Comparison of Two Surgical Epilation Procedures Based on the Nagata Method in All Degrees of Low Hairline Microtia.

Background: Various methods exist to manage unwanted hair in low hairline microtia. We present our 10-year experience that compares the two procedures toward all degrees of low hairline microtia. Methods: The tongue-shaped split-thickness skin graft procedure (modified Chen's procedure) and the modified Nagata procedure were used for ear reconstruction in 42 microtia patients with three degrees of low hairlines from 2010 to 2020. Hair follicles in the low hairline area were removed free-hand, and the removed area was replaced with extended temporoparietal fascia (TPF) flap during the ear elevation. The satisfaction score and the clearance percentages of the hair were used as outcome measures. Results: There was no significant difference in satisfaction scores and the hair clearance percentages of hair between two procedures (p > 0.05) and among three degrees of low hairline (p > 0.05), respectively. Although the complication rate showed no significant difference, the major types of complication in modified Chen's procedure was fluid accumulation (9.52%), whereas in modified Nagata procedure was hypertrophic scar (4.76%). Conclusion: Patients with low hairlines can be treated using two different microtia reconstruction techniques to limit hair growth on the new ear. The rib graft construct is covered by a TPF flap, which is then grafted with an ultrathin skin graft and shows benefit in this review of our 10-year experience. Clinical Trial Registration Information Provided: Registration no. and date registered: ChiCTR2000030214.

Reconstrucción palpebral multidisciplinar en el síndrome de Barber-Say: a propósito de un caso / Multidisciplinary eyelid reconstruction in Barber-Say syndrome: A case report

El síndrome de Barber-Say es una infrecuente displasia producida por la mutación del gen TWIST2 (2q37.3) que codifica una proteína que actúa a nivel epigenético. Presentamos el caso de un niño de 2 días en el que el ectropion, el hipertelorismo, la hipertricosis y demás rasgos dismórficos condujeron al diagnóstico clínico de síndrome de Barber-Say, posteriormente confirmado genéticamente. Alrededor de 20 casos se han publicado sobre este síndrome; sin embargo, en menos de la mitad se describe la técnica para abordar las malformaciones palpebrales, lo que supuso un reto quirúrgico. Nuestra actuación incluyó una tarsorrafia lateral y la toma de injertos de piel de la superficie palmar del antebrazo, área retroauricular y fosa supraclavicular, así como injertos grasos de la superficie interna de ambos muslos para la reconstrucción palpebral. Se trata del primer caso de síndrome de Barber-Say en el que se utilizan injertos supraclaviculares y del antebrazo

Barber-Say syndrome is an unusual dysplasia caused by the mutation of the TWIST2 gene (2q37.3), which encodes a protein that acts at an epigenetic level. The case is presented of a 2-day-old male child in whom ectropion, hypertelorism, hypertrichosis and other dysmorphic features led to the clinical diagnosis of Barber-Say syndrome, which was later confirmed with genetic tests. Around 20 cases have been reported on this syndrome, of which less than half have described the surgical technique, as it represents a surgical challenge. The approach in this case included a lateral tarsorrhaphy and skin grafts taken from the volar surface of the forearm, retroauricular area and supraclavicular fossa, as well as autologous lipografts from the inner side of both thighs for palpebral reconstruction. This is the first case of Barber-Say syndrome in which the use of skin grafts are taken from supraclavicular fossa and forearms

Multidisciplinary eyelid reconstruction in Barber-Say syndrome: A case report. / Reconstrucción palpebral multidisciplinar en el síndrome de Barber-Say: a propósito de un caso.

Barber-Say syndrome is an unusual dysplasia caused by the mutation of the TWIST2 gene (2q37.3), which encodes a protein that acts at an epigenetic level. The case is presented of a 2-day-old male child in whom ectropion, hypertelorism, hypertrichosis and other dysmorphic features led to the clinical diagnosis of Barber-Say syndrome, which was later confirmed with genetic tests. Around 20 cases have been reported on this syndrome, of which less than half have described the surgical technique, as it represents a surgical challenge. The approach in this case included a lateral tarsorrhaphy and skin grafts taken from the volar surface of the forearm, retroauricular area and supraclavicular fossa, as well as autologous lipografts from the inner side of both thighs for palpebral reconstruction. This is the first case of Barber-Say syndrome in which the use of skin grafts are taken from supraclavicular fossa and forearms.

Clinical Description, Molecular Analysis of TWIST2 Gene, and Surgical Treatment in a Patient With Barber-Say Syndrome.

Barber-Say syndrome is a rare autosomal dominant disease characterized by dysmorphic features, mainly of the eyelids and skin. It is caused by heterozygous mutations in gene TWIST2, localized in chromosome 2q37.3. The authors present the case of a pediatric patient with a clinical diagnosis of Barber-Say syndrome with ocular symptoms related to exposure keratitis. Molecular analysis of her DNA revealed a mutation on TWIST2 gene confirming the diagnosis of Barber-Say syndrome. Surgical treatment of the patient's eyelids resolved her signs and symptoms.

Successful treatment of Becker's Nevus with long-pulsed 1064-nm Nd:YAG and 755-nm alexandrite laser and review of the literature.

BACKGROUND: Becker's Nevus is an aesthetically troublesome condition secondary to hyperpigmentation and hypertrichosis. Although several lasers have been employed with varying degrees of success, the exact devices and treatment parameters have yet to be elucidated. OBJECTIVE: To assess the combination Nd:YAG and alexandrite laser as a safe and efficacious treatment for Becker's Nevus. METHODS: In a 20-year-old Fitzpatrick Skin Type IV male, a Becker's Nevus was treated with six sessions of long-pulsed 1064 nm Nd:YAG laser at six-week intervals followed by five sessions of long-pulsed 755 nm alexandrite laser at three-month intervals. RESULTS: This patient experienced a significant reduction in both hyperpigmentation and hypertrichosis after these treatment sessions. No serious adverse events were reported. CONCLUSION: This case supports the use of combination long-pulsed 1064 nm laser and 755 nm laser as a safe and efficacious treatment for Becker's Nevus.

Laser hair reduction and removal.

Hair removal by any means is unlikely to decrease in popularity, especially with the advent of laser technology allowing for effective treatment of hypertrichosis and hirsutism. There are many effective laser and intense light sources. Although virtually all skin types can be treated, the ideal target is a dark hair on light colored skin, and treatment of nonpigmented or vellus hairs has been disappointing with this method. The physical hair removal methods will continue to be popular options. The practice of aesthetic medicine should include consideration of offering hair reduction using lasers or light sources.

Necrotizing soft tissue infection of the scalp after fronto-facial advancement by internal distraction in a 7-year old girl with Gorlin-Chaudhry-Moss syndrome--a case report.

In 1960, Gorlin, Chaudhry and Moss described a syndrome consisting of craniofacial dysostosis in association with hypertrichosis, cardiac, genital, dental and ocular anomalies. Diagnosis is based on typical clinical findings and cannot be performed by molecular genetic analysis until now. There is little in the clinical literature concerning this rare craniofacial syndrome. For functional and psychosocial reasons, surgical correction of the complex craniofacial malformation in a 7-year old Hungarian girl with Gorlin-Chaudhry-Moss syndrome was performed by fronto-facial advancement using internal distraction devices. Postoperatively necrotizing soft tissue infection of the scalp developed leading to termination of the distraction process ahead of schedule and requiring aggressive surgical management. Typical physiological and clinical characteristics were observed both during the initial craniofacial correction as well as during the management of the infectious complication suggesting that the linking of different conditions (surgical trauma plus the selection of toxic microorganisms) has caused tissue destruction rather than the syndromal disorder or the surgical technique of distraction osteogenesis. Although skeletal improvement was achieved residual damage from the infectious complication must be considered as severe.

Trichiasis associated with prostaglandin analog use.

A previously unreported complication of the use of prostaglandin analog medications for glaucoma therapy is described. A patient with monocular open-angle glaucoma had trichiasis, a condition associated with the use of a prostaglandin analog. The patient was treated with radiofrequency cautery and is now asymptomatic. The unmedicated eye remains asymptomatic to date. Increased lash length, thickness, and pigmentation are well-documented side effects of prostaglandin analog glaucoma drops. Physicians must consider this when prescribing these medications for patients with misdirected eyelashes.

Laser-assisted hair removal for darker skin types.

Before the advent of longer wavelengths, longer pulse durations and more efficient cooling devices, laser-assisted hair removal was best suited for phototypes I-III with dark terminal hairs. Now, laser-assisted hair removal can be performed safely and efficaciously on darker skin types. The long-pulsed diode and Nd:YAG-wavelength-based laser systems are best suited to safely and effectively treat patients with darker skin types. By using conservative fluences, longer pulse durations and multiple treatments, safe and effective laser-assisted hair removal is possible for darker skin types. Patients with darker skin who suffer from hirsutism, hypertrichosis, and pseudofolliculitis barbae can finally be treated safely and effectively.

Efficacy of long- and short pulse alexandrite lasers compared with an intense pulsed light source for epilation: a study on 532 sites in 389 patients.

BACKGROUND: Undesirable hair growth presents a significant problem for many patients, and photoepilation has become a very popular procedure in aesthetic and cosmetic practice. Among the systems used are the long- and short-pulsed alexandrite lasers (LP-Alex, SP-Alex) and intense pulsed light (IPL) sources. The present study retrospectively examined the outcome of these systems from the viewpoint of efficacy and side effects. PATIENTS AND METHODS: Three hundred and eighty-nine patients (370 females and 19 males, mean age 36.4 yrs, skin types II-V) were admitted to the study, with a total of 532 treated sites. They were treated either with the LP-Alex, SP-Alex or IPL. Subjective evaluation and interview of the patients was held prior to every treatment session. Six to eight treatments were required with the alexandrite lasers, 2.4-2.8 months between treatments, and the IPL source required 8-9 treatments, 2-2.5 months apart. RESULTS: No significant difference was seen between the LP- and SP-Alex, or between both of them and the IPL source, although the period to regrowth was longer for the lasers. Erythema and oedema were more noticeable with the LP-Alex, as were crusting and hyper- and hypopigmentation. Discomfort was greatest with the LP-Alex and the IPL source. Hair induction at the borders of the treated area on the face and neck was seen only with the LP-Alex, and correlated statistically significantly with any episode of severe erythema, crusting or hyperpigmentation. CONCLUSIONS: There was no statistically significant difference between the LP-, SP-Alex and IPL photoepilation with regard to efficacy. Transient side effects were highest with the LP-Alex, and least with the IPL system. In the LP-Alex treated face and neck sites, 3.1% had hair induction in the borders of the treated areas.

Laser hair removal.

We are in a state of evolution in long-term hair removal. Safe and effective technology is now available. Lasers will always become smaller, faster, and perhaps more effective. For those interested in offering this procedure, evidence indicates that we are beyond the experimental phase. The treating physician should carefully review current available technology and receive proper training specific to that system.

Synopsis of laser assisted hair removal systems.

Conventional treatment options for hypertrichosis and hirsutism are tedious and time consuming. Laser hair removal offers an efficient way to permanently reduce excessive hair growth. Hair is damaged using the principle of selective photothermolysis with wavelengths of light well absorbed by follicular melanin and pulse durations that selectively thermally damage the target without damaging surrounding tissue. Patients with dark hair and light skin are ideal candidates. Multiple treatments (3 to 6) performed every 6-8 weeks are necessary to achieve a permanent reduction of hair growth. As the field develops, a better sense of the effectiveness of laser hair removal will evolve and reasonable expectations will be determined.

A clinical overview of hair removal using lasers and light sources.

The tremendous demand for removal of unwanted hair has led to the development of a wide range of noninvasive, user-friendly laser and light source systems; however, despite considerable advances in this field, these devices still have the potential to cause injury when used improperly. It is important to follow precise treatment guidelines in order to attain optimal results. This article gives an overview of the currently available lasers and light sources. It focuses on the practical aspect of laser hair removal by discussing patient selection, safety precautions, techniques using the different systems, pre- and post-laser treatment care, proper treatment endpoints, expected outcome, and possible side-effects and complications.

Hair removal using a long-pulsed alexandrite laser.

The use of lasers for hair depilation has become a common modality for physicians in the recent past. As new lasers are developed, the complex mechanisms affecting this form of treatment are now under close investigation. The long-pulsed alexandrite laser functioning at a wavelength of 755 nm has recently been added to the armamentarium of health care providers to assist patients with unwanted body hair. A review of the embryology and anatomy of the hair follicle are discussed, as well as the findings of recent studies using this form of laser therapy. Using the suggested treatment protocols offered laser assisted depilation may be effectively achieved. The degree and duration of reduction vary with anatomic site and improve with multiple treatments.

Hair removal using an Nd:YAG laser system.

Laser emission from neodymium-doped glass was first produced nearly 40 years ago. Later, a crystal of yttrium, aluminum, and garnet (YAG) was discovered to be a better lasing host for neodymium. The Nd:YAG laser has since been used for a variety of medical applications, more recently, this instrument has been used for the purpose of damaging hair follicles to epilate unwanted hair. This article reviews the background of the Nd:YAG laser with particular application to hair removal, summarizing the clinical and histologic studies presently available. Its current clinical use and possible future modification for elimination of excess hair are discussed.

Long-term epilation with long-pulsed neodimium:YAG laser.

BACKGROUND: Unwanted body hair can represent a severe cosmetic disturbance. The traditional methods used to epilate often have limitations, side effects, and unsatisfactory results. In recent years, various light sources (lasers and others) have been developed for long-term epilation of unwanted hair. OBJECTIVE: This study evaluates, on a large number of patients, the efficiency and safety of a long-pulsed low-potency Nd-Yag laser invented specifically for long-term hair removal. METHODS: Some 208 subjects needing epilation were divided into three groups and treated during an 11-month period. Group A included 79 patients with a normal distribution of unwanted hair; Group B 67 patients with constitutional hypertrichosis; and Group C 62 patients with hirsutism. Treatment sessions were performed with a fluence of 23-56 J/cm2 at 1-month intervals until obtaining desirable results. Follow-ups ranged from 1 to 6 months. In 3 patients 4-mm diameter punch biopsy specimens were obtained before the first session and again after 6 hours. A third biopsy was performed after 3 months. RESULTS: Every session resulted in a 20-40% hair loss, depending on the color of hair. Complete epilation was obtained in 4 to 6 sessions. Only white hair was not receptive to laser light, and its growth was not modified. No patients, including dark-complexioned patients, had blistering, hypo-or hyperpigmentation. No pain was present during treatment except for the axillary area. In the specimen obtained after 6 hours, very extensive necrosis of the hair follicular and sebaceous gland epithelium was evident. Histologic findings of the biopsies taken after three months showed complete disappearance of hair and moderate fibrosis. CONCLUSION: This study proves that the long-pulsed Nd:Yag laser treatment produces an excellent prolonged epilation with no relevant side effects. This laser light, having a 1064 nm wavelength, is minimally absorbed in superficial skin layers, and pronounced scattering up to 5 mm occurs targeting the deeper follicles.

Solar-induced postinflammatory hyperpigmentation after laser hair removal.

BACKGROUND: Postinflammatory hyperpigmentation (PIHP) is a frequently encountered problem in many cosmetic procedures. The treatment of PIHP is difficult and remains a challenge. OBJECTIVE: To treat a patient who developed multiple hyperpigmented macules on her thighs due to sun exposure after treatment of unwanted hair using a normal-mode ruby pulse laser. METHODS: The patient was treated daily with tretinoin (Retin A) 0.1% cream, triamcinolone 0.1% cream, and hydroquinone 4% cream with sunscreen (Solaquin forte), and was to avoid sun exposure. Several sites received monthly treatment of 40% trichloroacetic acid (TCA). The degree of clinical improvement of the hyperpigmentation was assessed by both the physician and the patient. RESULTS: Cosmetic results were fair. The amount of hair in her thighs was reduced but the PIHP responded only slightly to therapy. CONCLUSION: To our knowledge this is the first case of solar-induced PIHP following laser hair removal. The treatment of PIHP is difficult because there are few therapeutic options that are consistently successful. Avoidance of exposure to ultraviolet light should be emphasized to all patients prior to laser therapy. We demonstrated that serial TCA peels provided an additional benefit compared to medical treatment.

Treatment of a Becker's nevus using a 694-nm long-pulsed ruby laser.

Becker's nevus is an uncommon pigmented smooth muscle hamartoma that develops during adolescence and occurs primarily in young men. The nevus is characterized by hypertrichosis and hyperpigmentation and is usually located unilaterally over the shoulder, upper arm, and scapula. We describe a patient with a Becker's nevus who was treated with a long-pulsed ruby laser in order to decrease hair density and pigmentation.