ARTICLE | hair research | a strip with long hair is harvested (10–30 cm long
and 1–1.5 cm wide) and the donor area is closed with running suture or staples. The scar will be very fine, linear, horizontal and almost undectectable. sometimes a trichophytic closure is used, which will require the surgeon to carry out a desepidermisation of the inferior border of the excision. The strip with long hair is then segmented under stereomicroscope into follicular units (1–4 hairs). The newest implantation techniques allow for a
Figure. 9 (a) Frontal androgenetic alopecia (21 years). Before treatment median sagittal=37 cm, and parasagittal=31 cm (Hamilton IV). (b) After combined treatment: FUL, finasteride and 5% minoxidil: gain of 4 cm on MS=41 cm and 1.5 cm on SPM=32.5 cm (Hamilton III)
Implantation
Figure 10 Transplanted hair distribution for male androgenetic alopecia according to simplified classification
natural and aesthetic appearance with a fine implantation using microsurgical needles, blades and forceps, and a good choice of orientations and obliquities, an irregular and fine frontal hairline with hair done ‘one-by-one’ with 1000–4000 hairs per session. These refinements can be carried out using a final ‘stick and place’ technique.
The follicular unit extraction in the follicular unit extraction (FUe) technique (21) (Figure 8), the patient’s hairs are shaved throughout the donor area. The aim of FUe is to harvest intact follicular units from the donor area by hand or using power micropunches (0.7–1.25 mms), introduced at a depth of 2–5 mms. Follicular units are then gently extracted from the surrounding tissue with the help of microsurgical forceps; 500–1000 hairs can be transplanted in one session. The indications of the FUe techniques are for
Type Ia
Frontal recession 1000 hairs
in one or two sessions Type Ib
Frontal recession and crown alopecia
2000–3000 hairs in one or two sessions
patients who: ■ routinely shave their scalp ■ have no laxity of the scalp ■ are afraid of getting a fine linear scar (which can be eventually corrected with FUe a second time) ■ Want a short treatment session ■ have no sign of wide baldness evolution. The contraindications of this technique are for patients
who have a very low hair density in the donor area, or those who want a great amount of transplanted hair.
Type IIa
Frontal recession 2000–3000 hairs in one or two sessions
Type IIb
Frontal recession and crown alopecia
4000–5000 hairs in two sessions
The conventional follicular unit technique The conventional follicular unit technique (FUs–FUT) is a procedure similar to that of the FUL technique. The only difference is that the hairs are previously shaved.
Type III
Complete baldness 6000 hairs
in two or three sessions 52 ❚ Figure 11 Frontal androgenetic alopecia, before (a) and after (b) one session follicular unit long hair (FUL) May 2011 |
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Aspect after correction
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