lower wound edges showed better outcomes with CED. CONCLUSIONS: The TFD tip of donor strips achieved proper hair alignment for most hair transplant patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Comparative Study of Topical Therapy on Striae Alba between a Herbal Extract Cream and 0.1% Tretinoin Cream in Adolescence.

Background: Striae are commonly developed in adolescence as a result of active growth spurt. Although they create little physical health issue, they are cosmetic concerns to the patients. Effective striae treatment can help improve their mental health and personality. Objective: To compare the effects of a herbal extract cream and 0.1% tretinoin cream in the treatment of striae alba. Material and Method: Forty eight participants aged between 10 - 19 years old, with striae alba at their thighs were randomized into two groups. Each group was separately treated with 0.1% tretinoin and herbal extract for 16 weeks. The width, length and surface roughness of the lesions were assessed including histological evaluation and participants' satisfaction. Results: Thirty nine participants completed the study after 16 weeks. Compared to initial lesions, the striae width was reduced by 9.01% (p = 0.002) in tretinoin group and 13.09% (p<0.001) in herbal extract group. The length was reduced by 9.54% in tretinoin group (p<0.001) and 8.73% in herbal extract group (p<0.001). The surface roughness assessed by Visioscan VC98 was reduced by 13.70% in tretinoin group (p = 0.036) and 17.24% in herbal extract group (p<0.001). From H&E staining, the mean difference of epidermal thickness was 4.79±7.15 microns in tretinoin group and 14.22±16.98 microns in herbal extract group. The mean difference of collagen amount was 13.75±6.02 units in tretinoin group and 6.60±4.92 units in herbal extract group. From Masson trichrome staining, the mean difference of collagen amount was 6.75±3.50 units in tretinoin group and 12.20±7.73 units in herbal extract group. From Verhoff van Gieson staining, the mean difference of elastin amount was 2.25±3.30 units in tretinoin group and 5.40±4.16 units in herbal extract group. There was no statistical significant difference between two groups in histological evaluation. The herbal extract caused irritant contact dermatitis only 4.55% in contrast to 72.73% from the tretinoin group. Most participants from both groups had moderate to high satisfaction according to the efficacy of their treatments. Conclusion: The herbal extract cream is as effective as 0.1% tretinoin cream in the treatment of striae alba. As tretinoin can cause skin irritation, the herbal extract can be a better alternative treatment.

A New Tool to Maximize Donor Harvesting With Safer Closure.

BACKGROUND: Scalp laxity is a major factor in achieving the maximum number of grafts in donor harvesting during hair restoration surgery. Proper assessment is important for each individual but especially so in patients presenting tight scalp. OBJECTIVE: To validate cross beam laser (CBL) for scalp laxity assessment in comparison with Mayer elasticity scale (MES). MATERIALS AND METHODS: In a retrospective study of 165 patients, both CBL and MES were used to evaluate scalp laxity in vertical plane at the center and lateral area before surgery. The real width (RW) of donor strip during surgery was considered the gold standard. RESULTS: Spearman correlation coefficient revealed that the CBL width was significantly correlated with the MES width in the following subgroups: (1) subjects undergoing their first session, (2) subsequent session patients, and (3) patients who required maximum number of grafts. Although the CBL width was statistically significant when compared with the RW in certain areas, whereas the MES width was statistically significant in all areas, the differences between the CBL width and the RW were minimal and clinically insignificant. CONCLUSION: The accuracy of scalp laxity measurements using the CBL procedure establishes CBL as a reliable tool for hair restoration surgery.