Determination of Scalp Vascular Topography by Laser Doppler Flowmetry and Comparison of Vascular Damage by Different Blades in Hair Transplantation.

BACKGROUND: Although necrosis is a rare complication in hair transplantation, it is extremely traumatic for both the patient and surgeon and also has potential medicolegal consequence. Studies have shown that ischemia in the recipient bed is related to tissue damage caused by the instruments used and the number of grafts per cm². OBJECTIVE: We aimed to measure the effects of different instruments on circulation by dividing the recipient area of hair grafts of the same person into 2 sides as right and left. METHODS AND MATERIALS: Sapphire percutaneous blade was used on the right side, and a handmade razor slit was used on the left side in 12 male patients with consent. Subsequently, vascularity was evaluated with laser Doppler flowmetry. RESULTS: Scalp vascularity has so far only been evaluated with macroanatomic studies in the literature. First, the authors evaluated the effect of local anesthesia and adrenaline-containing swelling fluids on vascularity with a Laser Doppler Flowmeter. Afterward, the tissue damage caused by sapphire percutaneous blades and handmade blades (obtained from razor blades) were quantitatively analyzed and compared with each other. CONCLUSIONS: Our results showed that handmade razor blades caused significantly less tissue damage.

Assessment and Treatment Outcomes of Persistent Radiation-Induced Alopecia in Patients With Cancer.

Importance: Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described. Objective: To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma. Design, Setting, and Participants: A retrospective cohort study of patients from January 1, 2011, to January 30, 2019, was conducted at 2 large tertiary care hospitals and comprehensive cancer centers. Seventy-one children and adults diagnosed with primary CNS tumors or head and neck sarcomas were evaluated for pRIA. Main Outcomes and Measures: The clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil were assessed using standardized clinical photographs of the scalp, trichoscopic images, and radiotherapy treatment plans. Results: Of the 71 patients included (median [range] age, 27 [4-75] years; 51 female [72%]), 64 (90%) had a CNS tumor and 7 (10%) had head and neck sarcoma. Alopecia severity was grade 1 in 40 of 70 patients (56%), with localized (29 of 54 [54%]), diffuse (13 of 54 [24%]), or mixed (12 of 54 [22%]) patterns. The median (range) estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose (odds ratio [OR], 1.15; 95% CI, 1.04-1.28) and proton irradiation (OR, 5.7; 95% CI, 1.05-30.8) were associated with greater alopecia severity (P < .001), and the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy (95% CI, 33.7-39.6 Gy). Predominant trichoscopic features included white patches (16 of 28 [57%]); in 15 patients, hair-shaft caliber negatively correlated with scalp dose (correlation coefficient, -0.624; P = .01). The association between hair density and scalp radiation dose was not statistically significant (-0.381; P = .16). Twenty-eight of 34 patients (82%) responded to topical minoxidil, 5% (median follow-up, 61 [interquartile range, 21-105] weeks); 4 of 25 (16%) topical minoxidil recipients with clinical images improved in severity grade. Two patients responded to hair transplantation and 1 patient responded to plastic surgical reconstruction. Conclusions and Relevance: Persistent radiation-induced alopecia among patients with primary CNS tumors or head and neck sarcomas represents a dose-dependent phenomenon that has distinctive clinical and trichoscopic features. The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA.

Low-level laser therapy and narrative review of other treatment modalities in androgenetic alopecia.

Androgenetic alopecia (AGA), also termed as androgenic alopecia or common baldness, is a condition where there is androgen mediated conversion of susceptible terminal hair into vellus hair. Although it is reported more commonly in males, it also affects females but the incidence is relatively unknown. AGA tremendously affects the psychology of the patient due to its chronicity of treatment and cosmetic implications. There are numerous treatment options available for AGA but the choice of treatment has to often be tailored according to the patient's needs, affordability, and compliance. This review focusses on the various treatment options available, with special emphasis on the role of low-level laser therapy (LLLT) in the management of AGA. The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Only articles available in English were considered for this review.

Guidelines for the diagnosis and treatment of male-pattern and female-pattern hair loss, 2017 version.

Male-pattern hair loss (MPHL, androgenetic alopecia) is a slowly progressive form of alopecia which begins after puberty. In 2010, we published the first Japanese edition of guidelines for the diagnosis and treatment of MPHL. It achieved the original goal of providing physicians and patients in Japan with evidence-based information for choosing efficacious and safe therapy for MPHL. Subsequently, new therapeutic drugs and treatment methods have been developed, and women's perception of MPHL has undergone change and the term "female-pattern hair loss (FPHL)" is becoming more common internationally. Thus, here we report a revised version of the 2010 guidelines aimed at both MPHL and FPHL. In these guidelines, finasteride 1 mg daily, dutasteride 0.5 mg daily and topical 5% minoxidil twice daily for MPHL, and topical 1% minoxidil twice daily for FPHL, are recommended as the first-line treatments. Self-hair transplantation, irradiation by light-emitting diodes and low-level lasers, and topical application of adenosine for MPHL are recommended, whereas prosthetic hair transplantation and oral administration of minoxidil should not be performed. Oral administration of finasteride or dutasteride are contraindicated for FPHL. In addition, we have evaluated the effectiveness of topical application of carpronium chloride, t-flavanone, cytopurine, pentadecane and ketoconazole, and wearing a wig. Unapproved topical application of bimatoprost and latanoprost, and emerging hair regeneration treatments have also been addressed. We believe that the revised guidelines will improve further the diagnostic and treatment standards for MPHL add FPHL in Japan.

Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men - short version.

Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80% Caucasian men and 42% of women. Patients afflicted with androgenetic alopecia may undergo significant impairment of quality of life. The European Dermatology Forum (EDF) initiated a project to develop evidence-based guidelines for the treatment of androgenetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.

Local Anesthesia Techniques in Hair Restoration Surgery.

Pain during hair restoration surgery and other dermatologic surgery procedures is one of patients' main fears. The authors briefly describe local anesthesia techniques they use in their surgical practice that make these procedures more pleasant for patients. The ability to provide a pain-free experience during hair restoration surgery will increase patients' satisfaction and allow patients to return for subsequent procedures.

Hair loss in women.

Hair loss is a common cause of morbidity for many women. As a key member of the woman's health care team, the obstetrician/gynecologist may be the first person to evaluate the complaint of hair loss. Common types of nonscarring hair loss, including female pattern hair loss and telogen effluvium, may be diagnosed and managed by the obstetrician/gynecologist. A systematic approach to diagnosis and management of these common forms of hair loss is presented.

Patient selection, candidacy, and treatment planning for hair restoration surgery.

Patient consultation, examination, and selection are crucial for successful outcomes in hair restoration surgery. The hair restoration surgeon must take a holistic approach in identifying those patients who are and who are not candidates for surgery. In this article, an overview of the consultation, pertinent physical examination features relating to patient candidacy, and several treatment paradigms are discussed. Additionally, those findings that may lead to poor results and conditions that are contraindications to hair restoration surgery are reviewed.

Hair: what is new in diagnosis and management? Female pattern hair loss update: diagnosis and treatment.

Female pattern hair loss (FPHL) is the most common cause of alopecia in women. FPHL is characterized histologically with increased numbers of miniaturized, velluslike hair follicles. The goal of treatment of FPHL is to arrest hair loss progression and stimulate hair regrowth. The treatments for FPHL can be divided into androgen-dependent and androgen-independent. There is an important adjuvant role for nutritional supplements, light therapy, and hair transplants. All treatments work best when initiated early. Combinations of treatments tend to be more efficacious.

Alopecia femenina y sistemas de integración capilar: estudio de la repercusión psicológica / Alopecia female hair integration system: a study of the psychological impact

Fundamento: Es sabido que la alopecia femenina provoca una intensa repercusión en el psiquismo. Sin embargo, no existen estudios que calibren los cambios que puedan producirse en el mismo, cuando el aspecto de la paciente mejora gracias a la implantación de un Sistema de Integración Capilar. Un Sistema de Integración Capilar (SIC) es una prótesis parcial de cabello, de carácter semipermanente, personalizada, hecha a mano con pelos naturales de iguales características de color, grosor y textura al cabello del paciente, que se ajusta a la porción del cuero cabelludo carente de pelo y que se integra, sin intervención quirúrgica, cabello a cabello ocultando las zonas afectadas y creando una apariencia homogénea. El objetivo de este trabajo es conocer en qué medida la implantación del SIC mejora el estado psicológico de las pacientes que sufren alopecia de diferentes tipos. Material y método: Se estudió en 24 mujeres con alopecia moderada-grave de diferentes tipos que acudieron de forma sucesiva al Instituto Médico Dermatológico (IMD) de Madrid (España) entre febrero y julio de 2011 para ser tratadas con SIC. Se completó el cuestionario Hospital Anxiety and Depression Scale (HADS) antes y 3 meses después de la implantación del SIC. Se comparó la evolución en el tiempo de los cuadros de ansiedad y depresión a través del test de McNemar como herramienta estadística. Resultados: Ansiedad: al inicio del estudio el 83,33% de las pacientes mostraban diferentes niveles de ansiedad. A los 3 meses de la (AU)

Rationale: It is well know that female alopecia has a severe psychological impact. However, there are no studies assessing the psychological changes that may occur when the patient’s image improves due to the implementation of a Hair Integration System (HIS). A HIS is a partial, personalized, semipermanent hair prosthesis made of natural hair with the same characteristics of color, thickness, and texture than the patient’s hair and that is adjusted to the portion of the scalp lacking the hair and that is integrated hair by hair without any surgical intervention, covering the areas affected and yielding a homogenous appearance. The aim of this work was to know to what extent the implantation of HIS improves the psychological status of patients suffering from different types of alopecia. Material and methods: We studied 24 women with severe to moderate alopecia of different types consecutively consulting to the Instituto Médico Dermatológico (IMD) of Madrid (Spain) between February and July of 2011 to be treated by HIS. The patients completed the Hospital Anxiety and Depression Scale (HADS) before and 3 months after the implantation of HIS. The time course of anxiety and depression disorders was compared by using the McNemar test. Results: Anxiety: at the study beginning, 83.33% of the patients showed different anxiety levels. Three months after the implantation of HIS, 74.99%of the patients showed a statistically significant improvement (p value < 0.01) in the anxiety status. Depression: at the study beginning, 66.67% of the patients showed depression signs. Three months after, the signs of depression were no longer existent in 100% of the patients. Conclusions: this study confirms that alopecia disorders have a negative psychological impact (anxiety, depression) in women. HIS is an efficacious tool for the cosmetic treatment of alopecia, with almost immediate positive psychological effects (AU)

Alopecia: a review of laser and light therapies.

Since the 1980s, laser technology has become increasingly popular to treat a variety of cutaneous conditions. Its successful use as an epilator comes with the rare but interesting side effect of paradoxical hypertrichosis. In this review, we summarize cases describing hair growth after photoepilation, as well as studies testing laser and light sources as treatment for alopecia, particularly androgenetic alopecia and alopecia areata. We also discuss the possible biologic mechanisms by which phototherapy induces hair regeneration.

The latest innovations in hair transplantation.

Hair restoration began as a result of the fortuitous finding by Dr. Norman Orentreich that hair follicles taken from an area of nonbalding scalp could be implanted into an area of male pattern hair loss and continue to grow terminal hair. Since that time, hair transplants have progressed from the use of large plugs to the use of follicular units (normally occurring clusters of hairs). This has allowed surgeons to create undetectable results in cases of androgenetic alopecia and well as other conditions associated with hair loss. Advances continue in hair restoration technique ranging from surgical approach to instrumentation and ways to enhance growth. In this article, the more recent surgical and medical innovations in hair reconstruction are reviewed.

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.

Contemporary hair transplantation.

BACKGROUND: The field of hair transplantation has evolved considerably over the last quarter century. Performed correctly, the cosmetic results of contemporary hair transplantation are virtually undetectable in women and men. Large, pluggy "punch grafts" have been replaced with natural-appearing follicular unit grafts, which maintain their existing anatomy and with proper technique can match the orientation of surrounding hair follicles. OBJECTIVE: To review all of the steps involved in hair transplantation surgery and to provide an overview of medications used in conjunction with transplantation to help prevent hair loss. MATERIALS, METHODS, AND RESULTS: The authors review key aspects of the consultation, physical examination, selection of appropriate candidates, excision of donor area, hairline design, graft creation and placement, and postoperative instructions. The role of medications such as minoxidil and finasteride in preventing ongoing hair loss is an essential part of the treatment plan. For nonsurgical candidates, other treatments such as wigs, hairpieces, and camouflages are reviewed. Future trends may involve the use of low-level laser light therapy, dutasteride, and cloning of follicles. CONCLUSION: Patients and physicians alike are pleased with the results of contemporary hair transplantation, and physicians can now recommend the procedure without reservation. The authors have indicated no significant interest with commercial supporters.

Medical treatments for male and female pattern hair loss.

UNLABELLED: Male and female pattern hair loss affects a large percentage of the population, and patients frequently present for treatment of this to their dermatologist. Here we review the many treatments available for hair loss. We review the evidence for each, and outline the most effective treatment strategies for both men and women. LEARNING OBJECTIVE: At the conclusion of this article, the reader should be able to describe the most effective treatments for hair loss, understand their mechanism(s) of action, and explain which treatments are the best in different settings.

Hair transplantation for men.

Men throughout history have suffered from various degrees of hair loss. Modern techniques for hair transplantation give rise to natural and long-lasting results. In this paper we provide an overview of the procedure, including the harvesting of donor hair in the occipital scalp, and its redistribution along the frontal- and mid-scalp areas. Special consideration must be made to choosing the candidates carefully and to performing their surgery in a manner that looks appropriate for all ages. We describe the role of medications for male pattern hair loss and with hair transplantation.

Techniques to reduce pain associated with hair transplantation: optimizing anesthesia and analgesia.

The importance of pain control in hair transplantation cannot be overemphasized. Adequate preoperative sedation to reduce anxiety, raise pain threshold, and induce amnesia is fundamental to minimizing operative pain. Most of the pain associated with the procedure results from injection of the local anesthetic. Once initial anesthesia is achieved, proper maintenance of anesthesia is of paramount importance especially with the trend toward larger numbers of grafts being performed in one session with prolonged operative times. The choice of local anesthetic agents, infiltration technique, optimal field blocks and nerve blocks, proper hemostasis, timely repetition of anesthesia, and use of analgesics intraoperatively, with the goal of maintaining the patient pain-free during the procedure, are fundamental. In addition, reduced pain on infiltration can be achieved with buffering and warming of the local anesthetic solution as well as techniques to decrease sensation or partially anesthetize the skin prior to injection. Techniques such as bupivacaine donor area field block in the immediate postoperative period and early administration of analgesics can greatly influence postoperative pain. Along with excellent cosmetic results attainable with modern techniques, improving patients' experiences during the surgical process will enhance the public perception of hair transplantation and will encourage prospective patients to seek this treatment modality.