Dr Robin Unger Assistant Professor Mt Sinai, NY
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
*
Dr Robin Unger
Assistant Professor Mt Sinai, NY
* Hair transplant surgery is unique in the field of
cosmetic medicine. Although some technical
errors and problems are visible immediately,
many of the most significant consequences are
not evident until 10,20,30,40 years later.
* This presentation will illustrate some of the
most significant problems encountered in hair
transplant surgery, describe how to avoid them
– and how to correct them if possible.
*
* Poor growth of transplanted grafts
* Lack of artistry in hairline design and execution
* Overharvesting of grafts and scars
* Poor placement of grafts
* Density of grafts too high or low
*
* Limited coverage of a large recipient area,
unnatural distribution of hair
* Transplanted area not connected to the fringe
hair
* More evident scars from harvesting
* Hairline incorrectly designed for final Norwood
Pattern
*
*
*
*
*
*
*
*
*
After two unified excisions Hair worn normally and shaved
*
Robotic FUE - photos from promotional materials
*
* Current FUE leaves 3000-5000 extraction sites to heal
by secondary intention after two surgeries. If a 0.8mm
punch is used (0.8xpi) this translates to 75.36-125.6cm
of scar OR if a 1.0mm punch is used 94.20-157.0cm of
scar tissue in the “minimally invasive surgery
* The unified elliptical harvest is 1-1.5cm in width and
approximately 20cm in length. When closed properly it
leaves a 1-2mm scar that runs its length, between 20-
40cm of scar. A second procedure is usually done to get
3000-5000 grafts, but the first scar is removed in that
procedure. So still 20-40cm of scar.
**
Thus far options are limited: tattoos
(micropigmentation) can improve
appearance* Extended time out of body * Limit time out of body and * Overly dense sites use special storage solutions * Patient factors * Respect vascular supply (smoking,scars,?) * Use smoking cessation aids, * Dessication of grafts post-operative ATP solution * Grafts with insufficient * Train and supervise staff surrounding tissue
* Time out of the body has become a significant factor affecting hair transplant surgery. Some surgeries last over 12 hours. Ideally these longer surgeries should have alternating harvest/implantation cycles. * Special holding solutions for the grafts have been developed. We use HypoThermosol FRS and liposomal ATP maintained at a low temperature to reduce cell damage while grafts are outside the body. Although the studies are limited, in one study this solution showed a 72% survival after 5 days storage at 4 celcius, while the grafts stored in saline showed 0% survival.
* A good surgeon should have multiple tools in
their toolbox, FUE is one such tool.
* FUE can be a reasonable choice for those who
will retain a wide dense rim and want the
option to “buzz” their hair short or as a final
surgery in a patient who already had UTE.
* For many patients, overharvesting via FUE at a
young age will predictably leave a patient with
limited coverage, visible punctuate scars in the
future and a moth eaten donor area.
**
*
* It is very rare, however there are some patients who have reduced yield of grafts even if everything is done correctly. One study by Dr. Jerry Cooley measured oxygen readings of the scalp using visible light spectroscopy. Readings from fingertips and ankles were uniform between patients, while those of the scalp were highly variable. Even after the application of a vasodilator the improvement in scalp readings was highly variable
*
*Platelet
Rich
Plasma
PRP is being used more extensively as part of hair transplant surgery. In my
practice we always combine it with a product called ACell to optimize its
possible effectiveness
There are NO good randomized controlled studies to confirm its
effectiveness. Unfortunately, as most of us at the conference are aware,
such studies are exceptionally difficult to do with regard to hair. It has
been years of anecdotal clinical observation that has to suffice as “study”
I started using it about 3 years ago in some surgeries and it was clear that
patients very frequently had earlier hair growth, and sometimes denser
hair growth, than expected. It is used in every HT I perform now.*Method
of use
In hair transplant surgery, the PRP is mixed with ACell matristem powder.
Some of this mixture is used to bathe the cells prior to insertion. A
portion of it is injected into the recipient area.
The PRP mix can also be injected into areas not being transplanted in order
to evaluate whether it will be effective in reversing miniaturization in
that region.
The FUE donor area is injected with the mixture and some is massaged into
the donor sites to potentially improve healing and regrowth of hair in
sites where transected follicles have remained .*ACell
ACell is a commercially available extracellular matrix. It has been shown to aid in
chronic wound healing, muscle regeneration, and healing of wound in poorly
perfused areas such as the tip of the nose. It is known to activate local stem
cells.
It can be used in hair transplant surgery to improve wound healing in the donor area
and to improve the texture of the scalp in areas where previous transplant
surgery has been performed. The ACell wound sheets are used prior to elliptical
donor closure to improve healing in patients for whom it is indicated
It can also be used for the grafts prior to insertion to promote angiogenesis and
reduce fibrosis in the base of the site.*
*
*Good
candidate for
individual
follicular unit
trimming FUE
*Over age 45
*large dense permanent hair
bearing rim
*fear of the “scalpel”
*unable to shave for procedure for
social reasons*
*
*
Before and after one surgery – age 40 with limited financial resources
You can also read
