Management of Cowlick in Female Hairline Correction Surgery.

PURPOSE: To investigate the results of two grafting methods to manage CLs in the FHL of women. BACKGROUND: The present study was performed to investigate the results of two grafting methods to manage cowlicks (CLs) in the frontal hairline of women. METHODS: Patients were categorized into two groups based on the grafting method: the matching with the original hair direction (MOD) group and the matching with the CL hair direction (MCD) group. Satisfaction ratings were compared between the two groups. RESULTS: Among 80 patients, 77 had a single CL and 3 had a double CL. In the MOD group, 7 of 12 (58.3%) patients underwent a touch-up procedure for density enhancement with an average of 123 follicular units; the average patient and physician satisfaction ratings were 4.84 and 4.60, respectively. In the MCD group, 7 of 68 (10.3%) patients underwent a touch-up procedure for density enhancement around the CL; the average patient and physician satisfaction ratings were 4.64 and 4.50, respectively. CONCLUSION: In female hairline correction surgery, the surgeon must choose between MOD and MCD by considering the location, shape, and pattern of the CL; the facial shape; and the patient's preference. Delicate graft placement is required to obtain natural-looking results. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .

A Practical Guide to Hair Graft Placement Using the Sharp Implanter Method.

Purpose: Hair transplantation using the sharp implanter method is increasing in popularity. However, there has been little discussion pertaining to surgical know-how or specific techniques that increase efficiency and precision. We describe surgical techniques that enable dense packing in a swift and efficient fashion with the sharp implanter method using photos and videos. Patients and Methods: Grafts were placed using the sharp implanter method while adhering to several important principles. Eleven principles regarding the following aspects of hair transplant surgery were explained: gripping the implanter, graft placing technique that minimizes graft popping and tissue trauma when using the implanter, efficient team surgery system with assistant staff, direction and sequence of graft insertion, effective regimen for using epinephrine to control bleeding, selection of appropriately sized implanter tip, selection and usage of wide and narrow channel implanter tips, importance and methods of depth control, and staff training. Results: High graft survival and dense and natural hair density can be obtained with the sharp implanter method when performed in compliance with the principles described here. Conclusion: Appropriate use of the sharp implanter technique allows efficient and rapid graft insertion and achieves natural outcomes.

Multi-Wave Punch for Follicular Unit Excision Hair Transplantation Surgery.

Follicular unit excision is widely used for hair transplantation because it lacks a donor scar and is associated with less postoperative pain. Obtaining high-quality grafts and minimizing hair follicle damage during graft harvesting are key. This review elaborates on the types and dynamics of punches used in follicular unit extraction. We also describe the utility and advantages of a new "Multi-Wave Punch," a new type of punch designed to optimize graft extraction and reduce follicular injury. This multi-wave punch is composed of three different parts. The cutting edge at the end is blunt-angled. Adjacent is the leading edge, which is characterized by several horizontally oriented multi-wave shapes. Most proximal is the main body, which is decagonal in shape. Because of the multi-wave and decagonal structure, the punch easily enters the outer layers of the scalp. The wave energy is transmitted to the surrounding tissue, separating hair follicles from adjacent tissue, facilitating extraction, reducing follicular damage, and ensuring higher quality grafts.

Natural results of scalp micropigmentation: A review.

BACKGROUND: Scalp micropigmentation has developed rapidly in recent years to the extent that it is now considered a major means of hair loss treatment along with medication and hair transplantation. AIMS: To deliver correct information in terms of patients' curiosity regarding scalp micropigmentation and the most frequent complaints that doctors receive as well as to rectify misinformation. METHODS: A review of the literature was performed, and information is herein presented on various scalp micropigmentation procedures, the authors' experiences in this area, and special tips to achieve a natural result. RESULTS: The fundamental knowledge and proper techniques described in this article can aid in achieving more successful scalp micropigmentation results. CONCLUSION: Scalp micropigmentation is a widely used technique to camouflage various scalp scars and alopecia; therefore, it is important to be aware of the principles and skills necessary to achieve a natural result.

Long hair follicular unit excision: personal experience.

BACKGROUND: Long hair follicular unit excision (FUE) is the most state-of-the-art surgical technique in the field of hair transplantation surgery. Long hair FUE reduces the signs of surgery by camouflaging the recipient area with long hair, and allows hair curl identification when placing grafts. In addition, donor area shaving can be omitted. METHODS: This article presents the surgical approach and methods of long hair FUE. Patients were categorized by sex, age, recipient site, purpose of the surgery, and history of previous hair transplantation. Medical charts and photographs were reviewed to obtain the transection rate and calculated density for each patient. RESULTS: Long hair FUE was applied to 134 patients (112 women and 22 men). Thirty-four patients received eyebrow hair transplantation, 73 underwent female hairline correction surgery, nine patients underwent sideburn reconstruction, two were treated for female pattern hair loss, and 19 were treated for male pattern baldness (MPB). Four of the patients with MPB also underwent eyebrow transplant surgery. Of the patients with MPB, 17 (89%) had Norwood type III baldness, and two (11%) had type IV hair loss. The mean number of grafts required was 292 for eyebrow transplantation, 1,214 for female hairline correction, 251 for sideburn reconstruction, 1,344 for female pattern hair loss, and 1,567 for MPB. The mean follicle transection rate was 9.2%, and the mean calculated number of follicles per graft achieved was 2.23. CONCLUSION: This long hair FUE method introduced by the authors is an excellent surgical method when performed by surgeons with sufficient skill and expertise.