"Combination Grafting" of Scalp and Body Hair to Enhance the Visual Density of Hair Transplant and Coverage of Higher Grade of Baldness.

Hair transplant is becoming the most common cosmetic procedure across the world with demand for higher density and coverage of baldness. This needs more number of donor hair follicles. Scalp donor has limitations to fulfill the required number of follicles for Norwood Grade VI and VII baldness. The body hair follicles can be used to cover up the deficit.The objective of this study was to observe the use of body hair follicles to increase the visual density and for better coverage for higher grades of baldness as an adjuvant to scalp hair follicles. MATERIALS AND METHODS: A total of 16 patients were evaluated for the availability of body donor hair, and consent for body hair harvesting was obtained from them. The beard was the first preference and then chest and abdomen hair follicles were used in combination with scalp hair follicles to cover bald area of Norwood grade IV and above baldness. Body hairs were harvested using follicular unit extraction (FUE) technique. Postoperative pictures were taken, and patient satisfaction, doctor's observation, and global photographic evaluation was carried out. OBSERVATIONS: The patient's photographs were taken after 4, 8, and 12 months of hair transplant. The results were analyzed on the basis of global photography. The use of body hair with scalp has enhanced the visual density, leaving to better coverage in even higher grades of baldness.

A Histological and Clinical Evaluation of Plasma as a Graft-holding Solution and Its Efficacy in Terms of Hair Growth and Graft Survival.

Background: There is a time lag between hair follicle harvesting and implantation; during this time, hair follicles have ischemic injury. We need a holding media or a solution to minimize or neutralize ischemic injury. Aim and Objectives: The aim of this study was to evaluate plasma as a graft-holding solution in terms of its efficacy in hair growth and hair graft survival. Materials and Methods: A split-scalp study was carried out. The left side was designated as the control area (Group A), where graft implanted was kept in Ringer's lactate (RL), and the right side behaved as the test area (Group B), which received grafts preserved in autologous plasma. The P value was calculated. Observations: MTT [3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide] staining for graft stored in RL at 12-72h showed poor hair follicles cells survival, whereas graft kept in plasma showed viable cells even after 72h. The hair count and density in plasma group were significantly higher than the RL group. There was an improvement in hair thickness in both groups from 6 to 12 months. Conclusion: Autologous plasma is an easily available graft-holding solution. Platelets along with the plasma provide multiple growth factors promoting epithelialization, neovascularization, and action on hair follicle stem cells to improve growth. The fibrin coating around graft makes it sticky and prevents dehydration. The split-scalp controlled study certainly shows the advantages of using plasma over other extracellular graft-holding solutions.

Donor Harvesting: Follicular Unit Excision.

FUE or follicular unit excision is one of the methods for hair follicle harvesting in hair transplantation. FUE involves harvesting hairs from the donor area, under local anesthesia which is most commonly the scalp but occasionally beard, chest and other parts of the body, using a circular punch less than a mm, mounted on a manual handle or a motorized hand device or more recently a robotic device. First hair transplant was done by Dr Shoji Okuda in 1937. The term "follicular unit extraction" was coined by William Rassman in 2002. The modern era of FUE begins with the work of several surgeons Woods, Rassman, Cole, Harris and Rose. FUE has gone through various stages of development from manual to motorized and blunt to sharp, serrated trumpet and flared punches. Now the use of the robot in FUE with extraction and incision making is also in use. In 2017 nomenclature committee headed by Parsa Mohebi of ISHRS, recommended the term "FOLLICULAR UNIT EXCISION" is most appropriate as it explains the two steps of the process: incision and extraction and incision is done by a physician. FUE is a surgeon based time-consuming procedure with the long learning curve. Use of motorized device and sharp punches has certainly helped to increase speed in an experienced hand. FUE method of hair transplant is the most demanding procedure. If done properly it is a safe procedure. with the experience, use of better quality of instrument the disadvantages of FUE like transection can be reduced. The above informations were collected from various papers published in authentic journals and textbooks.

Decoding Facial Esthetics to Recreate an Esthetic Hairline: A Method Which Includes Forehead Curvature.

CONTEXT: The evidence suggests that our perception of physical beauty is based on how closely the features of one's face reflect phi (the golden ratio) in their proportions. By that extension, it must certainly be possible to use a mathematical parameter to design an anterior hairline in all faces. AIM: To establish a user-friendly method to design an anterior hairline in cases of male pattern alopecia. MATERIALS AND METHODS: We need a flexible measuring tape and skin marker. A reference point A (glabella) is taken in between eyebrows. Mark point E, near the lateral canthus, 8 cm horizontal on either side from the central point A. A mid-frontal point (point B) is marked 8 cm from point A on the forehead in a mid-vertical plane. The frontotemporal points (C and C') are marked on the frontotemporal area, 8 cm in a horizontal plane from point B and 8 cm in a vertical plane from point E. The temporal peak points (D and D') are marked on the line joining the frontotemporal point C to the lateral canthus point E, slightly more than halfway toward lateral canthus, usually 5 cm from the frontotemporal point C. This line makes an anterior border of the temporal triangle. RESULT: We have conducted a study with 431 cases of male pattern alopecia. The average distance of the mid-frontal point from glabella was 7.9 cm. The patient satisfaction reported was 94.7%. CONCLUSION: Our method gives a skeletal frame of the anterior hairline with minimal criteria, with no need of visual imagination and experience of the surgeon. It automatically takes care of the curvature of the forehead and is easy to use for a novice surgeon.