Does the recipient site influence the hair growth characteristics in hair transplantation?

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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.

Ann Dermatol Venereol 2002 May;129(5 Pt 2):801-3

Androgenetic alopecia

Androgenetic alopecia (AGA) is the combined result of an androgen-dependent process and genetic transmission. These characteristics have mainly, if not exclusively, been demonstrated in men and perhaps improperly extended to women. When considering the androgen-dependent process, AGA must only be limited to the androgen receptor areas. In the scalp, these receptors have only been detected in the frontal and vertex areas but never in the temporal or the occipital areas. Male AGA exhibits these clinical features, whereas in women hair loss is rarely limited to this localization, even when large areas of hair loss often appear with age. It is now commonly accepted that male AGA is associated with an increase in 5 alpha reductase activity leading to an increase in local production of dihydrotestosterone. The mechanism by which the local dihydrotestosterone increase leads to hair follicle loss is not clearly demonstrated. Inhibition of cell proliferation in the dermal papilla and a vascular process based on the inhibition in local production of vascular endothelial growth factor (VEGF) have been proposed. The increase in 5 alpha reductase activity is genetic and depends on androgen receptor polymorphism, characterized by a decrease in the number of CAG sequences on the exon 1. Male AGA is associated with an insulin-resistant process and to a higher risk of polycystic ovary in the lineage. Therapeutically, this hormone-dependent process explains the well demonstrated efficacy of 5 alpha reductase inhibitors. In women, except in some rare cases, alopecia is diffuse and the mechanisms are different. Their origin is unknown, and probably ambiguous. Based on an association with Hashimoto's thyroiditis, an auto-immune origin could be suggested in some cases. Alopecia is unaffected by thyroid substitution. Pharmacological doses of oestrogens (pregnancy, contraception) have a beneficial effect on such alopecia, probably through different mechanisms: anti-androgen effect, increased VEGF, proliferative effect of dermal papilla cells. However, it is important to mention that the dermal papilla has an aromatase, particularly in the occipital area, the activity of which has not been assessed in female alopecia. In practice 5 alpha reductase inhibitors are ineffective in women. It is likely that the predominance observed in the frontal and vertex areas, occasionally in elderly women, is a result of the two combined disorders, the almost physiological androgen-dependent hair loss combined with diffuse loss. Pharmacological doses of oestrogens associated with anti-androgen progesterone-like agents are widely used with positive results, but not demonstrated by clinical trials.

Clin Exp Dermatol 2002 Jul;27(5):410-7

Alopecia areata - animal models.

Several rodent models with spontaneous and induced alopecia areata (AA), a nonscarring inflammatory hair loss disease with suspected autoimmune elements, have been identified. Of these, the C3H/HeJ mouse and DEBR rat have been most extensively used in examining AA development. Flow cytometry and micro array characterization, manipulation of inflammatory cells by in vivo cell depletion or cell receptor blockade, lymph node cell transfer between affected and unaffected rodents, and the recent use of transgenic knockout mice have given important insights into the development of AA. From our current understanding of rodent models, the development of AA relies upon a general genetic susceptibility where major susceptibility genes may be supplemented by minor disease severity modifying genes. However, the actual onset of AA, its duration, extent, and persistence in individual rodents may be modified by epigenetic factors. Rodent AA seems to be fundamentally, but not exclusively, Th1 cell mediated. Onset of disease may be dependent on several factors including the break down of the putative anagen stage hair follicle immune privilege, appropriate antigen presentation with costimulation of lymphocytes, presence of autoreactive lymphocytes, and a deficiency of functional immune system regulatory cells. Rodents have already been used in examining a variety of current AA treatments and developing new therapies with some success. With a greater understanding of AA disease mechanisms through rodent model research, improved and more specific treatment interventions may be defined.

Dermatol Surg 2002 May;28(5):394-400; discussion 401

A method for evaluating and treating the temporal peak region in patients with male pattern baldness.

BACKGROUND: In the past, hair restoration surgeons have focused most of their attention and efforts on the reconstruction of the hairline region and the area on top of the head. However, little attention has been given to the temporal peaks and the areas immediately posterior to them. OBJECTIVE: The goals of this article are to describe the pattern baldness process at the temporal peaks and the region immediately posterior to them, and to describe a method for the evaluation and treatment of these very important and often neglected areas. METHODS: A method for evaluating and grading the temporal peak region is given. A surgical technique for treating this problem is described. This method consists of making 1.0 mm spear blade incisions at a very acute 10 degrees angle in the newly designed anterior peak and in between the hair follicles that remain in the area posterior to the peak. The grafting of the finest one-haired grafts available in between existing hair follicles is accomplished with the help of 3.5x expandable loupes. The anterior temporal peak design is coordinated with the position of the frontal hairline restoration; the more anterior the hairline, the more anterior the temporal peak and vice-versa. RESULTS: The results of evaluating the temporal peak areas and treating them appropriately have consistently restored the cosmetic harmony between the frontal hairline and the temporal peak region. It is important, however, to only utilize the finest hairs available to create an aesthetically pleasing result. CONCLUSION: When evaluating patients for hair restoration surgery, it should be a common practice to evaluate the temporal peak regions and the areas immediately posterior to them. These areas should be appropriately treated so that the frontal hair restoration coordinates with that of the temporal peak. The further anterior one comes with the hairline, the more anterior must come with the temporal peak restoration and vice-versa.

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