Follicular unit transplantation.

Follicular unit transplantation (FUT) is the culmination of decades of refinement and evolution of hair transplantation techniques. Hair naturally grows in groups of one to four individual follicles separated by intervening soft tissue. These clumps or groups of hairs are termed FOLLICULAR UNITS. FUT uses microscopic dissection to separate these units for transplantation in a fashion that most closely resembles naturally occurring hair. FUT has grown to become recognized by many prominent hair restoration surgeons as the state-of-the-art method of hair replacement surgery for both male and female pattern alopecia. Although larger punch grafts, scalp flaps, and alopecia reductions may play a role in certain cases, FUT achieves results that are difficult to differentiate from naturally occurring hair. The central attributes of the technique are the provision of natural-appearing hairlines with reasonable density together with low morbidity and minimal "downtime." Nevertheless, the technique is only as effective as the technician, and results are heavily dependent on the forethought of the architect.

The path of nasal reconstruction: from ancient India to the present.

Nasal reconstruction, first described over 2600 years ago in India, has undergone several modifications in its development. However, there is a misconception that this surgery began with the forehead flap repair, and the history of the subsequent two and a half millennia is poorly represented in most surgical texts. This article presents a review of the historical significance of nasal injuries in antiquity and the various technical developments along the path to modern nasal reconstruction, from ancient India through medieval Europe to modern England and America. Although written texts from 6th-century BC India through 16th-century AD Europe described pedicle flap repair of nasal defects, it was not until the late 18th century that the first written description of the forehead flap appeared. Forehead flap repair developed on an alternate pathway, being transmitted via an oral tradition, typically within families of craftsmen, at least as early as the 14th century. These ancient authors recognized the need for accurate flap design and sizing, donor site repair, precise tissue apposition, protection of the flap pedicle, hemostasis, deepithelialization of the wound, and replacement of intranasal lining. By appreciating ancient surgical techniques and examining the particular issues these procedures attempted to address, the surgeon will gain an additional and more detailed perspective of nasal reconstruction that will aid in providing excellent care to his patients.

Rejuvenation of the aging upper third of the face.

Age-related changes to the upper third of the face manifest, typically, as brow ptosis and the development of deep skin furrows. Depression of the brow evolves as gravity and the action of the corrugator supercilli, procerus, and orbicularis draw on the progressively inelastic forehead skin. Facial mimetic muscle action reveals itself over time via the development of deep forehead rhytids. Facial plastic surgeons have at their disposal several effective surgical, and recently, medical interventions to address these changes. Each technique has merits and suitable applications. This review examines the history of rejuvenation of the upper face, details the pertinent treatment modalities, and evaluates the context in which each is applicable.

Medpor alternative for microtia repair.

Autologous costal cartilage has been the material of choice for framework in auricular reconstruction. However, the advent of porous high-density polyethylene (Medpor) has provided an effective alternative in microtia repair. A ready-to-use allopastic material, Medpor has distinguished itself from other implants via its durability, tensile strength, biocompatibility, and malleability. Results from clinical experience and bench research support this claim. When using this material, the authors noted impressive results with low associated morbidity.