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Qian H, Ye Z, Hu Y, Chen L, Li L, Qin K, Ye Q, Zuo X. Dahuang-Gancao decoction ameliorates testosterone-induced androgenetic alopecia in mice. JOURNAL OF ETHNOPHARMACOLOGY 2025; 341:119347. [PMID: 39800247 DOI: 10.1016/j.jep.2025.119347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 12/22/2024] [Accepted: 01/08/2025] [Indexed: 01/15/2025]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Dahuang-Gancao decoction (DGD) is a traditional Chinese medicinal formula that is recorded in the Synopsis of the Golden Chamber, and is widely used to treat damp-heat in the body. Since the pathological factors of androgenetic alopecia (AGA) also reflect damp-heat blockage, DGD has great potential for the treatment of AGA and has been used effectively in clinical practice. AIM OF THE STUDY The aim of the study was to investigate whether external application of DGD could promote the activation and proliferation of hair follicle stem cells (HFSCs) and improve AGA through the Wnt/β-catenin pathway. MATERIALS AND METHODS The main chemical components of DGD-contained serum were identified by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and database search. Cell Counting Kit-8 (CCK8) was used to investigate the appropriate concentration. Hair regeneration was assessed by hair growth score and histopathological staining. The proliferation of HFSCs and the activation of Wnt/β-catenin pathway were detected by Western blot, immunofluorescence staining, real-time reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA). The AGA mouse model was induced by external application of testosterone (T). Immunofluorescence staining was performed to localize HFSCs by CK15, followed by staining with Ki67, β-catenin, and Cyclin D1, respectively. RESULTS The results illustrated that the 10% DGD group and the 10% DGD + HLY78 group could significantly promote the expression of Wnt10b and β-catenin and the proliferation of HFSCs in vitro, while the 10% DGD + IWR-1 group could reverse the promotion effect of DGD. Animal experiments showed that compared with the model group (T group), DGD promoted hair follicles to enter the anagen phase, as evidenced by an increase in hair growth score, an increase in the number of hair follicles in hematoxylin and eosin (HE) staining, and a significant increase in the ratio of the number of anagen follicles to the total number of hair follicles (AF/AF + TF). In addition, DGD upregulated the expression of Wnt/β-catenin signaling pathway proteins in the skin tissues of AGA mice. It also promoted the proliferation of HFSCs and the expression of β-catenin and Cyclin D1 cytokines in the region of HFSCs. CONCLUSION Both oral and external application of DGD can promote the proliferation of HFSCs by activating the Wnt/β-catenin signalling pathway. External application of DGD can promote the hair follicles to enter the anagen phase, which can ameliorate the symptoms of alopecia in AGA mice. Therefore, compared to oral DGD, external application of DGD is an effective and safer way of administration for the treatment of AGA.
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Affiliation(s)
- Huanzhu Qian
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhen Ye
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Hu
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Liulin Chen
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linzhen Li
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Kaihua Qin
- Health Preservation and Rehabilitation College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiaobo Ye
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Xiaohong Zuo
- Eye School of Chengdu University of Traditional Chinese Medicine, Ineye Hospital of Chengdu University of Traditional Chinese Medicine, KeyLaboratory of Sichuan Province Ophthalmopathy Prevention & Cureand Visual Function Protection with Traditional Chinese Medicine Laboratory, China.
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Shichang L, Jufang Z, Xiangying Y, Yali W, Li N. Self-management in the post-hair transplantation recovery period among patients with androgenetic alopecia: A qualitative study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100234. [PMID: 39282021 PMCID: PMC11401157 DOI: 10.1016/j.ijnsa.2024.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/11/2024] [Accepted: 08/13/2024] [Indexed: 09/18/2024] Open
Abstract
Background The success of hair transplantation surgeries for androgenetic alopecia is evaluated by postoperative long-term outcomes. Patients' self-management during the long recovery period affects this outcome. Objective This study aimed to explore patients' self-management status, facilitators, and impediments in the postoperative period and to provide a reference for developing a postoperative self-management intervention program. Methods Patients who underwent hair transplantation for androgenetic alopecia were selected using purposive sampling. They were interviewed using one-to-one semi-structured interviews at a general tertiary hospital in Hangzhou from March to April 2022. Qualitative research analysis software Nvivo 12.0 was used to analyze the collected data. Results The self-management of postoperative patients with androgenetic alopecia during the recovery period encompasses six areas: more problems with postoperative medication (e.g., not being able to take medication on time) and wound care (e.g., not daring to shampoo, etc.), not being able to review their postoperative condition on time (due to busy schedules at work and at home), more hindrances to the establishment of good living habits (affected by overtime work, socialising, and bad habits of the people around them), and seeking positive ways of relieving bad emotions (stress, anxiety, depression, etc.), worrying about one's image during recovery and taking the initiative to obtain and use resources to promote recovery (through the Internet, books, etc.). Conclusions Various factors impact the postoperative self-management abilities of patients, including medication, shampooing, and emotions. It is essential to design support programs to enhance these abilities and improve long-term hair transplantation outcomes.
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Affiliation(s)
- Liu Shichang
- Department of Plastic Surgery, The First People's Hospital, 310000, Address :No.261, Huansha Road, Hangzhou, Zhejiang, China
| | - Zhang Jufang
- Department of Plastic Surgery, The First People's Hospital, 310000, Address :No.261, Huansha Road, Hangzhou, Zhejiang, China
| | - Yang Xiangying
- Department of Plastic Surgery, The First People's Hospital, 310000, Address :No.261, Huansha Road, Hangzhou, Zhejiang, China
| | - Wu Yali
- Department of Plastic Surgery, The First People's Hospital, 310000, Address :No.261, Huansha Road, Hangzhou, Zhejiang, China
| | - Ning Li
- Department of Plastic Surgery, The First People's Hospital, 310000, Address :No.261, Huansha Road, Hangzhou, Zhejiang, China
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Zhou Y, Zhang J, Yi Y, Xie X, Lei R, Fan Z, Sun P, Hu Z, Qu Q, Miao Y. Characterization and Risk Factors of Folliculitis after Hair Transplantation: A Multicenter Retrospective Study. Plast Reconstr Surg 2024; 154:1115e-1122e. [PMID: 37904273 DOI: 10.1097/prs.0000000000011175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
BACKGROUND Postoperative folliculitis is a common complication of hair transplantation (HT) requiring effective preventive interventions. This study characterized postoperative folliculitis and determined risk factors in patients undergoing HT. METHODS The authors retrospectively reviewed 1317 patients who underwent HT and completed 9-month follow-up between January of 2018 and June of 2021 at 4 medical centers. The incidence of postoperative folliculitis and demographic characteristics were assessed. Logistic regression analysis was used to identify risk factors, and the characteristics of different types of folliculitis were compared. RESULTS The overall incidence of postoperative folliculitis was 12.11%, and clinical characteristics varied among the different types of folliculitis. Surgery in summer (OR, 1.772 [95% CI, 1.05 to 2.992]), number of transplant grafts 4000 or greater (OR, 4.818 [95% CI, 1.45 to 16.014]), transplant density greater than 45 grafts/cm 2 (OR, 2.152 [95% CI, 1.376 to 3.367]), and first nursing time greater than 3 days (OR, 1.555 [95% CI, 1.088 to 2.223]) were the main risk factors for postoperative folliculitis. CONCLUSIONS Postoperative folliculitis after HT presents different characteristics. Surgical factors and postoperative nursing care were demonstrated to be related to folliculitis. The authors propose a preventive folliculitis model based on preoperative, intraoperative, and postoperative factors. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Yi Zhou
- From the Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University
- Center for Plastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)
| | - Jiaxian Zhang
- From the Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University
| | - Yanhua Yi
- Department of Burn, Would Repair Surgery, and Plastic Surgery, Department of Aesthetic Surgery, Affiliated Hospital of Guilin Medical University
| | - Xiang Xie
- Department of Plastic Surgery, Peking University Third Hospital
| | - Rui Lei
- Department of Plastic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine
| | - Zhexiang Fan
- From the Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University
| | - Pingping Sun
- From the Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University
| | - Zhiqi Hu
- From the Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University
| | - Qian Qu
- From the Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University
| | - Yong Miao
- From the Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University
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Abraham JR, Singh RP, Srivastava SK, Mammo DA. HAIR TRANSPLANTATION COMPLICATED BY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS SEPSIS AND ENDOGENOUS ENDOPHTHALMITIS. Retin Cases Brief Rep 2024; 18:301-304. [PMID: 36730419 DOI: 10.1097/icb.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/01/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe a case of endogenous endophthalmitis as a complication from hair transplantation. METHODS Case report of a 53-year-old man with a history of recent hair transplantation. RESULTS The patient presented with a febrile illness and blurry vision 1 week after hair transplantation. Infectious workup included blood cultures positive for methicillin-resistant Staphylococcus aureus, and he was treated with IV antibiotics. Initial ocular examination demonstrated 20/30 and hand motions in the right and left eyes, respectively, with significant vitritis. He underwent vitreous tap and injections of vancomycin and dexamethasone in both eyes and removal of purulent staple from the site of recently transplanted hair. His ocular and systemic symptoms improved. Approximately 3 months after initial clearing of the initial infection he had recurrence of bacteremia that prompted repeat intravitreal and systemic antibiotics. His vision returned to baseline with mild residual optic nerve pallor and atrophic retinal changes in the left eye. CONCLUSION Hair transplantation is associated with minimal systemic complications, but in rare cases, sepsis is possible and can result in intraocular seeding causing endophthalmitis. MRSA endogenous endophthalmitis frequently results in negative vitreous taps and treatment outcomes in the literature have been shown to vary widely including a return to baseline vision as in the described case.
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Affiliation(s)
- Joseph R Abraham
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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Williams KL, El-Maghraby S. Complications with Follicular Unit Excision. Facial Plast Surg 2024; 40:234-244. [PMID: 37907286 DOI: 10.1055/a-2201-8302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Hair restoration surgery (HRS) is typically a safe outpatient or office-based procedure when physicians follow high ethical standards and uphold community practice standards. Patients' clinical outcomes are mostly operator dependent, and temporary and permanent complications rarely occur. Follicular unit excision (FUE) donor harvesting, in particular, is a challenging harvesting technique requiring a long learning curve, physical stamina, higher than average hand-eye coordination and manual dexterity. The types of complications associated with FUE are comparable to linear strip excision (LSE). Similar to LSE donor harvesting, FUE complications may occur irrespective if standard precautions are followed by the physician. As in any skin and scalp procedure, injuries and poor cosmetic outcomes occur despite appropriate preoperative precautions and intraoperative technique. In increasing and greater instances, however, FUE complications are observed when the physician fails to follow hair restoration practice standards and routine surgical precautions. Physician induced, or iatrogenic complications occur more often when untrained licensed surgeons perform HRS, and who fail to meet practice standards and best practices. In the last decade, physician-influenced FUE complications, or iatrogenic cause of FUE injuries are increasingly observed which results in poor aesthetic outcomes. Higher than average FUE complication rates occur in cases involving inadequately trained physicians, as well as in cases where improper delegation of the FUE hair transplant procedure is performed by unlicensed and untrained individuals. In this chapter, we described commonly encountered HRS complications, as well as physician influenced, or iatrogenic causes of FUE complications.
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Okochi H, Onda M, Momosawa A, Okochi M. An Analysis of Risk Factors of Recipient Site Temporary Effluvium After Follicular Unit Excision: A Single-Center Retrospective Study. Aesthetic Plast Surg 2024; 48:1258-1263. [PMID: 37816944 DOI: 10.1007/s00266-023-03699-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Temporary hair loss at the recipient site after hair restoration surgery is called shock loss (SL). This study analyzed the risk factors for SL among patients who received follicular unit excision. MATERIALS AND METHODS This study included 621 patients (554 males and 67 females). Twenty-three patients had SL (9 males and 14 females with a mean age of 40.8 years). The prevalence of SL was analyzed in relation to sex, age, graft follicular units, cause of alopecia, diabetes mellitus, smoking, drinking alcohol, and local anesthesia agent. RESULTS Sex was identified as a risk factor for SL (odds ratio [OR]: 30.18; 95% confidence interval [CI] 9.43-96.55; p<0.001). Among female patients, age was identified as a risk factor for SL (OR:1.07; 95% CI 1.00-1.15; p=0.039). Over 40 years, the female pattern hair loss group had a significantly higher risk for SL than a female cosmetic group younger than 39 years. CONCLUSION Sex was the only risk factor found for SL in this study. In addition, age was identified as a risk factor for SL among female patients. We believe our results provide information and risk factors for SL, not only for hair transplant surgeons, but also patients who will receive follicular unit excision. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Hiromi Okochi
- Department of Plastic and Reconstructive Surgery, Yamanashi University, 1110 Shimokato, Chuo City, Yamanashi, Japan
| | | | - Akira Momosawa
- Department of Plastic and Reconstructive Surgery, Yamanashi University, 1110 Shimokato, Chuo City, Yamanashi, Japan
| | - Masayuki Okochi
- Department of Plastic and Reconstructive Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan.
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Keene SA, Susacasa A, Miranda P, Radwanski H. Follicular Unit Excision-Linear Ellipse Donor Harvesting Technique: Combining Standard Follicular Unit Excision with Follicular Unit Excision inside a Linear Strip (Modified Linear Strip Excision) to Optimize Graft Yield. Facial Plast Surg 2024; 40:205-213. [PMID: 37879352 DOI: 10.1055/a-2198-2703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Follicular unit excision (FUE) graft dissection has become the dominant method of donor harvesting globally, however, only a percentage of donor hair can be excised inside the safe donor area before visible donor thinning occurs. Compared to linear strip excision (LSE) where all follicular units inside the harvested ellipse of hair are used, FUE poses substantial limitations for lifetime graft yield and, therefore, cosmetic coverage in patients with advanced pattern hair loss. This paper reviews how combining the donor harvesting methods of FUE and LSE has been shown to optimize graft yield while minimizing the risk of donor depletion from overharvesting. It then describes a surgical technique called FUE-Linear Ellipse (FUE-LE) where FUE dissection of grafts inside a demarcated linear ellipse eliminates the need for a large dissection team which has posed a barrier for many new practices that offer both the donor harvesting methods. For practices that currently offer only FUE, the addition of the LSE method by the modified FUE-LE technique is possible without specialized staff training or associated equipment costs. In this paper, surgery practices that have adopted this technique will report on their experiences. Hair restoration surgeons are encouraged to provide both methods of donor harvesting (FUE and LSE using FUE-LE) in order to optimize graft yield for patients and avoid long-term donor depletion. Based on limited experience, it appears the technique of FUE-LE will help achieve this goal.
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Affiliation(s)
| | | | - Paulo Miranda
- Clinica Pelle, Nova Redentora, Sao Jose do Rio Preto, Brazil
| | - Henrique Radwanski
- International Society of Hair Restoration Surgeons (ISHRS), Rio de Janeiro, Brazil
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Chen J, Qu Q, Guo Y, Hu Z, Li X, Fan Z, Yang J, Tang Q, Miao Y. Recipient site scalp necrosis: A rare postoperative complication of hair transplantation. J Cosmet Dermatol 2024; 23:622-629. [PMID: 37814471 DOI: 10.1111/jocd.16017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Recipient area scalp necrosis is considered a potential complication of hair transplantation, but has rarely been reported. A small number of patients have developed scalp necrosis after hair transplantation with the widely used Follicular unit excision (FUE) technique. There are no guidelines to prevent and manage this complication. The aim of this study was to provide an insight into the pathogenesis, prevention, and management of scalp necrosis following hair transplantation. METHODS From 2012 to 2021, among more than 10 000 patients who underwent hair transplantation, only three developed scalp necrosis in our clinical experience, besides, one patient transferred to our hospital because of scalp necrosis after undergoing hair transplantation. According to the disease etiology and patients' symptom, a combination of wound management and antimicrobial therapy was employed. This study was approved by the institutional ethics committee of Nanfang Hospital. RESULTS Of the four patients, three received timely treatment and had a good prognosis. Necrosis became confined and healed within 2-3 weeks. Grafts in the lesion area partially survived. In case 4, due to improper treatment at the early stage, the lesion developed extensively and deeply, which not only delayed wound healing, but also resulted in complete loss of grafts. CONCLUSION Preoperative prophylaxis, timely diagnosis, and immediate treatment of scalp necrosis can prevent serious complications and reduce morbidity after hair transplantation.
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Affiliation(s)
- Jian Chen
- Guangzhou, Guangdong, People's Republic of China From the Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Qu
- Guangzhou, Guangdong, People's Republic of China From the Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yilong Guo
- Guangzhou, Guangdong, People's Republic of China From the Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiqi Hu
- Guangzhou, Guangdong, People's Republic of China From the Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xingdong Li
- Barley Microneedle Hair Transplant Hospital, Beijing, China
| | - Zhexiang Fan
- Guangzhou, Guangdong, People's Republic of China From the Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Juanmin Yang
- Department of Plastic Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiang Tang
- Surgery Department of Burn Plastics and Wound Repair, Affliated Hospital of Youjang Medical University for Nationalities, Baise City, China
| | - Yong Miao
- Guangzhou, Guangdong, People's Republic of China From the Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Krishnamurthy R, Jaganathan BK, Rangaswamy R, Jeganathan C. A Novel Method of Intraoperative Calculation in Follicular Unit Transplantation: 'The Sequential Strip and FUE Method'. Aesthetic Plast Surg 2024; 48:297-303. [PMID: 36928376 DOI: 10.1007/s00266-023-03300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/11/2023] [Indexed: 03/18/2023]
Abstract
Hair loss, in particular androgenetic alopecia, has troubled humans since the dawn of history. Treatment options for hair restoration have undergone massive transformation from punch grafting to follicular unit transplantation. Current surgical treatment options in hair restoration fall broadly under two categories, follicular unit transplantation most commonly known as strip method and follicular unit extraction (FUE). The strip method though widely used initially is not so common now due to its fair share of disadvantages ranging from linear donor scar, scar widening to strip overharvesting and wastage of grafts. Follicular unit excision (FUE) was introduced as an alternative method for extraction of grafts to combat the donor linear scar produced by strip method but the disadvantages of FUE include the number of grafts harvested in a single session, moth eaten appearance of donor area caused by over extraction of grafts and harvesting from outside the safe zone. Newer developments like extraction of axillary hair, body hair and pubic hair have been sought to overcome the limitations of number of grafts harvested in a single session of FUE. With more patients now affected by alopecia in their early 20s, there is an ever-increasing demand from the patients for the youthful hairline and hence the focus has shifted towards mega and giga sessions of hair transplantation which pose danger of over extraction of grafts leading to depletion of available donor sites. This article elaborates the combined sequential strip and FUE method along with an intraoperative calculation model to overcome the limitations of over extraction and wastage of grafts. (1) Combination of techniques Strip method with FUE. (2) An intraoperative calculation model that aids in limiting over extraction and wastage of grafts. (3) It is a real time model which can be applied in practice with ease.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ramachandran Krishnamurthy
- Apollo Cosmetic Clinic, Apollo Spectra Hospitals, Sathya Dev Avenue, MRC Nagar, Chennai, Tamil Nadu, 600028, India
| | | | - Ravi Rangaswamy
- Apollo Cosmetic Clinic, Apollo Spectra Hospitals, Sathya Dev Avenue, MRC Nagar, Chennai, Tamil Nadu, 600028, India
| | - Charan Jeganathan
- Apollo Cosmetic Clinic, Apollo Spectra Hospitals, Sathya Dev Avenue, MRC Nagar, Chennai, Tamil Nadu, 600028, India
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Othman S, Glat P. Surgical Management for Hair Restoration: A Review of Contemporary Techniques. Aesthetic Plast Surg 2023; 47:2415-2424. [PMID: 37193885 DOI: 10.1007/s00266-023-03391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Hair loss can cause psychological distress for patients, regardless of the etiology or extent of the defect. Many conservative and pharmacological approaches are successful in management, but refractory or severe cases often mandate surgical treatment. Surgical techniques have been refined over the course of a century, and we aim to review the most contemporary strategies. METHODS A review of the literature was performed using the databases PubMed, Web of Science, and Embase, in May 2020. Articles were included if they discussed techniques used within the past 10 years, in search of more contemporary strategies and the most widely used approaches. RESULTS The use of local flaps, scalp reduction surgery, and hair transplantation techniques are all used for various indications. Modern hair transplantation can be further divided into follicular unit excision and follicular unit transplantation, each with its own advantages. Local flaps are most often used for post-traumatic and reconstructive indication, while hair transplantation can be used for smaller cosmetic lesions or in combination with a variety of other reconstructive techniques. CONCLUSION Hair loss continues to be a challenging pathology for both patients and physicians, regardless of etiology. When conservative treatment is inadequate, there exist multiple surgical techniques that can feasibly restore hair, though the exact degree of success may vary between patients. The proper technique is dependent upon etiology, patient specific factors, as well as surgeon experience and comfort. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sammy Othman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New York, NY, USA
| | - Paul Glat
- Section of Plastic Surgery, Department of Surgery, St. Christopher's Hospital for Children, Philadelphia, PA, 19134, USA.
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Barrera-Ochoa CA, Alonso-León MT, Arenas R, Vega-Memjie ME, Asz-Sigall D. Secondary alopecia induced by aesthetic procedures: An unrecognized potential complication. Australas J Dermatol 2023; 64:322-329. [PMID: 37265044 DOI: 10.1111/ajd.14090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/02/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023]
Abstract
Surgical facelifts and noninvasive techniques such as mesotherapy, hyaluronic fillers and botulinum toxin, among other procedures are widely used nowadays to reverse skin ageing and achieve rejuvenation effects. Secondary alopecia due to cosmetic procedures is a rare side effect and is poorly described in the literature. The mechanisms in which hair loss develops after an aesthetical procedure or surgical technique are not well known. The development of secondary scarring alopecia or non-scarring alopecia depends upon the interaction between different external factors, the individual host response and the extent of damage to the hair follicle anatomy. Current knowledge hints at the type of substance used, pressure to hair structures and vasculature due to the materials used, previously unknown or unaware hair disorder, and poor surgical techniques to be the main factors contributing to the development of secondary alopecia. Physicians and patients must be aware of all the substances used for the procedures and be attentive to any change in hair density or hair loss. Clinicians must have a low threshold to take biopsies if the risk of scarring alopecia may occur. Herein, we review the clinical, trichoscopic, histopathological findings and potential pathophysiological mechanisms of hair loss due to different aesthetic procedures.
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Affiliation(s)
| | | | - Roberto Arenas
- Micology Section, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | | | - Daniel Asz-Sigall
- Dermatology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
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Devjani S, Ezemma O, Kelley KJ, Stratton E, Senna M. Androgenetic Alopecia: Therapy Update. Drugs 2023; 83:701-715. [PMID: 37166619 PMCID: PMC10173235 DOI: 10.1007/s40265-023-01880-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
Androgenetic alopecia (AGA), also known as male pattern hair loss (MPHL) or female pattern hair loss (FPHL), is the most common form of alopecia worldwide, and arises from an excessive response to androgens. AGA presents itself in a characteristic distribution unique to both sexes. Despite its prevalence, AGA can be quite challenging to treat. The condition is chronic in nature and stems from an interplay of genetic and environmental factors. There are only two US Food and Drug Administration (FDA)-approved drugs for the condition: topical minoxidil and oral finasteride. However, numerous non-FDA-approved treatments have been shown to be effective in treating AGA in various studies. Some of these treatments are relatively new and still to be explored, thus emphasizing the need for an updated review of the literature. In this comprehensive review, we discuss the evaluation of AGA and the mechanisms of action, costs, efficacies, and safety profiles of existing, alternative, and upcoming therapeutics for this widespread condition.
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Affiliation(s)
- Shivali Devjani
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Ogechi Ezemma
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Kristen J Kelley
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Emma Stratton
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Maryanne Senna
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA.
- Harvard Medical School, Boston, MA, USA.
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Topical Delivery of Atraric Acid Derived from Stereocaulon japonicum with Enhanced Skin Permeation and Hair Regrowth Activity for Androgenic Alopecia. Pharmaceutics 2023; 15:pharmaceutics15020340. [PMID: 36839662 PMCID: PMC9960134 DOI: 10.3390/pharmaceutics15020340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Atraric acid (AA) is a phenolic compound isolated from Stereocaulon japonicum that has demonstrated anti-androgen properties and was used to design an alternative formulation for the treatment of alopecia. This new topical formulation was designed using a solvent mixture system composed of ethanol as a volatile vehicle, oleic acid as a permeation enhancer, and water for skin hydration. The ideal topical AA formulation (AA-TF#15) exhibited an 8.77-fold higher human skin flux and a 570% increase in dermal drug deposition, compared to 1% (w/w) AA in ethanol. In addition, compared to other formulations, AA-TF#15 (1% [w/w] AA) activated keratinocytes and human dermal papilla cell proliferation at a concentration of 50 µM AA, which is equivalent to 50 µM minoxidil. Moreover, AA-TF#15 treatment produced a significant increase in hair regrowth by 58.0% and 41.9% compared to the 1% (w/w) minoxidil and oral finasteride (1 mg/kg)-treated mice. In addition, AA-TF#15 showed a higher expression level of aldehyde dehydrogenase 1, β-catenin, cyclin D1, and pyruvate kinase M2 proteins in the skin of AA-TF#15-treated mice compared to that of those treated with minoxidil and oral finasteride. These findings suggest AA-TF#15 is an effective formulation for the treatment of scalp androgenic alopecia.
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Rajendran RL, Gangadaran P, Kwack MH, Oh JM, Hong CM, Sung YK, Lee J, Ahn BC. Application of extracellular vesicles from mesenchymal stem cells promotes hair growth by regulating human dermal cells and follicles. World J Stem Cells 2022; 14:527-538. [PMID: 36157528 PMCID: PMC9350621 DOI: 10.4252/wjsc.v14.i7.527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/19/2022] [Accepted: 06/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dermal papillae (DP) and outer root sheath (ORS) cells play important roles in hair growth and regeneration by regulating the activity of hair follicle (HF) cells. AIM To investigate the effects of human mesenchymal stem cell-derived extracellular vesicles (hMSC-EVs) on DP and ORS cells as well as HFs. EVs are known to regulate various cellular functions. However, the effects of hMSC-EVs on hair growth, particularly on human-derived HF cells (DP and ORS cells), and the possible mechanisms underlying these effects are unknown. METHODS hMSC-EVs were isolated and characterized using transmission electron micro scopy, nanoparticle tracking analysis, western blotting, and flow cytometry. The activation of DP and ORS cells was analyzed using cellular proliferation, migration, western blotting, and real-time polymerase chain reaction. HF growth was evaluated ex vivo using human HFs. RESULTS Wnt3a is present in a class of hMSC-EVs and associated with the EV membrane. hMSC-EVs promote the proliferation of DP and ORS cells. Moreover, they translocate β-catenin into the nucleus of DP cells by increasing the expression of β-catenin target transcription factors (Axin2, EP2 and LEF1) in DP cells. Treatment with hMSC-EVs also promoted the migration of ORS cells and enhanced the expression of keratin (K) differentiation markers (K6, K16, K17, and K75) in ORS cells. Furthermore, treatment with hMSC-EVs increases hair shaft elongation in cultured human HFs. CONCLUSION These findings suggest that hMSC-EVs are potential candidates for further preclinical and clinical studies on hair loss treatment.
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Affiliation(s)
- Ramya Lakshmi Rajendran
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Prakash Gangadaran
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Mi Hee Kwack
- Department of Immunology, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Ji Min Oh
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Young Kwan Sung
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- Department of Immunology, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Jaetae Lee
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu 41944, South Korea.
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15
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Gong JH, Kim DD, Mehrzad R. Medical Malpractice Litigations after Hair Restoration Surgery in the United States. J Plast Reconstr Aesthet Surg 2022; 75:2831-2870. [DOI: 10.1016/j.bjps.2022.06.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
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Pitak-Arnnop P. An evidence-based approach to antibiotic prophylaxis for oral, craniomaxillofacial plastic/head and neck surgical procedures. J Clin Pharm Ther 2022; 47:844-850. [PMID: 35132644 DOI: 10.1111/jcpt.13618] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Subedi L, Pandey P, Shim JH, Kim KT, Cho SS, Koo KT, Kim BJ, Park JW. Preparation of topical bimatoprost with enhanced skin infiltration and in vivo hair regrowth efficacy in androgenic alopecia. Drug Deliv 2022; 29:328-341. [PMID: 35040730 PMCID: PMC8774136 DOI: 10.1080/10717544.2022.2027046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To prepare a topical formulation of bimatoprost (BIM) with high skin permeability, we designed a solvent mixture system composed of ethanol, diethylene glycol monoethyl ether, cyclomethicone, and butylated hydroxyanisole, serving as a volatile solvent, nonvolatile co-solvent, spreading agent, and antioxidant, respectively. The ideal topical BIM formulation (BIM–TF#5) exhibited 4.60-fold higher human skin flux and a 529% increase in dermal drug deposition compared to BIM in ethanol. In addition, compared to the other formulations, BIM–TF#5 maximally activated human dermal papilla cell proliferation at a concentration of 5 μM BIM, equivalent to 10 μM minoxidil. Moreover, BIM–TF#5 (0.3% [w/w] BIM) significantly promoted hair regrowth in the androgenic alopecia mouse model and increased the area covered by hair at 10 days by 585% compared to the vehicle-treated mice, indicating that entire telogen area transitioned into the anagen phase. Furthermore, at day 14, the hair weight of mice treated with BIM–TF#5 (5% [w/w] BIM) was 8.45- and 1.30-fold greater than in the 5% (w/w) BIM in ethanol and 5% (w/v) minoxidil treated groups, respectively. In the histological examination, the number and diameter of hair follicles in the deep subcutis were significantly increased in the BIM–TF#5 (0.3 or 5% [w/w] BIM)-treated mice compared to the mice treated with vehicle or 5% (w/w) BIM in ethanol. Thus, our findings suggest that BIM–TF#5 is an effective formulation to treat scalp alopecia, as part of a novel therapeutic approach involving direct prostamide F2α receptor-mediated stimulation of dermal papilla cells within hair follicles.
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Affiliation(s)
- Laxman Subedi
- Department of Biomedicine, Health & Life Convergence Sciences, BK21 Four, Biomedical and Healthcare Research Institute, Mokpo National University, Jeonnam, Republic of Korea
| | - Prashant Pandey
- Department of Biomedicine, Health & Life Convergence Sciences, BK21 Four, Biomedical and Healthcare Research Institute, Mokpo National University, Jeonnam, Republic of Korea
| | - Jung-Hyun Shim
- Department of Biomedicine, Health & Life Convergence Sciences, BK21 Four, Biomedical and Healthcare Research Institute, Mokpo National University, Jeonnam, Republic of Korea.,College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Jeonnam, Republic of Korea
| | - Ki-Taek Kim
- Department of Biomedicine, Health & Life Convergence Sciences, BK21 Four, Biomedical and Healthcare Research Institute, Mokpo National University, Jeonnam, Republic of Korea.,College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Jeonnam, Republic of Korea
| | - Seung-Sik Cho
- Department of Biomedicine, Health & Life Convergence Sciences, BK21 Four, Biomedical and Healthcare Research Institute, Mokpo National University, Jeonnam, Republic of Korea.,College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Jeonnam, Republic of Korea
| | - Kyo-Tan Koo
- BioBelief Co., Ltd., Seoul, Republic of Korea
| | - Beum Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Park
- Department of Biomedicine, Health & Life Convergence Sciences, BK21 Four, Biomedical and Healthcare Research Institute, Mokpo National University, Jeonnam, Republic of Korea.,College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Jeonnam, Republic of Korea
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Mysore V, Muniswamy S, Chathra N, Venkataram J. Oral clonidine as a pre-anesthetic medication in hair transplantation surgery-A pilot study. J Cosmet Dermatol 2022; 21:4554-4558. [PMID: 35037380 DOI: 10.1111/jocd.14758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hair transplantation (HT) is a safe and rewarding procedure for a patient as well as the surgeon. Clonidine may be a good adjuvant in HT because of its analgesic, anxiolytic, and sedative effects. OBJECTIVE To study efficacy of Clonidine as a preoperative medication in HT. METHODS & MATERIALS The study was a prospective trial of 46 consecutive patients who underwent HT between January and May 2017. Patients with normal vital parameters on arrival were given Tab clonidine (0.1 mg) 30 min before starting of the procedure [Clonidine group (n = 30)]; rest were included in the control group (n = 16). Vitals were monitored every 30 min during surgery until the end. Patients were assessed for pain, level of sedation during surgery and for postoperative analgesia. RESULT All patients who received clonidine, except one, were comfortable and experienced no pain throughout the duration of surgery; nine went into deep sleep. Of the 16 patients in the control group, no patients reported deep sleep, 3 felt restless, and 4 had mild pain. There were no untoward effects in both groups. CONCLUSION Our study suggests that clonidine is useful as a pre-anesthetic medication in HT. However, this is a pilot study and further larger studies are needed.
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Abstract
Hair transplant surgery per se has low risk, is relatively safe, and has minimum incidence of complications. However, it is a well-accepted fact that no medical science procedure exists without any potential risk of complications. The complication may be a single complaint in the form of pain, itching, dissatisfaction related to the procedure's outcome, or surgical complication in the form of infection, wound dehiscence or skin necrosis. Inadequate counselling increases unsatisfaction. Improper examination increases the complications, and incomplete medical history and history of allergy increases the risk during surgery. The author collected data of his 2896 patients, operated over a period of 10 years, and recorded the complains and complications. The most common complications were sterile folliculitis, noted in 203 patients, vasovagal shock in seven patients of, hypertensive crisis in one patient, hiccups in six patients, facial edema after hair transplant in 18 patients, graft dislodgement in 8 patients, infection in two diabetic patients, minor necrotic patches in recipient area in three patients, keloid development in one patient, numbness in 18 cases, and hypersensitivity in recipient and/or donor area. Donor area effluvium was seen in one case and three patients showed recipient area effluvium. Twenty-six patients were not happy with the results, and five cases showed partial loss of implanted hair. The overall significant life-threatening or major complications were zero, but the total minor complications' percentage was 0.10%. The key to minimize complaints and complications are detailed counselling, taking careful medical history and history of allergy, and proper examination of patients.
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Affiliation(s)
- Anil Kumar Garg
- Rejuvenate Plastic Cosmetic & Hair Transplant Centre, Indore, Madhya Pradesh, India
| | - Seema Garg
- Rejuvenate Plastic Cosmetic & Hair Transplant Centre, Indore, Madhya Pradesh, India
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20
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Contin LA, Santos LDN, Pereira IJN, Rocha VB. Anagen Effluvium after Therapeutic Scalp Surgery: Unreported Phenomenon. Skin Appendage Disord 2021; 7:311-314. [PMID: 34307480 DOI: 10.1159/000513087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Many procedures are performed on the scalp, such as excision of pilar and sebaceous cysts, melanocytic nevi, and reduction surgery for scarring alopecia, among others. In hair transplants, telogen effluvium is often reported 3 months after surgery; however, hair loss usually happens much earlier, around second week after the procedure, not compatible with the time required for hair to enter telogen and exogenous phases in normal conditions. Case Reports We report 3 cases of anagen hair loss 4 weeks after surgeries, with perilesional trichoscopy suggesting anagen effluvium, with typical signs such as black dots and exclamation hairs. Discussion There are only a few reports about hair loss around operated areas. The cause of this postoperative anagen effluvium is probably a transient ischemia. Conclusion The practical importance of this phenomenon is to properly orient patients because most of the hair will be lost, since 85% of them are anagens, and also will have spontaneous recovery in the next 3 months.
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Affiliation(s)
- Leticia Arsie Contin
- Department of Dermatology, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | | - Ivan José Netto Pereira
- Department of Dermatology, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Vanessa Barreto Rocha
- Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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21
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Exploring the Potential of Mesenchymal Stem Cell–Derived Exosomes for the Treatment of Alopecia. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2021. [DOI: 10.1007/s40883-021-00204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Patel V, Nolan IT, Card E, Morrison SD, Bared A. Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice. Aesthet Surg J 2021; 41:NP42-NP51. [PMID: 33565575 DOI: 10.1093/asj/sjaa430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients. OBJECTIVES This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients. METHODS A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction. RESULTS We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations. CONCLUSIONS Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Viren Patel
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Elizabeth Card
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
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Piccolo D, Crisman G, Conforti C, Buzzi M, Genovesi C, Marchi D, Mazzaracchio D, Goldust M. Trichobiolight: A new, effective protocol in the treatment of androgenetic alopecia and telogen effluvium. Dermatol Ther 2021; 34:e14799. [PMID: 33486860 DOI: 10.1111/dth.14799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
Androgenetic alopecia (AGA) with its precursor miniaturization of anagen phase (MA) and telogen effluvium (TE) represent nonscarring hair loss diseases which causes moderate to severe aesthetic and psychologic discomfort in affected people. Several therapeutic approaches have been tested through the latest decades, with different degree of success. In this study we aim to analyze the efficacy and outcome of an innovative therapeutic protocol, named TRICHOBIOLIGHT, a combination of active principles conveyed by mesotherapy directly on the scalp with a subsequent photobiostimulation session with LED light (630 nm). About 107 patients (49 women, 58 men, mean age 45-year-old) with clinical and trichoscopic diagnosis of MA, AGA, and TE have been enrolled at Skin Center of L'Aquila, Avezzano and Pescara (Italy) and subsequently treated with the TRICHOBIOLIGHT protocol. 4 patients dropped out at the beginning of the study: 2 patients because of an histological diagnosis of scarring alopecia and lichen scleroatrophicus, and 2 patients dropped out because of adverse reaction to the treatment. Excellent to good outcome have been reached in the 82.5% of patients (85/103), 9 patients (8.7%) reached a sufficient result while 7 patients (6.8%) partially respond to the treatment. Two patients (2%) did not respond at all. TRICHOBIOLIGHT is a promising protocol, working through the combined action of the active principles and the photobiostimulation, that lead to a strengthening and thickening of the residual hair, giving an optical thickening effect that provides high quality aesthetic results and, consequently, appreciable psychological results.
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Affiliation(s)
| | | | - Claudio Conforti
- Dermatologic Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | | | | | | | | | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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24
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Ha DH, Kim HK, Lee J, Kwon HH, Park GH, Yang SH, Jung JY, Choi H, Lee JH, Sung S, Yi YW, Cho BS. Mesenchymal Stem/Stromal Cell-Derived Exosomes for Immunomodulatory Therapeutics and Skin Regeneration. Cells 2020; 9:E1157. [PMID: 32392899 PMCID: PMC7290908 DOI: 10.3390/cells9051157] [Citation(s) in RCA: 314] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022] Open
Abstract
Exosomes are nano-sized vesicles that serve as mediators for cell-to-cell communication. With their unique nucleic acids, proteins, and lipids cargo compositions that reflect the characteristics of producer cells, exosomes can be utilized as cell-free therapeutics. Among exosomes derived from various cellular origins, mesenchymal stem cell-derived exosomes (MSC-exosomes) have gained great attention due to their immunomodulatory and regenerative functions. Indeed, many studies have shown anti-inflammatory, anti-aging and wound healing effects of MSC-exosomes in various in vitro and in vivo models. In addition, recent advances in the field of exosome biology have enabled development of specific guidelines and quality control methods, which will ultimately lead to clinical application of exosomes. This review highlights recent studies that investigate therapeutic potential of MSC-exosomes and relevant mode of actions for skin diseases, as well as quality control measures required for development of exosome-derived therapeutics.
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Affiliation(s)
- Dae Hyun Ha
- ExoCoBio Exosome Institute (EEI), ExoCoBio Inc., Seoul 08594, Korea; (D.H.H.); (H.-k.K.); (J.H.L.); (S.S.)
| | - Hyun-keun Kim
- ExoCoBio Exosome Institute (EEI), ExoCoBio Inc., Seoul 08594, Korea; (D.H.H.); (H.-k.K.); (J.H.L.); (S.S.)
| | - Joon Lee
- School of Chemical and Biological Engineering, Seoul National University, Seoul 08826, Korea;
| | | | - Gyeong-Hun Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasweong-si, Gyeonggi-do 18450, Korea;
| | | | | | | | - Jun Ho Lee
- ExoCoBio Exosome Institute (EEI), ExoCoBio Inc., Seoul 08594, Korea; (D.H.H.); (H.-k.K.); (J.H.L.); (S.S.)
| | - Sumi Sung
- ExoCoBio Exosome Institute (EEI), ExoCoBio Inc., Seoul 08594, Korea; (D.H.H.); (H.-k.K.); (J.H.L.); (S.S.)
| | - Yong Weon Yi
- ExoCoBio Exosome Institute (EEI), ExoCoBio Inc., Seoul 08594, Korea; (D.H.H.); (H.-k.K.); (J.H.L.); (S.S.)
| | - Byong Seung Cho
- ExoCoBio Exosome Institute (EEI), ExoCoBio Inc., Seoul 08594, Korea; (D.H.H.); (H.-k.K.); (J.H.L.); (S.S.)
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Alhamzawi NK. Keloid Scars Arising after Follicular Unit Extraction Hair Transplantation. J Cutan Aesthet Surg 2020; 13:237-239. [PMID: 33209003 PMCID: PMC7646428 DOI: 10.4103/jcas.jcas_181_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hair transplantation is considered safe compared to other cosmetic procedures. However, scarring is still an inevitable potential complication. Keloid scarring is a rare complication of hair transplantation and usually associated with strip harvesting rather than follicular unit extraction (FUE). A case of keloids at the donor site following FUE hair transplantation is presented. Hair transplant practitioners should be aware of the risks of the procedure when considering hair restoration to ensure safer outcomes.
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Affiliation(s)
- Nabeel K Alhamzawi
- Department of Dermatology, Al Diwaniyah Teaching Hospital, Diwaniyah, Iraq
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27
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Kerure AS, Agrawal SM, Dhurat R, Ginzburg A. Donor Area Acute Effluvium following Follicular Unit Extraction-Trichoscopic Simulator of Alopecia Areata: Series of Four Cases. J Cutan Aesthet Surg 2019; 13:31-34. [PMID: 32655248 PMCID: PMC7335467 DOI: 10.4103/jcas.jcas_77_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Follicular unit extraction (FUE) is a popular hair transplant technique, which involves extraction of follicular grafts from the donor area, usually occipital area of scalp. We have described few cases where non-scarring alopecia patches appeared at donor area similar to that of alopecia areata clinically, after 2–3 weeks of surgery. Even trichoscopically, findings were similar to alopecia areata showing exclamation marks, black dots. However, on histopathology, there were dilated blood vessels, mucin deposition, and only few lymphocytes, which mimic histopathology of healing wound. We hypothesize that compromised blood supply and trauma to the existing hairs after harvesting can lead to post-hair transplant effluvium, which is probably due to anagen effluvium.
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Affiliation(s)
- Amit S Kerure
- Dr. Amit Kerure Skin Clinic, Navi Mumbai, Maharashtra, India
| | - Sandip M Agrawal
- Department of Dermatology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Rachita Dhurat
- Department of Dermatology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Alex Ginzburg
- Department of Dermatology, Ginzburg Hair Clinic, Ra'anana, Israel
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