A comparison of graft implantation techniques for hair transplantation.

Modern hair restoration surgery involves moving hair-bearing grafts from the posterior scalp into areas of hair loss for correction of androgenic alopecia. Over the past decade, this procedure has been refined in multiple ways for the creation of increasingly natural results. The following is a comparison of commonly used graft harvesting, sectioning, and implantation techniques currently in use for hair restoration today. This comparison includes data on total procedure time, graft cutting time, graft insertion time, labor requirements, and cost.

Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques. The American Society for Dermatologic Surgery, Inc.

Previous attempts at classifying small graft transplants have focused mainly upon graft size and have not taken into consideration other technical factors involved in graft production that may influence the outcome of the surgery. The proposed classification attempts to consider these factors by including various technical aspects of harvesting, dissection, and placement, all of which impact the quality and quantity of the small grafts used in the procedure. By standardizing the nomenclature, as well as the description of the other factors involved in the surgery, communication between physicians and patients may be facilitated. In addition, different procedures may be more accurately studied and compared.

Male pattern alopecia. Surgical options.

The surgical options for male pattern alopecia are discussed with emphasis on the most recent and widely accepted technique, combination micrografting. Candidate selection is standardized and emphasized, along with possible complications, techniques, and postoperative care. A variety of results are shown relative to candidate selection which demonstrate the natural and aesthetically pleasing nature of modern hair transplants.

The role of facial proportion in hair restoration surgery.

Facial aesthetics involve basic artistic principles that relate individual features to the face as a whole. These principles, such as balance and proportion, are key elements in the development of hair restoration surgery and can be applied to reconstructive procedures for the trauma or burn patient. This paper describes the application of anthropometric and artistic principles used in hair reconstruction. Attention has been directed to the procedures used to determine hairline contour and placement, and certain aspects of frontotemporal recession management. The frontal hair has a profound effect on facial balance because of the major role hair plays in framing and visually enhancing the face. The presence of frontal hair and facial framing also serves to retain a vital element of autonomy in appearance for the individual.

Posttransplant epidermoid cysts secondary to small graft hair transplantation.

BACKGROUND: Epidermoid cysts sometimes result from small-graft hair transplantation. Although hair transplant surgeons are aware of this complication, it has not been reported to date. OBJECTIVE: Our purpose is to report the clinical and histological features of posttransplant epidermoid cysts. METHODS: Four patients with posttransplant cysts, and the histological features of two of these cysts, were reviewed. RESULTS: All cysts occurred at the site of a recent micro- or minigraft, and were small; one had become infected. Serial sectioning of one scalp biopsy showed a micrograft lying in the subcutaneous tissue in close proximity to an epidermoid cyst. The cyst apparently arose from the follicular infundibulum of the graft. CONCLUSION: Posttransplant epidermoid cysts are examples of epidermal inclusion cysts. They are treated by conservative excision, and may require drainage for secondary infection. Careful operative technique should prevent some of these cysts.

New devices for scalp reduction. Intraoperative and prolonged scalp extension.

BACKGROUND: Scalp reduction for male pattern and other extensive, permanent crown-vertex alopecias has been a beneficial, adjuvant procedure in hair replacement surgery and has been augmented by unsightly and sometimes painful intraoperative and chronic scalp expansion techniques. METHODS: Ten patients underwent scalp reduction for male pattern baldness utilizing intraoperative Sure-Closure, a skin-stretching device. Ten patients had Frechet Extenders placed under the scalp during their scalp reductions with subsequent removal 28 days later followed immediately by second reduction procedures. RESULTS: The skin-stretching device, Sure-Closure, allowed the excision of 20%-30% more alopecic scalp during scalp reduction than what would have been possible with scalp reduction alone. The Frechet Extender when combined with a lazy S excision pattern for scalp reduction procedures generated between 25% and 50% more excision of alopecic scalp than with scalp reduction alone. CONCLUSION: Scalp reduction procedures can be more effectively performed with minimal complications and fewer reductions required per patient using either intraoperative scalp extension with the Sure-Closure device or chronic scalp extension with the Frechet Extender.

Halsey needle holder for micro and mini slit grafting.

BACKGROUND: Few suggestions have been made to date concerning how to more reproducibly place scalp slits for micro- and minigrafts. OBJECTIVE: To improve on the unpredictable consistency of depth and angle of scalp slits for micro- and minigrafting. METHOD: Seven-inch Halsey needle holders were used to stabilize the cutting instruments (No-Kor microblades, #15c, and #15 blades) for making scalp slits for micro- and minigrafts on approximately 80 patients over 5 months. CONCLUSION: Using the Halsey needle holder or stabilization of the blades for slit placement of scalp micro- and minigrafting is superior to directly holding the blades by improving on depth, angle control, ease of holding and adjustment, and greater reproducibility.

The paramedian scalp reduction with posterior Z-plasty. A technique to minimize the "slot" defect.

BACKGROUND: One consistent and undesired sequela resulting from scalp reductions has been the "slot" or "trough" defect, referring to the scar following the final reduction. Attempts to correct this have not been entirely satisfactory. OBJECTIVE: To present an approach to minimize the "slot" defect that consists of staged modified paramedian scalp reductions combined with a large posterior Z-plasty during the final reduction. METHODS: A paramedian crescent-shaped ellipse was marked onto the patient's scalp parallel and adjacent to the existing fringe hair. Subsequent reductions were performed in a similar manner approximately 2 months apart. The final reduction consisted of mobilization and transposition of the large flaps used in the posterior Z-plasty. RESULTS: Patients who underwent the staged modified paramedian reductions combined with a posterior Z-plasty had significant minimization and adequate camouflage of the undesirable "slot." CONCLUSION: Combining a large posterior Z-plasty with a paramedian reduction minimizes the slot defect.

Extended survival of patients with primary systemic amyloidosis.

Systemic amyloidosis can produce a wide variety of clinical manifestations, including characteristic cutaneous findings. Large series of patients with primary systemic amyloidosis have shown that systemic amyloidosis, with or without associated myeloma, has a median survival of no more than twenty-four months. We present a case of systemic amyloidosis that has been present in a woman for eighteen years, as manifested by periorbital purpura and an immunoglobulin G kappa light chain paraproteinemia. She was otherwise healthy; results of bone marrow examination showed no overt myeloma. We speculate that kappa light chain paraproteinemia could prove to be a marker for a more benign type of systemic amyloidosis.

Treatment of keratoacanthomas with intralesional methotrexate.

Multiple modalities exist for the treatment of keratoacanthoma. Excisional surgery is currently the treatment of choice for the majority of keratoacanthomas. This can result in functional and cosmetic defects when large or strategically located lesions are treated. An effective nonsurgical treatment would be desirable in such cases. Intralesional therapy, particularly with 5-fluorouracil, has been shown to be effective in the treatment of keratoacanthomas. Systemic methotrexate has been tried, with variable success. We report an open, noncontrolled study of nine consecutive patients with unusually large or strategically located solitary keratoacanthomas treated successfully with intralesional methotrexate. All lesions responded promptly, with complete resolution after a mean of 3.0 weeks and a mean of 1.7 injections. No side effects occurred, and scarring was minimal. We concluded that intralesional methotrexate is a simple and effective modality for the treatment of select keratoacanthomas and may offer greater efficacy, a more rapid response, decreased pain, and lower cost compared with intralesional 5-fluorouracil.

Hair transplantation in advanced male pattern alopecia. The role of incisional slit grafting.

The technique of incisional slit grafting is described and discussed. The results of the use of this technique for hair transplantation in patients with Norwood Type VII or advanced alopecia are reported.

Incisional slit grafting.

Incisional slit grafting, a new and greatly improved technique in hair transplantation, is described. Incisional slit grafting utilizes larger numbers of smaller grafts than does traditional punch grafting. No tissue is removed from the recipient bed. The vascular supply is conserved, resulting in an increased graft yield. The clumping and stalking effect associated with traditional round grafting is eliminated largely, and a more natural frontal hairline is achieved.

Triple rhomboid flap for crown alopecia correction.

The triple rhomboid flap offers significant advantages over previously described methods for reducing vertex alopecia. The circular area of alopecia is converted into a hexagon. The hexagon is then excised and closed by rotation of three rhomboid flaps from the hair-bearing periphery. The specific indications for this flap are reviewed, the technical aspects are discussed, and illustrations are provided.

A spitting image.

Three cases of injection of human saliva are presented, all of which occurred among incarcerated men. Although no previous cases have been described, we believe that this entity is not uncommon in the prison population.

Modification of a trypsin-detergent method for DNA flow cytometry of human epidermis.

An existing technique (Vindelov et al. Cytometry 3:323, 1983) has been modified for DNA flow cytometry of human epidermis obtained from 2 to 3 mm punch biopsies. By varying the length of time of digestion of the epidermal disc by trypsin from 5 to 70 min a controlled release of keratinocytes occurred beginning with the stratum basale and proceeding toward, but not including, the superficial layer of the epidermis, the stratum corneum.