Hair Restoration Surgery in Asians (eBook)

Foreword 5
Preface 8
Acknowledgments 10
Table of Contents 11
Contributors 14
Part I History and the Past 16
Back to the Future: A Brief but Signifi cantHistory of Hair Transplantation in Asians 17
Two Techniques of Hair Transplantation in Asia 20
Other Techniques of Hair Restoration in Asia 20
References 21
Part II Asian Hair: Knowing the Differences 22
The Prevalence of Male Pattern Baldnessin Asian Men 23
References 25
Knowing the Difference in Restoring theAsian Look 26
Skull and Facial Bone 27
Hairline 27
Scalp 28
Facts About Asian Hair in Hair Transplantation 29
Asian Hair: A Korean Study 32
References 33
Part III Consultation, Planning, and Hairline Design 34
The Key to Success in Consultation 35
Hair Restoration Surgery in Poor Candidates 37
Body Dysmorphic and Obsessive-Compulsive Patients 37
Young Patients 37
Candidates with Very Fine Hair, Very Tight Scalp, and VeryLow Donor Density (Fig. 3) 38
Candidates in Norwood Class VI and VII WhoDemand Full Coverage 38
References 41
Preoperative Approach to Preexisting ScalpLesions 42
References 45
Planning for Ultra-Refi ned Follicular UnitTransplantation and the Hairline Design 46
Laser-Assisted Rapid Hairline Placement 49
Use of Landmarks in Hairline Placement [3,4] 49
Laser Devices for Hairline Placement 50
Tripod-Mounted Laser Level 50
2. Handheld Laser Device 50
Laser-Assisted Hairline Placement: Step by Step 50
Placing a Feminine Frontal Hairline 50
Placing a Male Frontal Hairline 51
Placing a Temporal Hairline 52
Placing Eyebrows and Moustache 52
Placing a Symmetrical “Scar” in the Donor Site 52
Advantages of Using a Handheld Laser Device 52
Limitations of the Device 53
Amendment: Safety Precautions in Using a Class 3ALaser Pointer [11] 53
References 53
When to Restore the Temple Area 55
Crown: Area of Concern 57
Should We Use Single or Multiple FU Graftsin Asians? 59
Advantages of Combining FUGs and MUGs 59
Disadvantages of Combining FUGs and MUGs in Asians 59
Conclusions 61
References 61
Advantages of Microvascular Free Scalp FlapTransfer as a Means of Hair Transplantation 62
References 64
Is There a Place for Scalp Flap in ModernHair Restoration Surgery? 66
References 69
Part IV Medical Treatment 70
Medical Treatment of Hair Loss 71
Male Pattern Hair Loss 71
Under Investigation 72
Female Pattern Hair Loss 73
Minoxidil 73
Under Investigation 73
Antiandrogens 73
Medical Treatment and Hair Transplantation 73
Asian Herbal Medications Being Investigated for HairLoss in Men and Women 74
Conclusion 75
The Use of Herbal Medicine 76
References 76
Is There a Place for Oral Minoxidil?An Overview 78
Clinical Pharmacology 78
Side Effects of Oral Minoxidil 78
Salt and Water Retention 78
Cardiovascular Effects 79
Hypertrichosis Without Virilism 79
Other Effects 79
Contraindication 79
Role in Treating Alopecia 79
Topical Minoxidil 79
Oral Minoxidil 80
Case Report 82
Reference 82
Part V Preoperative Care 83
Preoperative Care for Super Mega-Sessions 84
Part VI Local Anesthesia and Tumescence 86
Safe Use of Local Anesthesia andTumescence Fluid in the Donor Siteas an Offi ce-Based Procedure 87
The Safe Use of Drugs 87
Premedication 88
Drugs for Local Anesthesia 88
Monitoring 89
Personal Techniques 89
References 90
Preparing for a Painless Surgery: Medicationor Meditation? 92
Premedication 92
Short- and Long-Acting Local Anesthetic 93
Part VII Donor Harvesting 95
Site Selection in Donor Harvesting: A Longand Winding Road 96
Donor Site Selection 96
Defi ning the Donor Area 97
Mega-Session 98
Small Session 98
Preoperative Scalp Massage 99
Step-by-Step Scalp Massage 99
References 100
The Strip: How Long, How Wide,and Where? 101
Recipient Area and Desired Number of Grafts 101
Hair Count 102
Strip Size and Width 103
Mid-Occipital Area 104
Mastoid 104
Supra-Auricular Area 104
Marking the Strip 104
References 105
A Refined Open Donor Harvesting toMinimize Follicular Transection 106
Instruments 106
Preparation and Technique 106
Dividing the Strip 110
References 112
Other Methods of Donor Harvesting 113
References 115
OmnigraftTM 117
Criticism of Multi-Bladed Knife and Hairtome 117
Criticism of Powered FUE 118
Criticism of Graft Replacement by Implantation Hand Piece 119
References 119
Donor Wound Closure 120
Bleeding from Wound 120
Trichophytic Closure 120
Undermining 121
Suturing Materials 122
Retention Stitches (Figs. 3,4) 122
First Session 123
Subsequent Sessions 124
References 124
Donor Strip Removal and Wound Closure inSuper Mega-Session: My Personal Technique 126
Wound Closure 127
Follicular Unit Extraction in theAsian Population 128
Part I: Personal FUE Technique 128
Instruments 128
Preoperative Preparation 129
Positions 129
Marking the FUE Donor Area 129
Local Anesthesia and Tumescence 130
Graft Selection 130
The Five-Step Approach 130
Postoperative Care of the Donor Site 132
Part II: FUE Mega-Session: Special Considerations inAsian Populations 133
Complications 133
Advantages of FUE 134
Indications for FUE 134
Poor Candidates for FUE 134
References 134
Part VIII Graft Preparation: Personal Techniques 136
Slivering and Graft Cutting 137
Slivering 137
Graft Cutting 138
An Alternative Way of Graft Cutting 140
References 141
Graft Dissection in Super Mega-Session: MyPersonal Technique 142
Part IX Recipient Site Preparation and Insertion 144
Dense Packing 145
Premade Incisions: When and Where to Begin 147
A Debate over Premade Incisions Versus“Stick and Place” 153
Technique of Fast and Effi cientGraft Insertion 155
Implanter 158
Part X Hair Restoration in Women andTranssexual Males 161
Hair Restoration Surgery in Asian Women 162
Initial Consultation 162
Hair Loss Etiologies Not Indicated for Hair Transplantation 163
Hair Loss Etiologies that May Be Indications forHair Transplantation 163
Preoperative Considerations in Asian Women 164
Hair Characteristics of Asian Women and Implications forthe Hair Transplantation Procedure 165
Approach to Hair Transplantation in Asian Women 166
Female Pattern Hair Loss 166
Scarring Alopecia Caused by Burns or Inactive Disease 168
References 169
Hair Restoration Surgery inTranssexual Males 171
Incidence 171
Female to Male Transgender/Transsexual Female 171
Male to Female Transgender/Transsexual Male 171
Designing the Hairline 172
Technique 173
Medical Treatment 173
References 174
Part XI Repairs: Personal Techniques 175
Repair of Iatrogenic Scarring andNon-Scarring Alopecia fromCosmetic Surgery 176
Alopecia from Temporal Lift, Facelift, and Coronal Lift 176
Repair to Scars Resulting from Facelifts and Temporal Lifts 176
Repairing Scars Following the Temporal Lift 177
Post-trichial Scars 177
For Those with Russian Thread Lift 177
Repairing Conventional Forehead Lift 177
A Pretricheal Incision (Figs. 1, 2) 179
Repairing Facelift with Temporal Lift 180
References 180
Cicatricial Alopecia in Hair Transplantation 181
References 183
The Repair of Unwanted Plugs 184
Strategy for the Repair 184
Plugs in the Front 184
Plugs at the Crown 187
References 187
Repair of Scalp Flap 188
Abrupt and Straight Hairline 188
Hair Loss in the Scalp Flap 188
Hair Loss in the Areas from Which the Scalp Flap Was Taken 188
Progressive Hair Loss Behind the Scalp Flap 189
Too-Thick Appearance of the Scalp Flap 190
Poor Hairline Design with Blunt Frontotemporal Angle 190
A Backward Hair Direction 191
References 191
Repair of Artifi cial Fiber Implantation 192
Group 1: Unhappy Patient Who Has Already Discontinued AI 193
Group 2: Patient Who Has Infection from the Fibers 194
Group 3: Patients Who Refuse to Remove theRemaining Fibers 194
References 195
Part XII Special Procedures in HairRestoration Surgery 196
Eyebrow Transplant 197
Indications for Eyebrow Transplantation [3] 197
Anatomy of the Eyebrow 198
Surgical Techniques 199
Keys and Considerations in Transplanting Asian Eyebrows 202
Postoperative Care 202
Complications 203
References 203
Eyelash TransplantK. Imagawa 204
My Method 204
Postoperative Phase 206
Complications 206
References 206
Sideburn Transplant 208
What Is a Sideburn? 208
Indication for Sideburn Transplant 208
The Procedure 209
Postoperative Care 210
References 210
Mustache Transplant 211
Characteristics of the Mustache 211
Design 211
Donor Harvesting 212
Insertion 212
Postoperative Care 213
References 214
Chest Hair Transplant 215
Patient Selection 215
Planning and Procedure 216
Postoperative Care 217
References 218
Pubic Hair Transplant 219
Method 219
Donor Preparation 219
Anesthesia on the Recipient Site 219
Transplant to the Recipient Site 220
Postimplantation Management 220
Long-Term Follow-Up 222
Reference 222
Postoperative Care 225
Postoperative Instruction Sheet Usedin Our Clinic 227
REMEMBER: 227
WARNING: 227
POSTURE: 227
DIET: 227
SLEEPING: 227
POSTOPERATIVE MEDICATIONS: 228
SHAMPOO AND CLEANING: 228
NAUSEA/VOMITING: 228
HICCUPS: 229
BLEEDING: 229
HEAD BAND: 229
SWELLING: 229
STITCHES: 229
EXERCISE AND ACTIVITY: 229
SWIMMING AND SUN: 229
FOLLICULITIS AT THE GRAFT SITE: 230
CUT & DYE:
SAUNA: 230
GROOMING: 230
GETTING INTO CARS: 230
Part XIII Postoperative Care 224
Part XIV Complications 231
Complications and the Solutions 232
Medical Complications 232
Necrosis and Wound Dehiscence 233
Pain, Numbness, Hypoesthesia, Hyperesthesia, and Neuralgia 233
Folliculitis 234
Infection 234
Bleeding 235
Hiccups 236
Syncope 236
Aesthetic Complications 236
Unnatural Appearance: Unnatural Hairline, Bad Hair Direction 236
Poor Growth and Ongoing Hair Loss 237
Temporary Hair Loss After Surgery 238
Facial Edema 238
Pitting 239
Prevention of Pitting 240
Repair of Pitting 240
Tenting (Goosebump Appearance) 240
Prevention of Tenting 240
Correction of Tenting 241
References 241
Part XV The Business Side 242
Marketing and Management 243
Staff Training 243
Marketing 244
References 245
Part XVI Hair Transplants in the Future 246
Hair Cloning and Follicular Cell Implantation 247
Follicular Cell Implantation 249
New Tools for Hair Transplants 250
Application of Stem Cells in Hair Restoration Surgery 252
Adipose-Derived Stem Cells: The Stromal VascularFraction (SVF) 252
Product Supplied: Kits 252
Adipose-Derived Stem Cells and Hair Restoration 253
Preoperative Preparation 253
Lipo-Aspiration 254
Stem Cell Extraction: Isolation of the Stromal Vascular Fraction 255
Conclusion 257
References 257
Subject Index 258