Follicular unit extraction: minimally invasive surgery for hair transplantation.

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Dermatol Surg 2002 Aug;28(8):720-8

Follicular unit extraction: minimally invasive surgery for hair transplantation.

BACKGROUND: Follicular Unit Transplantation (FUT) is performed using large numbers of naturally occuring individual follicular units obtained by single-strip harvesting and stereo-microscopic dissection. Donor wound scarring from strip excision, although an infrequent complication, still concerns enough patients that an alternative solution is warranted. OBJECTIVE: The purpose of this paper is to introduce Follicular Unit Extraction (The FOX Procedure), in which individual follicular units are removed directly from the donor region through very small punch excisions, and to describe a test (The FOX Test) that determines which patients are candidates for this procedure. This paper explores the nuances, limitations, and practical aspects of Follicular Unit Extraction (FUE). METHODS: FUE was performed using 1-mm punches to separate follicular units from the surrounding tissue down to the level of the mid dermis. This was followed by extraction of the follicular units with forceps. The FOX test was developed to determine which patients would be good candidates for the procedure. The test was performed on 200 patients. Representative patients who were FOX-positive and FOX-negative were studied histologically. RESULTS: The FOX Test can determine which patients are suitable candidates for FUE. Approximately 25% of the patients biopsied were ideal candidates for FUE and 35% of the patients biopsied were good candidates for extraction. CONCLUSION: FUE is a minimally invasive approach to hair transplantation that obviates the need for a linear donor incision. This technique can serve as an important alternative to traditional hair transplantation in certain patients.

Cancer Pract 2001 Nov-Dec;9(6):283-9

Psychological sequelae and alopecia among women with cancer.

PURPOSE: This article reviews the relevant literature on treatment-induced alopecia in women with cancer and describes the development of a computer-assisted intervention to reduce distress associated with this side effect. DESCRIPTION OF PROGRAM: Alopecia has been cited as the most disturbing anticipated side effect by up to 58% of women preparing for chemotherapy, with 8% being at risk for avoiding treatment. Women with cancer who experience alopecia as a side effect, compared with women with cancer and no alopecia, report lower self-esteem, poorer body image, and lower quality of life. Although physicians' recommendations are the most influential factor on cancer treatment choice, body image and effects on sexuality are the next most influential factors. A study of a computer-imaging intervention, based on concepts related to guided imagery and anticipatory grief, has been launched in an effort to aid women in coping with anticipated treatment-related alopecia. RESULTS: While we are still waiting for final data collection and analysis from the computer intervention study, the feedback thus far has been positive. CLINICAL IMPLICATIONS: The intervention described here may prove to be effective in desensitizing women with cancer to hair loss and facilitating an adjustment to self-acceptance. As such, a higher quality of life during the difficult time of coping may be maintained. The development of a computer-imaging intervention offers an opportunity to integrate a standard psychosocial intervention, personalized for each patient, into the routine patient care in the oncology setting.

Br J Nurs. 2003 May 8-21;12(9):550-8.

Case study of alopecia universalis and web-based news groups.

This article presents findings from an 18-month case study of a web-based news group used by individuals with alopecia universalis. Content analysis of 228 episodes of web-based communication that occurred in relation to themes of discussion was undertaken, supported by the use of concept mapping (Northcott, 1996). Analysis identified a core concept relating to that of a community of shared experience together with four supportive themes. The themes were the search for understanding and meaning, carrying on, seeking balance between past, present and future, and relating to new self, others, and the world. The article discusses the increased growth in the use of the web as a vehicle for exploring health concerns and the specific ethical and methodological issues raised by research in this area.

Dermatol Surg. 2003 Mar;29(3):230-4; discussion 234.

Corrective hair restoration techniques for the aesthetic problems of temperoparietal flaps.

BACKGROUND: Temperoparieto-occipital flaps (Juri flap) and temperoparietal flaps (Elliott) were commonly performed in the previous decades but have fallen out of favor for the most part with the development of follicular unit hair transplantation. Besides high complication rates, these procedures created straight abrupt hairlines in many cases, posterior hair direction, hair density that was disproportionately thick, and blunt temperofrontal angles. OBJECTIVE: Because there are many patients who live with cosmetic deformities created by previous flap procedures, the objective of this article is to present a series of techniques that will restore these patients to normal cosmesis. METHODS: The techniques for amelioration of poor cosmesis secondary to flap procedures are (1) undulating follicular unit grafting anterior to the hairline, (2) removal of 2- to 3-mm cylinders of hair-bearing scalp at the anterior hairline, (3) removal of 2- to 3-mm cylinders of hair-bearing scalp from within the flap itself, and (4) appropriate fusiform excision techniques to create a normal temperofrontal angle. RESULTS: The combination of the aforementioned techniques has restored a very natural cosmesis in patients who have poor aesthetics after flap surgery. CONCLUSION: Many patients exist who have had Juri and Elliott flaps. Although the cosmetic deformities that are created from these flaps are difficult to improve, they can be ameliorated effectively through a series of maneuvers that are described in this article.

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