Correction of unaesthetic hair transplantation

Received on: 04/05/2011
Approved on: 18/06/2011

This study was carried out at Santa Casa de
Belo Horizonte – Belo Horizonte (MG), Brazil.

Conflicts of interests: none
Financial support: none

Abstract

When outdated techniques and large skin grafts are used in hair transplants, the results are unattractive and disfiguring. More recently, natural looking results have been achieved by transplanting follicular units. The correct shape and implantation level in the hairline contribute to a natural appearance. Correction methods include: camouflage with follicular units, removal of transplanted hairs and suture, reduction of the scalp, correction of scars, and laser therapy. In this article, the combination of different surgical techniques and laser epilation are described with satisfactory results in the correction of hair transplants.

Keywords: HAIR, TRANSPLANTATION, LASERS

INTRODUCTION

Hair transplants attempt to restore the natural look of the hair. An important aspect of hair restoration involves the correc- tion of previous transplants that were carried out using outdat- ed methods, which led to disfiguring results. 1 In the past, trans- plants were carried out using 3-4 mm grafts containing up to 25 hairs, which created an artificial appearance.

In the 1990s, a new method that transplanted follicular units (FU) was developed. 2 Since then, several advances in the technique have contributed to ever more natural results. FUs correspond to the anatomical clustering of hairs and contain from one to four terminal hairs, in addition to vellus hairs, the erector muscle of the hair, and a sebaceous gland.

In addition to the use of FUs, another decisive factor for natural results is the correct demarcation of the transplant''''''''s hair- line which must be compatible with the patient''''''''s gender, eth- nicity and age. Rather than adhering to rigid rules, creating the new hairline requires the surgeon to have an artistic sensibility.

In men, the implantation level of hairs in the hairline varies according to the individual, usually located in the transition of the vertical forehead to the horizontal scalp. The frontotempo- ral recessions must remain positioned in the sagittal line passing through the outer corner of the eyes. The FUs of a thread of hair are positioned more anteriorly with similar angulation, howev- er they are intentionally distributed irregularly in order to recre- ate the natural pattern.

Unfavorable transplant results are classified into three cate- gories: technical mistakes, poor planning and complications.3,4 Correction methods include: 1) anterior camouflage with FUs; 2) removal with or without redistribution of transplanted hairs and suture of the defect; 3) reduction of the scalp; and 4) cor- rection of the scar. In special situations, the removal of hairs can be carried out using laser, which can also improve the scar''''''''s appearance. 1,4,5

CASE REPORT

A 35-year-old male patient had two sessions of hair trans- plant at another medical service in January and July 2005. Grafts of six to 12 threads each had been implanted, in diverse direc- tions (some inverted causing inclusion cysts); and almost all in low hairline. Unsatisfied with the result (Figure 1), the patient sought the medical service where the authors work. He was using 1 mg/day finasteride and 5% minoxidil, denying comor- bidities.

METHODS

The first corrective surgery was conducted in November 2005, when the larger and poorly positioned grafts were removed with punches of 2-3 mm, followed by sutures with mono nylon 6-0 thread. Among the fragments removed with the punches, the FUs were reimplanted in the same surgery more posteriorly in the front region and were separated with the assistance of a stereomicroscope. The inclusion cysts were extirpated.

The epilation was started one month later with 800 nm diode laser in areas that had smaller grafts with varied angula- tion and transfixed follicles. Four sessions at one-month inter- vals were carried out (Figure 2).

In March 2006, a transplant of about 1,450 FUs was car- ried out in the frontal region. The 25 x 1 cm donor area at the back of the head included the old scar (Figure 3). A second transplant was conducted in July 2007, using approximately 1,300 FUs harvested from the back of the head, in the upper parietal region and anterior periphery of the vertex (Figures 4 and 5).

RESULTS

The treatment was concluded with periodic 800 nm diode laser epilation sessions (four sessions with monthly intervals), when a progressive improvement of the dilated pores and scars resulting from the initial corrective surgery were observed (Figure 6).

DISCUSSION / CONCLUSION

Hair transplants with larger grafts frequently result in an artificial appearance, contributing to the stigmatization of both patients and hair transplant surgery. Combined techniques for correcting hair transplants can improve patients'''''''' appearance and quality of life.

References

1 . Bernstein RM, Rassman WR, Rashid N, Shiell RC. The Art of Repair in Surgical Hair Restoration. Part I: Basic Repair Strategies. Dermatol Surg. 2002; 28(9): 783-94.

2 . Unger WP, Unger RH, Unger M. Hair Transplantation and Alopecia Reduction. In:Wolff K, Goldsmith LA, Katz SI et al. Fitzpatrick´s - Dermatology in General Medicine.New York:Mc Graw Hill;2008.p.2394-402.

3 . Bernstein RM, Rassman WR, Rashid N, Shiell RC. The Art of Repair in Surgical Hair Restoration. Part II: The Tatics of Repair. Dermatol Surg. 2003; 29(9): 995.

4 . Epstein JS. Revision Surgical Hair Restoration: Repair of Undesirable Results. Plast Reconstr Surg. 1999; 104(1): 222-32.

5 . Vogel JE. Correcting Problems in Hair Restoration Surgery: an Update. Facial Plast Surg Clin North Am. 2004; 12(2): 263-78.