Eyelash hair transplantation with strip composite eyebrow graft: an enhancing technique in tarsoconjunctival flap eyelid reconstruction procedure.

Purpose: To describe and evaluate the eyelash transplantation with strip composite eyebrow graft to improve eyelid anatomy in tarsoconjunctival flap eyelid reconstruction procedure. Methods: Twenty two patients with eyelid tumors managed by local excision and reconstruction using tarsoconjunctival flap reconstruction procedure were included. Eyelash graft was performed during flap division by harvesting a graft from the eyebrow and creating a recipient pocket in the receptor eyelid. Patients had a 1-year follow up. Eyelash orientation and follicle survival rate were recorded. Demographic variables were analyzed with descriptive statistics. For eyelash follicles survival rate assessment, we evaluated the number of follicles found in the first postoperative day with the follicles found at the end of the study using the Wilcoxon signed rank test. P < 0.05 was considered statistically significant. Results: All eyelash grafts showed a good follicle orientation and no cases of eyelashes misdirection toward the eyeball were reported. No statistical differences (p > 0.05) were found in Wilcoxon signed rank test when comparing the number of follicles present at the first postoperative day and the number of follicles present at the 12th postoperative month, meaning that the vast majority of follicles survived at the end of the study. Graft ischemia, necrosis or infection were not observed. Conclusions: Tarsoconjunctival flap is an outstanding option for eyelid reconstruction and eyelash transplantation with an eyebrow composite graft is an excellent procedure to enhance and recreate a normal eyelid.

Hair transplantation update: procedural techniques, innovations, and applications.

The advances in hair transplantation, particularly the advent of follicular unit transplantation, have greatly elevated the outcome of this procedure. Various modifications to the basic technique as well as innovations focused on the different aspects of the hair transplantation procedure have further enhanced this type of hair restoration surgery. In addition, there is ongoing expansion of the indications and applications of this procedure beyond the usual male pattern hair loss.

Follicular isolation technique with de-epithelialization for eyebrow and eyelash reconstruction.

BACKGROUND: The eyebrow and eyelash are two major sites in facial hair transplantation. Different methods have been experienced for better results. Surgeons tend to use smaller grafts. The authors modified the follicular isolation technique and added de-epithelialization to reduce complications and improve outcomes. METHODS: Sixty patients were allocated to either the isolation group or the isolation plus de-epithelialization group. Some patients underwent both eyebrow and eyelash transplantation; therefore, 79 procedures were performed on 60 patients. Scar formation, number and percentage of surviving transplanted hairs, hair growth orientation, and satisfaction with outcome were reviewed at 6 months. RESULTS: The mean number of preserved transplanted hairs in eyebrow transplantation at follow-up was not significantly different between the two groups, but the mean percentage of preserved transplanted hairs was significantly higher in the isolation plus de-epithelialization group. In eyelash reconstruction, the mean number and percentage of surviving hairs were significantly higher in the isolation + de-epithelialization group than in the isolation-only group. The isolation + de-epithelialization group had more cases of normal hair growth direction in both eyebrow and eyelash transplantation cases, although the difference was statistically significant only in eyebrow reconstruction. CONCLUSIONS: This study showed that follicular isolation plus de-epithelialization had better outcomes and fewer complications than did follicular isolation alone. This could be due to less need for suture in recipient sites, less risk for burying of epithelium of graft in the recipient site, less need for manipulation, lower graft volume, and less need for blood for survival and for removal of sweat glands. CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, II.

The latest innovations in hair transplantation.

Hair restoration began as a result of the fortuitous finding by Dr. Norman Orentreich that hair follicles taken from an area of nonbalding scalp could be implanted into an area of male pattern hair loss and continue to grow terminal hair. Since that time, hair transplants have progressed from the use of large plugs to the use of follicular units (normally occurring clusters of hairs). This has allowed surgeons to create undetectable results in cases of androgenetic alopecia and well as other conditions associated with hair loss. Advances continue in hair restoration technique ranging from surgical approach to instrumentation and ways to enhance growth. In this article, the more recent surgical and medical innovations in hair reconstruction are reviewed.

Replacing facial hair.

The face is the second most common area for hair transplantation after the scalp. Areas that are transplanted include eyebrows, eyelashes, moustaches, beards, temples and temporal points, as well as scars either traumatic or the side effect of cosmetic procedures such as rhytidectomies or brow lifts. The hair is harvested from the same area as the hair that is transplanted to the head. For this reason, it grows longer than nongrafted facial hair and must be trimmed regularly. Occasionally, hair lower in the neck region is harvested, which is finer than occipital hair; however, because of movement in the neck area, the scars are often larger. Body hair has been suggested as donor hair but is not recommended because it spends as much as 85% of its time in the telogen phase.

[Surgical treatment of traumatic madarosis]. / Khirurgicheskoe lechenie travmaticheskogo madaroza.

Traumatic madarosis is a cosmetic and anatomo-functional problem. Besides the repair of the eyelashes proper, the clinical status of the patient requires repair of the carcass of the damaged eyelid in order to prevent lagophthalmos. The technique of transplanting a free hairy graft from the eyebrows is described. The results of treatment were assessed by the following parameters: the flap taking in, thickness and direction of the new lashes growth, and stability of the eyelid. Complete healing of the graft and stability of the eyelid were attained in all the cases. Good thickness of the eyelashes and the ideal direction of their growth were more difficult to achieve. The causes of failures are discussed. Despite the shortcomings, the method of treating traumatic madarosis proved to be effective and is recommended for clinical use.

Surgical repair of congenital colobomas.

Congenital colobomas usually occur as full-thickness defects of the medial third of the upper lid and are commonly associated with a benign dermoid at the apex. Exposure keratopathy and corneal trauma are rare; however, it can be prevented with the Expo Bandage--Bubble (Fig 18). Periodic examinations should also be performed. Surgical resonstruction should be performed at approximately 3 to 6 months of age and primary closure should be attempted initially. Lateral cantholysis, lid-sharing surgery, and external levator resection may be required to correct the residual deformity.