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Surgical anatomy of the scalp. (A) Frontal view emphasizing the level of the hairline, relationship to the temporal triangle, and the lateral canthal line. (B) Profile view to illustrate the relationship between the lateral hump and lateral aspect of the forelock. (C) Caudal view to illustrate the relationship with the lateral canthal line and lateral extent of the anterior hairline.
Source publication
Hair restoration is a highly sophisticated subspecialty that offers significant relief to patients with hair loss. An improved understanding of the aesthetics of hair loss and cosmetic hair restoration, hair anatomy and physiology, and the development of microvascular surgical instrumentation has revolutionized the approach to surgical hair restora...
Contexts in source publication
Context 1
... conservative and princi- pled surgical plan for the recipient site is an initial forelock distribution hair transplant. The forelock is the area bounded anteriorly by the frontal hairline, posteriorly by the anterior crown region, and laterally by the parietal fringe ( Figure 1). This is a commonly maintained, normal distribution of hair seen in male patients with mild hair loss. ...
Context 2
... first landmark that needs to be determined is the height of the anterior hairline (AHL) (Figure 1). In most instances, the location of the most anterior, midfrontal portion of the hairline is between 7.5 and 9.5 cm above the glabella. ...
Context 3
... design should begin by ensuring the presence of a lateral hump (Figure 1). If the lateral hump is absent, this should be designed first. ...
Context 4
... landmark is important because it represents the lateral extent of the AHL. The intersection of the lateral AHL and the lateral hump is the apex of the frontotemporal recession and should always be convex in a male AHL design ( Figure 10). [75][76][77] The single most important component to achieving a natural appearance to the hair transplant is the creation of an outstanding AHL (Figure 11). ...
Context 5
... intersection of the lateral AHL and the lateral hump is the apex of the frontotemporal recession and should always be convex in a male AHL design ( Figure 10). [75][76][77] The single most important component to achieving a natural appearance to the hair transplant is the creation of an outstanding AHL (Figure 11). This is accomplished through proper location and design of the hairline as well as the use of large numbers of small grafts. ...
Context 6
... Typically, these single hairs are taken from the temporal donor fringe. Posterior to the single hair grafts are FU containing 2 and 3 hairs with stronger physical characteristics ( Figure 12). Recreating a female hairline requires a design that includes a more rounded temporal infill and lower hairline than the one normally created for men (Figures 13 and 14). ...
Context 7
... to the single hair grafts are FU containing 2 and 3 hairs with stronger physical characteristics ( Figure 12). Recreating a female hairline requires a design that includes a more rounded temporal infill and lower hairline than the one normally created for men (Figures 13 and 14). 80 When a forelock pattern is created, the rear border should be located somewhere along the midscalp. ...
Context 8
... or not there is a plan to graft the vertex, the rear hairline should be constructed with an irregular border of small grafts. The lead author prefers to create a tapered posterior forelock pattern of trailing design that renders the crown less circular and mimics a natural variation on the balding process ( Figure 15). A distribution of grafts recreating a natural whorl pattern can be constructed at the posterior aspect of the forelock. ...
Context 9
... distribution of grafts recreating a natural whorl pattern can be constructed at the posterior aspect of the forelock. The crown area can be further grafted as indicated but should always be considered as an extension of the posterior forelock to maintain a natural distribution of hair ( Figure 15). ...
Context 10
... sizes ranging from 23 to 18 gauge are typically used. A 19-gauge needle will produce a 1.1-mm slit that will accommodate the size of the majority of FU of average density ( Figure 16). Another popular instrument for site creation is the sharp-point, 22.5-degree or the "mindi" knife. ...
Context 11
... the hair progresses to the right side, a switch should be made so that the hair on the opposite side is angled toward the midline. As mentioned above, a whorl is created at the midpoint of the crown vertex area through a spiraling of the angulation of recipient sites through a 360-degree rotation ( Figure 15). ...
Context 12
... with site creation, numerous techniques and instru- ments are available for graft placement. The different Figure 10. This 58-year-old man with male pattern alopecia who underwent a 2500-graft follicular unit hair transplant is shown during immediate preoperative planning (A, C) and immediately postoperatively (B, D, E). ...
Context 13
... there are exceptions to the rule, most grafts enter a telogen phase for the first 3 months prior to entering their anagen phase. Full growth and evaluation of transplant results cannot reliably be assessed for 8 to 12 months following the procedure (Figure 17). ...
Context 14
... Hair transplants do grow in scar as well as radi- ated tissue; however, the survival rate is lower than in noninjured recipient beds. Formal studies on this topic have not been published ( Figure 18). ...
Context 15
... the case of hairline reconstruction for female-to- male gender reassignment, androgen supplementation and ensuing temporal recession or thinning is generally all that is necessary. In male-to-female reassignment, the hairline design includes a typical rounded temporal infill and the lower hairline described earlier for restoring FPHL (Figure 14). ...
Context 16
... include "ingrown" hair, foreign body reactions, epithelium logged into slit sites during recipient site creation, piggybacked grafts, and the "idio- pathic" intrinsic properties of the host scalp. In the majority Figure 13. (A, C) This 68-year-old woman with typical female pattern hair loss presented for hair restoration. (B, D) Eight months after undergoing a second treatment session, for a total of 3300 total grafts. of cases, a pathogen cannot be cultured from the lesions, but a secondary, uncultured bacterial agent cannot be excluded as having a secondary role in pathogenesis. ...
Context 17
... techniques and approach for correction of these challenging cases are beyond the scope of this cur- rent review. The references cited in this section provide the principles and fundamental techniques for restoring normalcy to a patient whose life has been undesirably transformed by the initial hair transplant procedures (Figure 19). ...
Similar publications
Background:
Hair restoration surgery (HRS) is a very promising and sought after aesthetic procedure with very few complications. Complications may occur in the donor or the recipient area, and it may be due to surgical or idiopathic causes.
Aim:
The aim was to analyze the complications in male patients who underwent HRS for androgenetic alopecia (...
Citations
... Alopecia comes in a lot of forms. Androgenetic alopecia [AGA] is the most prevalent type of alopecia that can be surgically treated [2] . By the time they turn 70, it's expected that between 70% and 80% of white men will have noticeable androgen-influenced alopecia [3] . ...
... The Inclusion criteria were: [1] Healthy patients suffering from AGA, [2] Age group between 25 years and 60 years, and [3] Patients with all types of hair, and Failure or intolerance of medical management to alopecia. ...
... The Exclusion criteria were: [1] Patients with other types of alopecia rather than AGA, [2] Patients with any associated local scalp infections, [3] Patients with unrealistic expectations, [4] Patients with total loss of hairs as there is no suitable donor site. ...
... Hasta hem medikal hem de psikolojik açıdan saç ekimine uygunluk yönünden değerlendirilmelidir. Androgenetik alopesi en yaygın saç nakli endikasyonunu oluşturan alopesi çeşitidir. 8 Bunun dışında kadın tipi saç dökülmesi, sekonder skatrisyel alopesiler, temporal trianguler alopesi, traksiyonel alopesi saç ekimi yapılabilen diğer endikasyonlardır. 9 Ayrıca remisyona girmiş primer skatrisyel alopesilerde de saç ekimi yapılabilmektedir. ...
... Frontal saç için 30-45 derece açı oluşturulması doğal görünüm için önemlidir. 8 Dikkat edilmesi gereken diğer bir husus ise alıcı bölgeler oluşturulurken var olan kıllara hasar verilmemesidir. ...
Saç ekimi popülaritesi giderek artan ve en sık yapılan kozmetik cerrahilerden birisidir. Saç dökülmesine bağlı oluşan kelliğin toplumsal algısı ve hastalarda meydana getirdiği mutsuzluk saç ekimine
olan ilgiyi giderek artırmaktadır. Yeni geliştirilen teknikler sayesinde daha iyi sonuçlar elde edilmekte
ve yüksek hasta memnuniyeti sağlanmaktadır. Saç ekimi çoğunlukla androgenetik alopesisi olan erkeklere yapılmakla birlikte kadınların da ilgisi giderek artmaktadır. Bu makalede 80 yıllık bir geçmişe sahip
olan saç ekiminin temel noktalarından bahsedilmiştir.
... In the field of hair transplantation (HT) surgery, transplantation techniques using autologous tissue dominate [1]. The most widely used techniques are follicular unit transplantation (FUT), also known as strip technique, and follicular unit extraction (FUE) [1,2]. ...
... In the field of hair transplantation (HT) surgery, transplantation techniques using autologous tissue dominate [1]. The most widely used techniques are follicular unit transplantation (FUT), also known as strip technique, and follicular unit extraction (FUE) [1,2]. ...
... While follicular unit transplantation involves excising strips of hair from the donor area and dissecting them into small follicular units (FUs), FUE involves harvesting individual follicular grafts with the help of a punch [1]. Neither technique is superior to the other [1,2]. ...
Introduction:
In the field of hair transplantation (HT) surgery, transplantation techniques from autologous tissue dominate. The most widely used techniques are follicular unit transplantation, also known as strip technique, and follicular unit extraction.
Case presentation:
We report a case of an HT sequence of particular interest because of its unusual clinical presentation, chronic relapsing nature, and aggressiveness. The clinical presentation (fluctuating and communicating lesions in the occipital region), course, and symptomatology support the hypothesis of PCAS.
Discussion:
PCAS or folliculitis dissecans or Hoffmann's disease is a rare disorder of unknown etiology. We speculate that the mechanical extraction of follicular units was the trigger. This case underlines the need for further studies as cases of PCAS may increase concomitantly with the increase in HT.
... Patients received the treatment in the frontal area of the scalp that was defined as the area extending between the frontal hairline till a vertical line drawn in front of the ears and bounded laterally by the parietal fringe. 23 The photography score was rated from 0 to 3; where 0 = no improvement, 1 = mild improvement, 2 = moderate improvement, and 3 = excellent improvement. Three blinded physicians regarding the patients and the treatment conducted the photography assessments and the mean photography score was calculated. ...
Background
Androgenetic alopecia (AGA) is a non-scarring disease with a progressive thinning of the scalp hair that follows a characteristic pattern. It is the most common form of alopecia, affecting up to 80% of men and 50% of women in the course of their life.
Objectives
The aim of this study is to evaluate the possible clinical benefit of lyophilized platelet derived growth factors(L-GF) locally injected in cases of AGA.
Patients and Methods
The present pilot study included 20 female patients with AGA. Patients were recruited from the outpatient clinic of Ain Shams University Hospital, in the period at the period from September 2018 till March 2019. The study was approved by the Research Ethical Committee, Faculty of Medicine, Ain Shams University and fulfilled all the ethical aspects required in human research.
Results
Treatment with L-GF resulted in improvement of AGA patients with minimal side effects.
Conclusion
Lyophilized platelet derived growth factors (L-GF) injection for AGA could represent new therapeutic option for delivering platelet growth factors. As a pilot study, the sample size of this work was small, despite the fact that we had statistical significant results. Further randomized wide scale comparative studies between conventional autologous PRP and L-GF are demanding to draw concrete results.
... In trichometry, the software can be used to derive various hair morphometric parameters, but it usually requires the user to manually delineate features of interest using on-screen tools such as digital calipers [2]. The quantitative assessment of these morphometric parameters is of great clinical value, not only in monitoring the progression and response to treatment for hair loss and thinning, but also in predicting post-transplantation outcomes [3]. Furthermore, androgenetic alopecia (AGA), which is the most common type of hair loss, is characterized by progressive hair follicle miniaturization and it has been demonstrated that measurement of hair shaft diameter can help clinicians diagnose this disorder in its earlier stages [4][5][6][7]. ...
Background
Although many hair disorders can be readily diagnosed based on their clinical appearance, their progression and response to treatment are often difficult to monitor, particularly in quantitative terms. We introduce an innovative technique utilizing a smartphone and computerized image analysis to expeditiously and automatically measure and compute hair density and diameter in patients in real time.
Methods
A smartphone equipped with a dermatoscope lens wirelessly transmits trichoscopy images to a computer for image processing. A black-and-white binary mask image representing hair and skin is produced, and the hairs are thinned into single-pixel-thick fiber skeletons. Further analysis based on these fibers allows morphometric characteristics such as hair shaft number and diameters to be computed rapidly. The hair-bearing scalps of fifty participants were imaged to assess the precision of our automated smartphone-based device in comparison with a specialized trichometry device for hair shaft density and diameter measurement. The precision and operation time of our technique relative to manual trichometry, which is commonly used by hair disorder specialists, is determined.
Results
An equivalence test, based on two 1-sided t tests, demonstrates statistical equivalence in hair density and diameter values between this automated technique and manual trichometry within a 20% margin. On average, this technique actively required 24 seconds of the clinician's time whereas manual trichometry necessitated 9.2 minutes.
Conclusion
Automated smartphone-based trichometry is a rapid, precise, and clinically feasible technique which can significantly facilitate the assessment and monitoring of hair loss. Its use could be easily integrated into clinical practice to improve standard trichoscopy.
... The 2 most commonly used local anesthetics are lidocaine 1% with epinephrine 1:200,000 and bupivacaine 0.25% with epinephrine 1:200,000. 1 Pain during infiltration can be minimized by injecting the anesthetic with small-caliber syringes (1-3 mL Luer lock) using 30-gauge needles and blunt microcannulas, and applying vibration anesthesia. 2,3 The first author recommends using 25-gauge microcannulas with a modified tumescent anesthetic solution, prepared by mixing 30 mL of lidocaine 1%, 70 mL of saline, and 0.4 mL of adrenaline 1:1000, giving a 100-mL solution of lidocaine 0.3% with adrenaline 1:250,000. ...
... 5,6 Although not essential, some surgeons like to perform a bilateral supraorbital nerve block. 1 Because lidocaine has a very rapid onset effect but lasts only 2-3 hours, bupivicaine 0.25% containing epinephrine 1:200,000 is injected in the frontal hairline as a ring block around 2 hours into the procedure. The use of bupivicaine achieves a longer-lasting anesthesia (3-8 hours) for the rest of the procedure. ...
... 11,12 Strip harvesting FUT When preparing for strip harvesting, most surgeons trim donor hair to 4-5 mm to facilitate graft handling. 1 However, some prefer to leave donor hair at a normal or only slightly shortened length, allowing patients a temporary impression after the procedure of how the transplanted hair might appear once fully grown; this is known as preview long hair FUT. 13 The strip should be harvested from a horseshoeshaped area of the mid-occipital scalp, known as the ''safe donor area.'' This safe zone comprises a horizontal band that is approximately 5-6 cm wide ( Fig 1). ...
The second part of this Hair Transplantation review concentrates on technical aspects of the surgery. First, we review the two main local anesthetics used in hair transplantation, lidocaine and bupivacaine, how to achieve long-lasting local anesthesia, and the techniques used to minimize the pain associated with anesthetic infiltrations. Second, we review the two donor harvesting techniques currently used: strip harvesting FUT and FUE. The technical aspects of each technique are described in detail, along with their advantages and drawbacks. Third, the different methods of graft implantation currently used by the majority of hair surgeons, including premade sites and stick-and-place, and the use of tools such as implanters are discussed. Finally, post-operative care, expected results, and the main complications involved in hair transplant surgery are reviewed.
... Patients received the treatment in the frontal area of the scalp that was defined as the area extending between the frontal hairline till a vertical line drawn in front of the ears and bounded laterally by the parietal fringe. 23 The photography score was rated from 0 to 3; where 0 = no improvement, 1 = mild improvement, 2 = moderate improvement, and 3 = excellent improvement. Three blinded physicians regarding the patients and the treatment conducted the photography assessments and the mean photography score was calculated. ...
Background
Various therapeutic modalities have been tried for female pattern hair loss (FPHL) treatment. To our knowledge, no previous studies had evaluated the therapeutic effect of lyophilized growth factor (L‐GF) intralesional injection in FPHL.
Objective
The current study aimed to evaluate the efficacy and safety of intralesional L‐GF injection in FPHL by clinical and trichoscopic evaluation.
Methods
This study included 20 patients with FPHL. All patients received three treatment sessions of intralesional injection of L‐GF four weeks apart. Patients were followed‐up for further three months. The outcome was evaluated by trichoscopy, photography score, patient's satisfaction score and side effects were reported.
Results
Trichoscopic evaluation showed significant post‐treatment increase in all hair parameters associated with a significant decrease in vellus hair count. Ludwig's grade II showed post‐treatment significant differences in all trichoscopic parameters from the baseline. No significant differences were detected regarding all trichoscopic parameters between the two Ludwig's grades post‐treatment. 80% of patients showed photography score improvement that was significantly higher in Ludwig's grade II than in grade I. 100% of patients showed improvement in patient's satisfaction score with insignificant difference between Ludwig's grades.
Conclusion
Intralesional injection of L‐GF is safe and improved various trichoscopic hair parameters and clinical scores in FPHL.
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... Saç ekiminin temel mantı ı saçların dökülmemeye programlanmı bölgeden alınarak kozmetik olarak ihtiyaç duyulan bölgeye nakledilmesi i lemidir. 3,4 Saç ekimi için uygun adayın belirlenmeSi Bütün kozmetik i lemlerde ba arılı kozmetik sonuçlar adayın uygun olup olmadı ının belirlenmesi ile ba lar. Saç ekimi için uygun aday belirlenirken en önemli kriterlerden biri hastanın beklentisini kar ılayacak miktarda donorunun olmasıdır. ...
Hair is the major component of man’s esthetic. Androgenetic alopesia is the most important cause of men hairloss and it is also the main indication for hairtransplant. Hair transplantaion is done mostly by follicular unit implantation which are taken one by one with special punches in recent years. The outcome of the procedure is mainly determined by the donor density of the patient, the size of hairless area,and the experience,knowledge and the skill of the phycisian. Hair transplantation is a very sophisticated subspeciality branch which provides a great relaxation for male patients. It is also the sole treatment model for androgenetic alopecia and other permanent hair loss diseases. With the advancement and diversification of hair transplantation technique, the improvement of the tools used in surgery and the increse in experiences which create natural results, the hair transplantation became the most demanded cosmetic surgery procedure by men. Hair transplantation results in recent years have a natural appearance and can be done with a very high level of patient satisfaction and safety. The future of hair restoration surgery focuses on cell-based treatments as well as minimal incision surgery.
... Saç ekiminin temel mantı ı saçların dökülmemeye programlanmı bölgeden alınarak kozmetik olarak ihtiyaç duyulan bölgeye nakledilmesi i lemidir. 3,4 Saç ekimi için uygun adayın belirlenmeSi Bütün kozmetik i lemlerde ba arılı kozmetik sonuçlar adayın uygun olup olmadı ının belirlenmesi ile ba lar. Saç ekimi için uygun aday belirlenirken en önemli kriterlerden biri hastanın beklentisini kar ılayacak miktarda donorunun olmasıdır. ...
... Follicular unit extraction (FUE) and follicular unit transplantation (FUT) are the gold standard surgical interventions for androgenic alopecia and account for >99% of transplant procedures [1,2]. Both of these techniques involve transplantation of healthy hair follicles from a safe donor area to a low-density region of thinning/balding [3,4]. ...
... Finally, variations in graft density and angle can have major impacts on cosmetic satisfaction. Photography and/or visual inspection is the current gold-standard means of characterization during treatment planning and evaluation of results [1]. However, this practice neglects the subdermal orientation/depth of follicles, which is the primary factor governing undesirable transection rates in FUE [13]. ...
Follicular unit extraction (FUE) and follicular unit transplantation (FUT) account for 99% of hair transplant procedures. In both cases, it is important for clinicians to characterize follicle density for treatment planning and evaluation. The existing gold-standard is photographic examination. However, this approach is insensitive to subdermal hair and cannot identify follicle orientation. Here, we introduce a fast and non-invasive imaging technique to measure follicle density and angles across regions of varying density. We first showed that hair is a significant source of photoacoustic signal. We then selected regions of low, medium, and high follicle density and showed that photoacoustic imaging can measure the density of follicles even when they are not visible by eye. We performed handheld imaging by sweeping the transducer across the imaging area to generate 3D images via maximum intensity projection. Background signal from the dermis was removed using a skin tracing method. Measurement of follicle density using photoacoustic imaging was highly correlated with photographic determination (R2 = 0.96). Finally, we measured subdermal follicular angles—a key parameter influencing transection rates in FUE.
