The influence of peri-incisional triamcinolone acetonide injection on wound edge apposition.

Local administration of corticosteroids has been demonstrated to have both beneficial and detrimental effects on wound healing. The advantages of limiting localized edema must be weighed against corticosteroids' disadvantageous inhibition of the normal growth factor profile production that is essential for would healing. A single-center prospective, randomized, controlled, single-blind study of 57 patients undergoing hair restoration surgery (HRS) by one of three different surgeons revealed: 1) no dehiscence along the donor wound; 2) no statistically significant difference (p < 0.05) in wound edge apposition noted between patients receiving or not receiving intralesional corticosteroids at any of the four measured scalp regions and 3) a non-statistically significant trend emerged suggesting the benefit of corticosteroid at the temples (points of decreased donor closing tension) versus its potential hindrance along the mastoids (points of increased tension). These results suggest that peri-incisional triamcinolone acetonide (PITMC) does not have a statistically significant effect on donor wound edge apposition within 8-10 days of HRS. A subtle, though not statistically significant, trend emerged demonstrating the benefit of PITMC with respect to early phase donor wound edge apposition in areas of least donor closing tension and the hindrance of PITMC in regions of increased tension.

Estimating the number of lifetime follicular units: a survey and comments of experienced hair transplant surgeons.

BACKGROUND: Quantitative estimates of the yield of follicular units (FUs) containing likely "permanent" hair for hair transplanting have been only theoretically estimated. OBJECTIVE: To clarify the number of likely permanent hair follicles in potential donor areas. METHODS AND MATERIALS: Thirty-four highly experienced surgeons were surveyed and estimated the number of FUs containing "permanent" hair in hypothetical 30-year-old male patients with varying hair densities and destined to develop Type V or VI male pattern baldness (MPB). RESULTS: Patients with average hair density and destined to develop Type V MPB were estimated to yield an average of 6,404 FUs, 4,963 FUs with below average density, and 7,904 FUs with above-average density. When Type VI MPB is anticipated, estimated mean harvest yields are 5,393 FUs with average density, 4,204 FUs with below-average density, and 6,661 FUs with above-average density. CONCLUSION: There are a finite number of FUs containing permanent hairs in any patient. The results of this survey provide a guideline that should be helpful in avoiding inappropriately aggressive goals such as creating overly dense or overly anterior frontal and temporal hairlines without regard for a cautious evaluation of the limitations of likely long-term donor/recipient area ratios. We present useful guideline numbers that can help physicians choose appropriate surgical goals.

Factors influencing postoperative hyperesthesia in hair restoration surgery.

BACKGROUND: While esthetic outcomes in hair restoration surgery (HRS) have improved markedly since the advent of follicular unit transplantation (FUT), various undesirable sequelae persist. We investigated the technical and demographic variables that may contribute to the frequency of postoperative hyperesthesia. METHODS: A multicenter retrospective chart review involving 552 patients undergoing HRS from 1999 to 2009. RESULTS: A total of 19 patients (3.4%) reported postoperative hyperesthesia in either the donor or recipient area of their scalp. Although many trends emerged, one variable significantly influenced the rate of this neurosensory symptom. While no patient who had all previous and current HRS sessions performed entirely within the same investigated surgical practice (n=42) experienced postoperative hyperesthesia, 14% of our patients who underwent prior HRS by a physician outside of the investigated surgical group (n=35) developed this complication (P=0.0404). The amount of intraoperative electrocautery to maintain hemostasis (P=0.0897), degree of tension upon donor wound closure (P=0.3044), and extent of donor wound edge undermining (P=0.4420) influenced the frequency of this sequela to a lesser degree. CONCLUSION: These results suggest that physicians planning repair sessions on patients who have undergone prior HRS by a physician at a different surgical center should include the specific caveat of increased incidences of postoperative hyperesthesia in their preoperative consultation.

Core curriculum for hair restoration surgery, recommended by the International Society of Hair Restoration Surgery (ISHRS).

BACKGROUND: Because hair restoration surgery (HRS) has changed so significantly, the International Society of Hair Restoration Surgery (ISHRS) presents the recently developed Core Curriculum for Hair Restoration Surgery (CCHRS). Physician competence in HRS demands a sound understanding of all of the alternate pathologic causes of hair loss, as well as their risks and treatments. OBJECTIVE: The CCHRS defines the knowledge, didactic information, medical insights, and surgical techniques that are essential to physician competence in the correct diagnoses and treatment of hair loss problems, in a manner consistent with patient safety and sound esthetic results. The ISHRS hopes that all existing surgical and dermatology training programs that teach HRS procedures will find the CCHRS useful in developing their curriculum relative to HRS and that this will facilitate the development of a new standard of training within the profession. METHODS: Developed and reviewed by a committee of experienced hair restoration surgeons. RESULTS: The CCHRS clearly defines the diagnosis and treatment of hair loss as a multidimensional specialty requiring knowledge of several medical disciplines, including genetics, endocrinology, dermatology, and surgery. CONCLUSION: The ISHRS believes that the CCHRS is an important contribution to physician education in HRS and that a clearly defined core curriculum will facilitate achieving contemporary results and higher patient satisfaction.

Hair transplantation: current concepts and techniques.

Because of changes in technique, hair transplanting can now be offered as a reasonable option to more male and female patients who are not responsive to, or likely to benefit from, medical treatment. These changes have also resulted in exceptionally natural-looking results, even after a single session in an alopecic area, or in many individuals with prior and cosmetically unacceptable transplanting results. Current concepts and techniques are described in the article. Possible disadvantages of some of them are also discussed. In particular, the apparent advantages of "megasessions" of 3000 or more grafts per session, "dense packing" of more than 40 follicular units per cm2 and a new method of harvesting single follicular units directly from the donor area (Follicular Unit Extraction), may not be advantageous as they first seem.

Recipient area hair direction and angle in hair transplanting.

BACKGROUND: A variety of recommendations for creating "natural" hair directions and angles in hair transplanting have been described. Objective. A method of accomplishing that goal is outlined. METHODS: Hair direction and angle are determined by multiple partings of the hair during the course of making recipient sites. Incisions are made to mimic such directions and angles. The direction is usually somewhat coronal and the use of grafts containing more than one follicular unit is particularly advantageous in producing a denser appearance. RESULTS: If the above technique is employed, one does not accelerate the rate at which existing hair in the recipient area is lost and the hair flows in a natural easy to manage fashion. CONCLUSION: Surgeons should nearly always mimic the scalp hair directions and angles seen in nature.

Hair transplanting: an important but often forgotten treatment for female pattern hair loss.

The techniques used in the early days of hair transplanting were not suitable for the treatment of a majority of women with pattern hair loss. For at least the last 10 years, changes in those techniques have resulted in a reversal of that situation. Today, many women with female pattern hair loss are suitable candidates for transplanting, however, this is not widely appreciated. This article provides potential explanations for this and demonstrates examples of the current methods. Hair transplanting should be considered as a potential treatment option for most women with pattern hair loss.