Ethical Considerations in Follicular Unit Excision Surgical Procedures.

Follicular unit excision (FUE) is an increasingly popular hair restoration technique. In many instances, it surpasses linear strip excision (LSE) surgery in terms of number of procedures and clinics dedicated to performing FUE. The rise in popularity relates primarily to a somewhat misguided perception that FUE produces less evidence of a surgical procedure having been performed. This is based on the fact that a linear scar is avoided. The procedure is easier to learn and "less invasive" as compared to LSE harvesting and requires less staff and capital expense. The FUE procedure is aggressively marketed often as "scarless surgery." This false statement, along with the ease of starting an FUE practice, has resulted in various ethical issues related to evaluation, methodology, and business practices. In this chapter, we discuss the ethical issues surrounding FUE hair restoration surgery and the examination of the mathematics of donor management as it relates to the ethical management of the FUE patient.

Combination Approaches for Combatting Hair Loss.

Significant androgenetic hair loss occurs in men older than 50 years, and in women it occurs in many who are perimenopausal, menopausal, and postmenopausal. By age 60 years, it is estimated that 80% of women experience hair loss. Other nonandrogenetic forms of hair loss occur due to various dermatologic disorders as well as systemic disorders. Children may also experience significant hair loss, often due to genetic abnormalities and incidences of trauma. In this article the author discusses a combination approach to hair loss for men, women, and children.

Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia.

BACKGROUND: Platelet-rich plasma (PRP) treatment may encourage hair growth by promoting cellular maturation, differentiation, and proliferation. OBJECTIVE: The objective of this study was to evaluate the effectiveness of PRP as a treatment for androgenetic alopecia (AGA). MATERIALS AND METHODS: A literature search combined with meta-analysis was used to calculate the overall standardized mean difference (SMD) in hair density in patients treated with PRP injections in comparison with baseline and placebo treatment. Chi squared analysis and Fisher exact test were used to investigate variation in protocols. RESULTS: The overall SMD in hair density was 0.58 (95% confidence interval [CI]: 0.35-0.80) and 0.51 (95% CI: 0.23-0.80, p < .0004) in favor of PRP treatment when compared with baseline and placebo treatment, respectively. CONCLUSION: Platelet-rich plasma is beneficial in the treatment of AGA. It is recommended that 3 monthly sessions of PRP (once monthly ×3 treatments) be used followed by a 3- to 6-month maintenance period.

Advances in Hair Restoration.

Hair loss affects millions of people worldwide and can have devastating effects on an individual's psychological and emotional well-being. Hair restoration technologies have advanced with the use of robotics and manual and motorized follicular unit extraction to provide patients excellent clinical results. Adjuvant modalities such as platelet-rich plasma injections, lasers and stem cells can further enhance the survivability and appearance of hair transplants.

Hair restoration surgery: challenges and solutions.

Hair loss is a common problem affecting both men and women. The most frequent etiology is androgenetic alopecia, but other causes of hair loss such as trauma, various dermatologic diseases, and systemic diseases can cause alopecia. The loss of hair can have profound effects on one's self esteem and emotional well-being, as one's appearance plays a role in the work place and interpersonal relationships. It is therefore not surprising that means to remedy hair loss are widely sought. Hair transplant surgery has become increasingly popular, and the results that we are able to create today are quite remarkable, providing a natural appearance when the procedure is performed well. In spite of this, hair transplant surgery is not perfect. It is not perfect because the hair transplant surgeon is still faced with challenges that prevent the achievement of optimal results. Some of these challenges include a limit to donor hair availability, hair survival, and ways to conceal any evidence of a surgical procedure having taken place. This article examines some of the most important challenges facing hair restoration surgery today and possible solutions to these challenges.

Robotic hair restoration.

The latest innovation to hair restoration surgery has been the introduction of a robotic system for harvesting grafts. This system uses the follicular unit extraction/follicular isolation technique method for harvesting follicular units, which is particularly well suited to the abilities of a robotic technology. The ARTAS system analyzes images of the donor area and then a dual-chamber needle and blunt dissecting punch are used to harvest the follicular units. The robotic technology is now being used in various locations around the world. This article discusses the use of the robotic system, its capabilities, and the advantages and disadvantages of the system.

Nonsurgical therapy for hair loss.

This article is an update of the currently available options for medical therapies to treat androgenetic alopecia in men and women. Emerging novel therapeutic modalities with potential for treating these patients are discussed. Because androgenetic alopecia is progressive in nature, stabilization of the process using medical therapy is an important adjunct to any surgical hair-restoration plan.

Hair restoration surgery: the state of the art.

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 restoration since the original description. Additional elements that contribute to the current state of the art in hair restoration include graft size, site creation, packing density, and medical control of hair loss. The results of hair restoration are natural in appearance and are provided with a very high level of patient satisfaction and safety. This aspect of cosmetic surgery is a very welcome addition to a traditional aesthetic practice and serves as a tremendous source for internal cross-referral. The future of hair restoration surgery is centered on minimal-incision surgery as well as cell-based therapies.

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.

Pigmentary disorders.

A large number of pigmentary disorders exist and although not all dermatologic entities are covered in this article, some of the pigmentary disorders that an internist or general practitioner is likely to encounter are reviewed. The clinician must be able to recognize pigmentary changes that suggest a serious underlying disease. In a situation where a malignancy or other serious illness may exist, an extensive evaluation to detect the disorder is required. This approach can allow for early treatment and referral to an appropriate specialist if necessary. The clinician must also recognize that pigmentary disorders that are essentially cosmetic still cause concern for the patient and can be emotionally distressing. These patients need emotional support and in some cases referral to a mental health specialist.

Histological changes associated with mesotherapy for fat dissolution.

Mesotherapy is a form of medical therapy popular in Europe and South America. It is used for treating a variety of medical conditions, including the treatment of localized fat deposits and cellulite. Phosphatidylcholine/deoxycholate injections are a popular technique to treat localized fat accumulations and have recently become synonymous with mesotherapy, although their history and technique are distinct. To treat localized fat deposits, phosphatidylcholine (PC) and deoxycholate (DC) are utilized. To date, there have been no published histological studies that explain the mechanism of action of PC and DC.Method. In this study the authors have obtained skin biopsies from a patient who had undergone mesotherapy with PC and DC. Punch biopsies were taken at one and two weeks after the procedure.Results. Each of the biopsies taken at one and two weeks after treatment with PC and DC showed a normal epithelium and dermis, with a mixed septal and lobular panniculitis. The fat lobules were infiltrated by increased numbers of lymphocytes and, in particular, macrophages. The macrophages consisted of conventional forms, foam cells, and multinucleated fat-containing giant cells. The inflammation was associated with serous atrophy and microcyst formation.Conclusion. This study demonstrates that mesotherapy with PC and DC affects the subcutaneous fat. We theorize that the reduction of subcutaneous fat likely follows inflammatory-mediated necrosis and resorption.

The potential role of minoxidil in the hair transplantation setting.

BACKGROUND: Over the last decade surgical management of hair loss has become an increasingly popular and satisfying procedure for both men and women, as innovations in donor harvesting, graft size, and hairline design have resulted in consistently natural-appearing hair restoration. OBJECTIVE: In addition, a better understanding of the regulation of the hair-growth cycle has led to advances in the pharmacologic treatment of androgenetic alopecia. METHODS: Currently there are two U.S. Food and Drug Administration (FDA)-approved agents that promote hair regrowth: over-the-counter topical minoxidil solution for men and women and prescription oral finasteride tablets for men. In October 2001, a group of 11 international experts on hair loss and hair transplantation convened to review the physiology and effects of pharmacologic treatments of hair loss and to discuss the value of administering topical minoxidil therapy as an adjunct to hair transplantation. RESULTS: This article presents the key findings and consensus points among the participants, including their current use of pharmacologic treatments, strategies for optimal results both pre- and postsurgery, and the importance of realistic patient expectations and compliance. CONCLUSIONS: Based on the surgeons' clinical experience, the use of approved hair regrowth agents in hair transplant patients with viable but suboptimally functioning follicles in the region to be transplanted can increase hair density, speed regrowth in transplanted follicles, and complement the surgical result by slowing down or stopping further hair loss.