Chronologic improvement in hair yield with follicular unit excision with changes in punch devices: A 10-year experience of a single center.

Follicular unit excision (FUE), which is a newer hair transplant procedure was thought to be only usable in limited areas at the beginning. However, it is the most preferred technique these days. It is known transection rates have decreased with punch technology (and experience) over the years. We analyzed the data from so-so many male patients who underwent hair transplantation by FUE method at our clinic retrospectively to elucidate how the development of punch technology affected the number of total grafts and FU containing multiple hairs. Between the years 2011 and 2020, male hair transplant patients operated with the FUE method at the author's dermatology clinic, was investigated retrospectively. Overall 1415 cases were included in the study. Total graft numbers and 1-4 hair FUs were calculated. There was a statistically significant difference in terms of number of total grafts, one hair follicular unit (I FU) three hair follicular unit (III FU) distributions according to operation year and punch type (p < 0.05). The serrated punch resulted in a significant increase in the numbers of total grafts and the trumpet punch resulted in a significant increase in the number of 3FU grafts. Our study has shown that hair yield has been increased with new punch technologies. With an increasing hair yield by the aid of evolving punch technology, hair transplantation with the FUE method has become the first choice for hair transplantation preferred by both doctors and patients.

Follicular unit extraction as a valuable method for the restoration of beard: Retrospective case series study.

BACKGROUND: Beard and mustache are important components of body image. Beard transplantation is the procedure to restore congenital absence or inefficient growth of beard and mustache. OBJECTIVES: The aim of the study is to report our results and experience in beard transplantation. METHODS: Patients with a demand for beard restoration who were treated with follicular unit extraction (FUE) hair transplantation method were included in this retrospective, case series study. Patients' birth date, race, presence of eunuchoidism, hair color, type and shaft thickness, and treatment details were retrieved from medical records. Patients were evaluated at least one year after the operation, and defect closure rates were calculated. At the follow-up examination, patients were asked to evaluate their satisfaction from the procedure. RESULTS: Ten patients were consecutively treated between May 2007 and June 2016. The mean age of the patients was 29.6 years. Three of our patients were eunuchoid and the others wanted beard transplantation to have a more masculine look. Follow-up period was median of 39 months. Four patients were satisfied and four patients were very satisfied with the procedure with a mean 53% closure rate. Better closure rates were associated with brown and red hair color, medium and fine hair thickness, and absence of eunuchoidism. Patients with straight hair were satisfied with the procedure significantly. CONCLUSION: Beard reconstruction by using the FUE method is a safe and effective method with high patient satisfaction rates.

Hair transplantation for therapy-resistant alopecia areata of the eyebrows: is it the right choice?

Alopecia areata is a common skin disorder of presumed autoimmune etiology and it usually shows an unpredictable course. Treatment of alopecia areata is challenging. There is very little information on the use of surgical therapies for the treatment of alopecia areata in the medical published work. A 24-year-old male patient was referred to a private hair transplantation clinic owned by one of the authors for the treatment of therapy-resistant alopecia areata affecting both eyebrows. He had quickly lost all body hair 4 years prior beginning from the scalp. He received psoralen and ultraviolet A (PUVA) therapy for alopecia universalis and all body hair re-grew except his eyebrows. Alopecia areata was stable for the 18 months following the last medical treatment he received. Because there was no response to various medical therapeutic agents, we decided to transplant occipital hairs to the eyebrow area. After the patient understood and accepted all risks, occipital hairs were transplanted to the eyebrows by using the follicular unit extraction technique. Postoperatively, the patient did not receive any topical or systemic therapies for alopecia areata. Although 40% hair re-growth was detected in his eyebrows at 1 year postoperation, this rate was 80% by 2 years postoperation. However, there was resistance to re-growth in the medial eyebrow regions. New eyebrows grew as occipital hairs and required trimming. His satisfaction from the surgical procedure was 90% at the end of the 24th postoperative month. Surgical treatment of diseases like alopecia areata is still controversial. Our case report offers an additional contribution to the published work on the surgical methods used in the treatment of stable alopecia areata.

Effectiveness of non-ablative three dimensional (3D) skin rejuvenation: a retrospective study involving 46 patients.

BACKGROUND: Three dimensional (3D) skin rejuvenation is proposed to be effective for all skin layers. The aim of this concept is to treat sun spots with broad-band pulse light; large pores, fine lines and vascular lesions with a long-pulsed 1064 nm neodymium-yttrium-aluminum-garnet (Nd:YAG) laser system and skin ptosis and laxity with a 1100-1800 nm infrared light source. OBJECTIVE: In this study, 46 patients treated with the 3D skin rejuvenation procedure were retrospectively evaluated to assess the effectiveness of the 3D procedure according to both patient and doctor satisfaction. METHODS: The 3D procedure was carried out over the course of five sessions with 15 day intervals between sessions. Results were judged by an experienced laser dermatologist both by direct patient examination and by comparison of "before" and "after" photographs. Results were ranked into five categories ranging from 0 to 4. At the final control, the patients were also asked to rate their satisfaction with the procedure in five categories, ranging from 0 to 4. RESULTS: All of our patients showed improvement, with an overall patient satisfaction score of 2.65. Female patients were more satisfied than male patients. Patient and doctor satisfaction scores were generally correlated. CONCLUSIONS: Our clinical results indicate that the 3D procedure is an effective nonsurgical skin rejuvenation method.

Confetti-like macular atrophy: A new entity?

Anetoderma, is characterized by herniated atrophic macules clinically and by decreased to absent dermal elastic fibers histopathologically. Atrophoderma is characterized by depressed, atrophic, pigmented patches clinically and by thickened and homogenized dermal collagen bundles with absence of elastolysis histopathologically. Atrophoderma elastolyticum discretum describes lesions that are reminiscent of atrophoderma clinically but they are compatible with anetoderma histopathologically. A 34-year-old female patient presented with diffuse, hypopigmented, atrophic, shiny macules on the upper limbs and upper trunk. Histopathological examination revealed an atrophic epidermis with disorganized, hyalinized and coarse collagen bundles in the middle and lower dermis. Elastic fiber loss and fragmentation were detected in the upper dermis. The other patient was a 42-year-old female patient. She applied with diffuse, hypopigmented, shiny, atrophic macules on the upper limbs and upper trunk. Histopathological examination revealed findings that were similar to those of the first case but there was near complete loss of elastic fibers throughout the whole thickness of dermis. Our cases did not show depressed or herniated atrophic macules clinically but the macules were at the same level with the surrounding healthy skin. Histopathological findings in these cases showed the histopathological features of both atrophoderma and anetoderma. These two cases are interesting because they may represent a clinicopathological entity which has not been described before.

Clinical experience in the treatment of different vascular lesions using a neodymium-doped yttrium aluminum garnet laser.

BACKGROUND: A neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been used with good results for the treatment of various vascular lesions. OBJECTIVE: To report our experience with a variable long-pulsed Nd:YAG laser for the treatment of different vascular lesions. MATERIALS AND METHODS: One hundred ten patients with different vascular skin lesions were included. Patients were examined before the treatment; 1 week after each treatment session; and 1, 2, and 3 months after the last treatment session. Improvement was judged according to clinical examination of the patients and by comparing pre- and post-treatment photographs. Results were graded in four groups using percentage resolution (0-25%, 26-50%, 51-75%, and 76-100%. RESULTS: One hundred five patients (19 port wine stains, 48 telangiectasias, 25 hemangiomas, and 13 other vascular lesions) completed the study; 71.5% of patients showed greater than 50% improvement. Good to excellent (more than 50%) results were achieved in 63.2% of patients with port wine stain, 80.0% of patients with hemangioma, 66.7% of patients with telangiectasia, and 84.6% of patients with other vascular lesions; 71.5% of all patients were very satisfied or satisfied with the results. CONCLUSION: A variable long-pulsed Nd:YAG laser was found to be effective in the treatment of different vascular lesions ranging from easy to difficult to treat. The authors have indicated no significant interest with commercial supporters.

A new experimental delayed wound healing model in rabbits.

Chronic wounds pose important problems in clinical practice and their treatment is difficult and costly. Here we describe a new delayed wound healing animal model. Fifteen male New Zealand rabbits were used in this study. A horizontal incision 4 cm in length was made on the dorsal part of the torso and pure skin flaps were raised in front of and behind this incision. This exposed the panniculus carnosus layer and it was resected. Skin flaps were returned to their places and sutured. After a 3 week period of healing third degree burn injury was inflicted using hot metal plates both on the healed flaps and at the same location on the opposite side. Scar samples were sent for histopathological examination after healing. The wounds on the panniculectomy side healed in an average of 43.20 days but on the control side they healed in an average of 32.80 days (p < 0.05). Wound healing was slower and scars were broader and more irregular on the panniculectomy side. In our new model, addition of panniculectomy to full thickness burn injury significantly delayed wound healing with a decrease in scar quality. This is a simple, economic and effective animal model to study delayed wound healing.

Report of two angiokeratoma of Fordyce cases treated with a 1064 nm long-pulsed Nd:YAG laser.

Various laser treatment modalities for angiokeratomas have been reported in the literature. A 60-year-old male patient presented for the treatment of multiple angiokeratomas of the scrotum and a 56-year-old female patient presented for the treatment of vulvar angiokeratomas. A 1064 nm long-pulsed Nd:YAG laser was used to treat the patients' lesions. The patients received two laser treatment sessions at an interval of 2 months. Nd:YAG laser treatment yielded successful results in the treatment of our patients' scrotal and vulvar angiokeratomas following two application sessions. We suggest that a long-pulsed Nd:YAG laser is a safe and effective method for the treatment of angiokeratoma of Fordyce.

Lateral foldplasty with or without partial matricectomy for the management of ingrown toenails.

BACKGROUND: Ingrown toenails are common and lead to significant morbidity. OBJECTIVE: This retrospective study was aimed at evaluation of our new surgical technique of lateral foldplasty with limited lateral matrix resection in some cases for the management of ingrown toenails with regard to recurrence rates, spicule formation, local infection, partial flap necrosis, and cosmetic outcome. METHODS & MATERIALS: Thirty-two patients with 52 ingrown nails were included in this study. Lateral foldplasty procedure alone was preferred for the surgical treatment of 18 ingrown toenails of mild to moderate severity. Lateral foldplasty with limited lateral matrix resection was performed in 34 ingrown nails in patients with broad nail plates or for moderate to severe cases with significant granulation tissue formation. RESULTS: Relapse rate, local infection rate, and partial flap necrosis rate were very low. Spicule formation was not observed. The cosmetic appearance of the nail did not disturb any patient treated with this procedure. CONCLUSION: The lateral foldplasty procedure alone or combined with limited lateral matrix resection is a cheap, simple, and satisfactory technique for the treatment of ingrown toenails with a low risk of relapse. This technique also has good cosmetic results.