Frontal-Temporal Triangle Area Hair for Eyebrow Restoration in Asians: A Comparative Study With Periauricular and Occipital Hair.

BACKGROUND: The frontal-temporal triangle area (FTTA) hair has a slow growth rate and thin caliber, which are similar to those of eyebrow hair. However, a comparison of cosmetic outcomes between FTTA and other scalp hair grafts in eyebrow transplantation has not been performed. OBJECTIVE: To compare the cosmetic outcomes of FTTA hair and periauricular and occipital area (POA) hair in eyebrow restoration. METHODS: A retrospective analysis of 155 patients with FTTA or POA hair transplants was performed. Comparative variables included patient characteristics, hair density, diameter, percentage of one-hair follicular units (FUs), number of transplanted FUs, harvesting time, transection rate, hair survival rate, frequency of eyebrow trimming, and patient satisfaction. RESULTS: There was a significant difference in hair density, diameter, percentage of one-hair FUs, and harvesting time between the FTTA and POA hair transplants. The FTTA hair grew significantly slower than the POA hair did. The patients in the FTTA group trimmed their postoperative eyebrows at a significantly longer interval than those in the POA group. The percentage of patients who were very satisfied with the surgery results was higher in the FTTA group. CONCLUSION: The FTTA hair grafts can provide aesthetically pleasing cosmetic results in eyebrow restoration.

Hair Loss and Hair Restoration in Women.

Hair restoration in women involves mastering both the medical and the surgical treatment. Preoperatively, women should be thoroughly evaluated for biochemical causes of hair loss along with a complete history and physical examination taken. The physician must recognize the clinical presentation of scarring alopecias and maintain a low threshold for biopsy to rule out this condition. Postoperative hair shock loss is a common feature following hair transplant in women, and the surgeon should understand the preoperative counseling and preventative measures needed, the intraoperative methods to reduce the incidence, and the postoperative strategies to handle the situation.

Eyebrow Hair Transplantation in Frontal Fibrosing Alopecia: Pitfalls of Short- and Long-Term Results.

BACKGROUND: Eyebrow hair loss is usually a primary feature of frontal fibrosing alopecia (FFA), which causes significant distress to patients and consequently seek medical help. Eyebrow hair transplantation is a well-accepted and aesthetically successful treatment, but there is a lack of information about the short- and long-term results in this subset of patients. OBJECTIVE: To report the short- and long-term eyebrow hair transplantation results in patients with FFA. PATIENTS AND METHODS: Ten patients diagnosed with FFA underwent eyebrow hair transplantation. The transplanted hairs were harvested from nonaffected follicles of the occipital scalp skin. On average, 120 to 270 single-hair follicles were implanted per eyebrow. RESULTS: Eighty percent of patients achieved excellent hair growth at 6- to 12-month follow-up and satisfactory short-term results (<2 years). However, majority started losing the transplanted hairs after 3 to 4 years. Only 1 patient did not lose transplanted hair in the long-term follow-up (>4 years). CONCLUSION: The results of eyebrow hair transplantation in FFA patients are variable and contentious. The short-term outcome is satisfactory, but in most patients, a progressive loss of transplanted hairs can be expected. Therefore, FFA patients inquiring about eyebrow transplantation should be advised about the high possibility of hair graft loss over time.

Eyelash hair transplantation with strip composite eyebrow graft: an enhancing technique in tarsoconjunctival flap eyelid reconstruction procedure.

Purpose: To describe and evaluate the eyelash transplantation with strip composite eyebrow graft to improve eyelid anatomy in tarsoconjunctival flap eyelid reconstruction procedure. Methods: Twenty two patients with eyelid tumors managed by local excision and reconstruction using tarsoconjunctival flap reconstruction procedure were included. Eyelash graft was performed during flap division by harvesting a graft from the eyebrow and creating a recipient pocket in the receptor eyelid. Patients had a 1-year follow up. Eyelash orientation and follicle survival rate were recorded. Demographic variables were analyzed with descriptive statistics. For eyelash follicles survival rate assessment, we evaluated the number of follicles found in the first postoperative day with the follicles found at the end of the study using the Wilcoxon signed rank test. P < 0.05 was considered statistically significant. Results: All eyelash grafts showed a good follicle orientation and no cases of eyelashes misdirection toward the eyeball were reported. No statistical differences (p > 0.05) were found in Wilcoxon signed rank test when comparing the number of follicles present at the first postoperative day and the number of follicles present at the 12th postoperative month, meaning that the vast majority of follicles survived at the end of the study. Graft ischemia, necrosis or infection were not observed. Conclusions: Tarsoconjunctival flap is an outstanding option for eyelid reconstruction and eyelash transplantation with an eyebrow composite graft is an excellent procedure to enhance and recreate a normal eyelid.

Fabrication of an Orbital Prosthesis Combined With Eyebrow Transplantation.

Fabrication of an orbital prosthesis is considered as a challenging procedure as compared to the other facial prosthesis due to the presence of inactive eye movements and the need of artificial hair in order to mimic eyelashes and eyebrows. Generally these structures are sewed or bonded in the silicone. However, deformation or hair loss is observed within time. This deformation is visible especially in the eyebrow. This clinical report represents a patient with an implant supported orbital prosthesis. Patient was not satisfied with the nature of her eyebrow that was sewed in the silicone. Therefore, an alternative approach of eyebrow transplantation was used for the patient. The patient expressed her better satisfaction of this definitive prosthesis supported with eyebrow transplantation.

Guidelines on Hair Restoration for East Asian Patients.

BACKGROUND: In East Asian countries, hair transplantation is a quite common procedure for treating pattern hair loss, cosmetically correcting the hairline, and correcting eyebrow and pubic hair defects. Although there are general guidelines concerning hair transplantation, certain factors need to be addressed to make the guidelines more specific and suitable to East Asian requirements. OBJECTIVE: To provide guidelines for hairline design, donor harvesting, graft preparation and placement, and medical treatment that are appropriate for hair transplantation in East Asian patients. METHODS: Recommendations are based on the experience of the authors, surgeons who perform hair transplantation, and a comprehensive review of the available literature on hair transplantation in East Asians. RESULTS: Data on hair thickness and graft density, hairline design, and graft creation and placement techniques have been collaboratively evaluated and used to establish overall guidelines. CONCLUSION: The use of the proposed guidelines by surgeons will hopefully enhance outcomes and bring greater consistency to hair transplantation procedures for East Asian patients.

Classificação clínica de ptose da cauda do supercílio / Clinical classification of brow ptosis

INTRODUÇÃO: O estudo do supercílio se emoldura como um grande desafio para a cirurgia plástica por sua complexa relação com as estruturas faciais. O objetivo é descrever uma classificação clínica de ptose da cauda do supercílio. MÉTODOS: Estudo transversal, com pacientes de ambos os sexos, com idade de 18 a 100 anos, subdivididos em três grupos segundo a faixa etária. Grupo 1: 18 a 30 anos, Grupo 2: 31 a 60 anos e Grupo 3: 61 a 100 anos. Realizaram-se três medidas de cada lado por examinadores distintos, sem que cada um soubesse o valor da aferição dos demais. RESULTADOS: Total de 90 pacientes, com idades variando entre 18 e 94 anos, sendo 39 (43,3%) do sexo masculino e 51 (56,7%)do sexo feminino. As medidas do Grupo 1, considerado como normal, com média de idade de 26,7 anos, e com média de 2,14 cm em relação a medidas da ptose da cauda do supercílio. Já no Grupo 2, média da faixa etária foi de 44,2 anos e a média foi de 1,9 cm. No Grupo 3, média de idade de 72,6 anos com média de 1,27 cm. A tabela com a Classificação da Ptose da Cauda do Supercílio, em que se atribuiu a cada intervalo um grau de ptose, variando de grau I ao grau IV. Cada grau foi correlacionado com um intervalo numérico em que: > 1,8 cm representa a normalidade; 1,7-1,5 cm o grau I de ptose; 1,4-1,2 cm o grau II de ptose;1,1-0,9 cm o grau III de ptose e < 0,8 cm o grau IV de ptose. Em referência à indicação cirúrgica, essa teve sua indicação nos graus II, III e IV. CONCLUSÃO: A medida objetiva da posição da cauda do supercílio possibilitou classificação do grau de ptose e orientação quanto à necessidade de intervenção cirúrgica.

INTRODUCTION: The study of the eyebrow is a great challenge for plastic surgery because of its complex relationship with facial structures. The present study aims to describe a clinical classification of brow ptosis. METHODS: A cross-sectional study with patients of both sexes and ages ranging from 18 to 100 years, subdivided into 3 groups according to age. Group 1: 18 to 30 years of age, Group 2: 31 to 60 years of age, and Group 3: 61 to 100 years of age. Three measurements were taken on each side by different examiners blinded to each other's results. RESULTS: A total of 90 patients, with ages ranging from 18 to 94, including 39 (43.3%) men and 51 (56.7%) women, were studied. Group 1, with a mean age of 26.7 years was considered normal, with mean brow ptosis of 2.14 cm. In Group 2, with a mean age of 44.2 years, the mean brow measurement was 1.9 cm. In Group 3, the mean age was 72.6 years and the mean brow measurement was 1.27 cm. The table outlining the brow ptosis classification assigns a degree of ptosis to each interval, ranging from I to IV. Each degree was correlated with a numerical range in which > 1.8 cm is normal, 1.7-1.5 cm corresponds to degree I ptosis, 1.4-1.2 cm to degree II ptosis, 1.1-0.9 cm to degree III ptosis, and < 0.8 cm to degree IV ptosis. Surgery was indicated for degrees II, III, and IV. CONCLUSION: The objective measurement of brow tail position enabled classification of the degree of ptosis and guides surgical decision-making.

Recovery of Transplanted Eyebrow From Radiation-Induced Anagen Effluvium.

Ablative surgery for skin cancer of the face can often leave patients with significant deformities. These disfigurements can include loss of hair in conspicuous areas such as the eyebrows, leaving the patients with unsightly facial asymmetry. Eyebrow transplantation serves to address this issue; however, it has often been discouraged in patients who are destined to receive radiotherapy to the cutaneous area in question. This is due to the anagen effluvium effect of radiation therapy on hair follicles. We present a case in which the transplanted eyebrow hair follicles survived the deleterious effects of radiotherapy, leaving the patient with a symmetrical and aesthetically satisfactory eyebrow appearance.

Ethnic considerations in hair restoration surgery.

Patients of different ethnicities have specific characteristics that are essential for hair transplant surgeons to understand so that aesthetic results can be achieved. In this article, the approaches of follicular unit extraction and follicular unit grafting or strip hair transplants for pattern hair loss are reviewed, along with the procedures of eyebrow and beard transplants and surgical hairline advancement/forehead reduction surgeries, within various ethnic groups.

Reconstrucción total y parcial de cejas con trasplante de unidades foliculares: 10 años de experiencia / Total and partial eyebrows reconstruction with folicular unit transplat: 10 years of experience

Las cejas son elementos integrales en el carácter de lacara y en la expresión del espectro de emociones. Su patrón de cabello es complejo: toma varias direcciones y está colocado en diferente posición y con forma distinta en hombres y mujeres. Esta complejidad de características hace de su reconstrucción un reto. Se han establecido tres líneas básicas para conseguir dicho fin: injertos compuestos, colgajos y trasplante de unidades foliculares. Exponemos la experiencia de 10 años en la reconstrucción de cejas a través del trasplante de unidades foliculares en la Clínica Planas de Barcelona (España)con 58 pacientes consecutivos tratados en ese lapso y94 cejas reconstruidas. Planteamos un estudio retrospectivo, observacional, transverso y descriptivo. Se analizaron la distribución de frecuencias y medidas de tendencia central de las variables. Los resultados obtenidos nos han permitido concluir que la técnica de trasplante de unidades foliculares es la mejor alternativa para la reconstrucción total y parcial de las cejas en casos seleccionados, con minúscula morbilidad, resultados netamente superiores y con una mínima interferencia en la vida del paciente (AU)

Eyebrows are integral elements in the character of the face and the expression of the spectrum of emotions. Its hair pattern is complex: it takes several directions and is placed in a different position and differently in men and women. This complexity of features makes reconstruction a challenge. In this way, we have established three basic areas to achieve this end: composite grafts, flaps and follicular units transplant. We report the experience of 10 years in the reconstruction of eyebrows throughout the follicular units transplantation technique at Clínica Planas in Barcelona (Spain) with 58 consecutive patients treated in this period and 94 eyebrows. A retrospective, observational, transverse and descriptive study was raised. We analyzed the frequency distribution and measures of central tendency of the variables. The results obtained have allowed us to conclude that the technique of follicular unit transplantations the best alternative for total and partial eyebrows reconstruction in selected cases, with a small morbidity. Results were clearly higher, with minimal interference in the patient's life (AU)

Hair transplantation update: procedural techniques, innovations, and applications.

The advances in hair transplantation, particularly the advent of follicular unit transplantation, have greatly elevated the outcome of this procedure. Various modifications to the basic technique as well as innovations focused on the different aspects of the hair transplantation procedure have further enhanced this type of hair restoration surgery. In addition, there is ongoing expansion of the indications and applications of this procedure beyond the usual male pattern hair loss.

Follicular isolation technique with de-epithelialization for eyebrow and eyelash reconstruction.

BACKGROUND: The eyebrow and eyelash are two major sites in facial hair transplantation. Different methods have been experienced for better results. Surgeons tend to use smaller grafts. The authors modified the follicular isolation technique and added de-epithelialization to reduce complications and improve outcomes. METHODS: Sixty patients were allocated to either the isolation group or the isolation plus de-epithelialization group. Some patients underwent both eyebrow and eyelash transplantation; therefore, 79 procedures were performed on 60 patients. Scar formation, number and percentage of surviving transplanted hairs, hair growth orientation, and satisfaction with outcome were reviewed at 6 months. RESULTS: The mean number of preserved transplanted hairs in eyebrow transplantation at follow-up was not significantly different between the two groups, but the mean percentage of preserved transplanted hairs was significantly higher in the isolation plus de-epithelialization group. In eyelash reconstruction, the mean number and percentage of surviving hairs were significantly higher in the isolation + de-epithelialization group than in the isolation-only group. The isolation + de-epithelialization group had more cases of normal hair growth direction in both eyebrow and eyelash transplantation cases, although the difference was statistically significant only in eyebrow reconstruction. CONCLUSIONS: This study showed that follicular isolation plus de-epithelialization had better outcomes and fewer complications than did follicular isolation alone. This could be due to less need for suture in recipient sites, less risk for burying of epithelium of graft in the recipient site, less need for manipulation, lower graft volume, and less need for blood for survival and for removal of sweat glands. CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, II.

[Management of eyelid burns]. / Particularités de la prise en charge des paupières brûlées.

Burns are devastating injuries scarring patients, both physically and psychologically, for life. This remains particularly true for facial burns. Eyelid burns occur in about 10% of thermal injuries and is a considerable challenge for the reconstructive surgeon given the particular anatomy of the eyelids. Reconstruction of the eyelids following burn injuries has been performed by plastic surgeons since the earliest days of reconstructive surgery, yet a consensus on a treatment regime has not been reached and plastic surgeons are divided on the subject. Controversies exist regarding the excision and debridement of eschar, temporary suture and surgical tarsorrhaphy, timing of surgery for eyelid contraction, and the role of full and split-thickness skin grafts in eyelid reconstruction. This paper describes the particularities of the treatment of burned eyelids in our Burn Center.

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.

Eyebrow composite graft for eyelash reconstruction: a case report and review of the literature.

Reconstructing the eyelash margin is a challenge for plastic surgeons because eyelashes have specific characteristics. There is still no gold standard procedure for this type of reconstruction, which seeks to protect the eyeball and make the eyelid appear natural. The eyebrow composite graft can be a good option for reconstructing the eyelash margin because it is technically simple and safe, and takes advantage of the structural similarity between the eyelashes and eyebrow. The results presented showed the effectiveness of the technique by providing improved occlusion and a good aesthetic result.