Year : 2011 | Volume
: 3 | Issue : 3 | Page : 14--15
Session F: Hair Restoration
|How to cite this article:|
. Session F: Hair Restoration.Int J Trichol 2011;3:14-15
|How to cite this URL:|
. Session F: Hair Restoration. Int J Trichol [serial online] 2011 [cited 2019 Nov 21 ];3:14-15
Available from: http://www.ijtrichology.com/text.asp?2011/3/3/14/82155
Hair transplantation- indications and current techniques
Andreas M. Finner
Trichomed Hair Clinic, Berlin, Germany.
Hair transplantation is a surgical treatment option in androgenetic alopecia (AGA) and scarring alopecia. It has evolved into a microsurgical procedure. In AGA, the coverage effect is permanent for bald areas. However, the density improvement in thinned areas is only permanent in spontaneously or medically stabilized alopecia. If hair transplantation is performed in early stages of AGA, donor hair should be reserved for future surgery if progression occurs. Follicular unit transplantation (FUT) has become the standard. These natural groups of 1-4 hairs are small and can be placed denser with less interfollicular tissue. They cannot be distinguished from original hair. An extensive consultation, appropriate patient selection and establishment of an exact individual surgical plan taking into account possible progression are crucial. The donor and recipient area situation can be analyzed pre-operatively using digital imaging. The surgery is done with local anesthesia. The follicular units can be harvested in a narrow strip with trichophytic closure and microscopic dissection (FUT) or by follicular unit extraction (FUE). Both methods have their special indications and can be combined. The FU are then placed into small into small recipient sites in an authentic density, direction and distribution. Certain rules and techniques apply for male and female AGA. The aesthetic result greatly depends on proper graft handling and the skills of the surgeon and the team. Possible future trends are automation and tissue engineering to increase donor hair supply. In combination with medical options, modern hair transplantation is an important tool for the management of alopecia.
Surgical management of scars and cicatricial alopecias
Nina Otberg*, Ken Washenik 1
Hair Transplant Center Berlin Potsdam, Hair Clinic - Skin and Laser Center Potsdam, Germany, 1 Bosley, USA.
Scars due to trauma and inflammatory cicatricial alopecias lead to an ultimate destruction of the pilosebaceous unit and therefore hair regrowth cannot be achieved with medical treatment. Cicatricial alopecias can lead to disfiguring hair loss and to psychosocial embarrassment and a lack of self-esteem. In theory, hair restoration surgery seems to be a great option to treat the disfiguring scars. Not only could it give the patient cosmetically satisfying results, but by adding new hair follicles, blood flow, atrophy and wound healing properties will also improve. However, in primary cicatricial alopecias, the hair follicle is the main target of the inflammatory process. Therefore, new implanted hair grafts would be destroyed, when introduced to areas of active disease. Hair transplantation can be an option for burnt-out stages, especially for lymphocytic primary cicatricial alopecias that tend to lead to more atrophic scars. In burnt-out primary cicatricial alopecias, a small test area with a limited number of grafts (20 - 30 grafts per cm 2 with a maximum total of 100 grafts) 6 month - 1 year before a larger session is mandatory to minimize the risk of disease progression and assure the success of a hair transplant procedure.
The role of platelet rich plasma to control anagen phase: Evaluation in vitro and in vivo in hair transplant and hair treatment
Fabio Rinaldi*, Elisabetta Sorbellini, Tommaso Coscera
International Hair Research Foundation (IHRF), Milan, Italy.
The hair follicle has a very complex biologic structure, regulated by specific growth cycles. The mature follicle undergoes successive transformation from anagen (active hair shaft production) to catagen (apoptosis-driven regression) to telogen (resting phase with the involution of hair follicle) and it is well known the role of apoptosis (by the pathway of caspasis cascade) in determining the passage from anagen to catagen. Many growth factors play a fundamental role in life-long cyclic transformation of the hair follicle, functioning as a biologic switch that are turned on and off in the different phases, controlling the active phase and promoting apoptosis to induce catagen and telogen. The main Growth Factors involved in the establishment of hair follicle are Vascular Endothelial GF (VEGF), Epidermal GF (EGF), Insulin 1-like GF (IGF 1), Fibroblast Growth Factor (FGF). We studied the effect of PRGP (Plasma Rich Growth Factors) on hair bulb to store hair grafts during hair transplant, comparing mictotic activity and apoptotic fragments of transplanted grafts stored in platelet rich plasma (PRP) and in Ringer's solution. We made an evaluation in vivo treating 100 subjects (50 men, 50 women) suffering from AGA in a double blind randomized clinical trial to evaluate the clinical effect of growth factors from PRP during 18 months. Our goal was to show if Growth Factors from PRP could prevent dermal papilla apoptosis, prolong anagen phase delaying catagen and telogen, and to evaluate if this effects in vivo could reduce diffuse hair loss and stimulate hair re-growth in Androgenic Alopecia. Our data confirm this hypothesis, and show that growth factors have a significant effect on hair bulb in vitro and in vivo, without side effects during the treatment period and after 12 months from the end of treatment.
Cellular hair restoration
Aderans Research Institute, New York University School of Medicine, USA.
With male and female pattern alopecia affecting millions of men and women worldwide, the drive to find ways to combat hair loss has preoccupied man for centuries. However, despite great advances, clinicians are still unable to meet the needs of many patients with hair loss. In order to address the unmet clinical need of an increased amount of donor hair available to restore the miniaturized follicles in balding areas, scientists have begun to apply the principles of organ regeneration to the hair follicle; bio-engineering follicular progenitors to induce follicle growth. The technology of autologous cell-based hair follicle restoration is based on the potent regenerative capability of the cellular constituents of the hair follicle and involves isolating trichogenic cells from a patient's scalp, expanding them in vitro and then injecting these autologous, multiplied cells back into the patient's scalp. There, they should be able to induce hair growth by one of two possible mechanisms; creation of new follicles formed from these dermal and epidermal follicular cells or by reprogramming existing miniaturized follicles toward growth. This technology has progressed to the clinical study stage. The design and interim data from the Phase II clinical trial currently underway in the United States will be reviewed.