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Dermatol Surg 2002 Nov;28(11):1035-42; discussion 1042
A philosophy and strategy for surgical hair restoration: a 10-year experience.
BACKGROUND: Three principal strategies have evolved for surgical hair restoration: follicular grafting, scalp reduction, and flap rotation. OBJECTIVE: Although grafting techniques have assumed a preeminent rank as the cornerstone of modern hair-replacement therapy, scalp reduction and rotation methods should not be entirely dismissed. METHODS: Over the past 10 years of clinical experience, the authors have relied on all three methods of hair restoration, carefully tailoring the optimal surgical approach to the patient's expressed concerns and particular regional hair deficit. RESULTS: We have found that scalp reduction and rotation provides a considerable density of hair unmatched by any grafting technique for the vertex and frontotemporal regions, respectively. CONCLUSION: Also we have concluded that the former yields the most natural result for a patient with significant crown baldness who desires hair restoration in that area. However, micro- and minigrafting still represent the overwhelming majority of our operative cases. This article attempts to review the surgical methodology and philosophy that have guided our approach to hair restoration.
Dermatol Surg 2002 Sep;28(9):795-8; discussion 798-9
Does the recipient site influence the hair growth characteristics in hair transplantation?
BACKGROUND: Recently hair transplantation has been widely applied not only to correct androgenetic alopecia, but also to correct hair loss on other parts of the body such as the eyebrows and pubic area. It is believed that the transplanted hairs will maintain their integrity and characteristics after transplantation to new nonscalp sites. OBJECTIVE: To evaluate whether the transplanted hairs maintain their hair growth characteristics after transplantation to a new anatomic site other than the scalp. METHODS: Three study designs were used. Study I: Hair transplantation from the author's occipital scalp to his lower leg was performed and clinical evaluations were made at both 6 months and at 3 years after the transplantation. Study II: After finding changes in hair growth characteristics, transplanted hairs were harvested from the leg and retransplanted to the left side of the nape of the neck (group A). As a control study, occipital hairs were transplanted to the opposite side (group B). Observations were made at 6 months after the operation. Study III: An observational study was done in 12 patients with androgenetic alopecia about 1 year after transplantation of occipital hair to frontal scalp. At each step, survival rates were documented and the rate of growth and the diameter of the shafts were measured for both recipient and donor sites. RESULTS: Study I: Surviving hairs on the lower leg showed a lower growth rate (8.2 +/- 0.9 mm/month), but the same diameter (0.086 +/- 0.018 mm) compared with occipital hairs (16.0 +/- 1.1 mm/month, 0.088 +/- 0.016 mm). The survival rate 3 years after transplantation was 60.2%. Study II: There was no significant difference in the growth rate, shaft diameter, and survival rate between retransplanted hairs (group A) and controls (group B). Groups A and B showed a lower growth rate, but the same diameter, compared with occipital hairs. Study III: There was no significant difference in the growth rate and shaft diameter between the transplanted hairs on the frontal scalp and the occipital hairs. CONCLUSION: These results strongly suggest that the recipient site affects some characteristics of transplanted hairs, such as their growth and survival rates.
Australas J Dermatol 2002 Aug;43(3):221-3
Lupus panniculitis clinically simulating alopecia areata.
A 27-year-old woman with a known history of lupus erythematosus presented with two circumscribed patches of non-scarring alopecia closely resembling alopecia areata. Scalp biopsy showed a predominantly subcutaneous and deep dermal lymphocytic infiltrate that surrounded the deep follicular segments and hair bulbs, as well as the eccrine glands. There was associated hyaline fat sclerosis. The epidermis, infundibular and isthmus segments of follicles were relatively spared and lacked the lichenoid inflammation and fibrosis seen with lupus erythematosus. The biopsy findings illustrate that the deep variant of lupus panniculitis may be concentrated around the hair bulbs and deep temporary segments of hair follicles and spare the permanent stem cell-rich follicular segments. This pattern is capable of producing a temporary hair-loss, clinically simulating alopecia areata. The clinical history, presence of subtle erythema and scalp tenderness on physical examination, as well as the biopsy findings, were important clues in distinguishing our case from a true combination of alopecia areata and lupus erythematosus.
: Chir Ital 2002 Mar-Apr;54(2):241-4
Chondroid syringoma. A case report.
Chondroid syringoma is a benign skin tumour characterized by several histological aspects similar to salivary gland adenomas. It generally affects the head and neck, mainly in the 6th and 7th decade of life. Its incidence in males is twice as high as in females. The neoplasm is usually an asymptomatic subcutaneous swelling that patients want removed for aesthetic reasons. Excision is the elective treatment. A few cases of malignant chondroid syringoma, however, have been reported. The neoplasm tends to produce metastases to both the regional and distant lymph nodes, causing the death of the patient. In these cases, radiation therapy follows the surgical excision. The authors report the case of a woman with chondroid syringoma located in the occipital region of the scalp. After a period of slow growth, the neoplasm suddenly increased in size. The patient asked for it to be removed out of concern for the concomitant hair loss.
Hair growth is a sophisticated biological process, which is still not thoroughly understood.
A multitude of therapeutic measures, including drugs, surgery, and suppelements have been made available, and used. However, due to the diversity of the problems underlying hair loss, there is no single solution for all hair loss cases. Most of chemical drugs and hair transplantation surgeries are not free from varying degrees of undesirable side effects on health.
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