ADIPOSE TISSUE GRAFTING IN CICATRICIAL ALOPECIA

Received on 19/02/2009.
Approved on 25/02/2009.
We declare no conflict of interest.

Abstract

Hair transplantation is one of the therapeutic options for the treatment of cicatricial alopecia; however, the adherence between the scalp and the periosteum hinders its execution and compromises the final result. The use of adipose tissue grafting, as fat fragments harvested from the infra-gluteal crease, at least 30 days before the transplantation to optimize the results, is proposed.

INTRODUCTION

Cicatricial alopecia can be corrected surgically by hair transplantation or reduction of the scar.¹ Surgical reduction of the scar area can originate new alopecia by excessive tension. Even in smaller lesions, surgical reduction can also fail, originating a new increase in the size of the scar.² Thus, we consider hair transplantation a simple and safe therapeutic option.

Especially in those cases in which alopecia results from cicatrization by second intention; besides atrophy, an intense adherence between the skin and the periosteum can be seen. This hinders insertion of grafts, even when they are inserted at an acute angle. Even in cases of successful transplantations, atrophy and depression in the scalp are unaesthetic and provoke unpleasant reactions to palpation, and can the cause of psychological problems, especially in female patients.³ To correct this problem and facilitate hair transplantation, we propose a session of lipografting in the receptor area before hair transplantation.

METHODS

After local anesthesia, we detached the area of adherence, creating a space between the periosteum and the skin, to be filled with adipose tissue removed from the infra-gluteal crease. The adipose tissue is harvested, through an opened incision, as small fragments with an Addson clamp and a delicate pair of scissors, and then placed in NS to be introduced in the space created later on. After 30 days or more, hair transplantation was performed. Adipose tissue transplantation increases the distance between the skin and the periosteum, facilitating graft placement and improving aesthetic results.

DISCUSSION

The disease or factor that originated the Cicatricial alopecia should be inactive at the time of correction. We chose the infra-gluteal crease as the donor site for two reasons: 1 – the gluteal region covers the incision line, hindering visualization of the scar; and 2 – the adipose tissue from this area is resistant since it is maintained despite being subjected to continuous traumatisms due to its location. The grafts are easier to be placed because the adipose tissue increases the distance between the skin and periosteum, which also decreases the depression in this area.

CONCLUSIONS

Adipose tissue grafting obtained in large lobules decreases its reabsorption and facilitates hair transplantation.

References

1 . Adler SC, Rousso D. Evaluation of past and present hair replacement techniques. Aesthetic improvement, effectiveness, postoperative pain, and complications. Arch Facial Plast Surg. 1999;1(4):266-71.

2 . Epstein JS. Revision surgical hair restoration: repair of undesirable results. Plast Reconstr Surg. 1999;104(1):222-32.

3 . Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol. 1998;139(5):846-50.

4 . Adler SC, Rousso D. Evaluation of past and present hair replacement techniques. Aesthetic improvement, effectiveness, postoperative pain, and complications. Arch Facial Plast Surg. 1999;1(4):266-71.

5 . Epstein JS. Revision surgical hair restoration: repair of undesirable results. Plast Reconstr Surg. 1999;104(1):222-32.

6 . Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol. 1998;139(5):846-50.