Eyebrow reconstruction following burn injury

Facial burns represent between one-fourth and one-third of all burns. Absence of the eyebrows or distortions in their position alter the character of the face. Thus, eyebrow repair or reconstruction can be an important "finishing touch" in the overall reconstruction of a burned face. Generally, there are three ways to reconstruct the eyebrow: use of superficial temporal artery island flap; composite graft from scalp; and mini or micrografts from scalp. This report presents 20 patients reconstructed with the above techniques. Eleven patients (eight male and three female) with superficial temporal artery island flaps; seven patients (two male and five female) with composite grafts from scalp; and two patients (female) with minigrafts. The results suggest that superficial temporal artery island flaps were more suitable for males and composite graft for females who generally require thinner and less dense eyebrows. Our experience with minigrafts for burn alopecia has not been adequate. Here in this article, different methods of eyebrow reconstruction are presented with the greater emphasis on superficial temporal artery flap.     

Beard reconstruction using hair grafts in a free flap

Hair transplantation using micrografts or minigrafts is a standard procedure used for hair restoration in androgenic, burn scar and cicatricial alopecia. These grafts have also been used to reconstruct the eyebrow, eyelash, mustache, beard and pubic escutcheon. A patient who underwent successful micrograft and minigraft hair transplantation into a free osteocutaneous mandibular flap reconstruction is presented. The patient was very satisfied with his reconstruction, and the hair transplants provided excellent camouflage for the flap.     

可调控眉毛密度的眉再造术同期治疗瘢痕性秃发的临床护理

目的:探索专项护理在眉再造同期治疗瘢痕性秃发术中的应用效果。方法:根据手术过程分两期进行专项临床护理。扩张器一期置入术后进行扩张器相关专项护理,严密监测扩张注水情况,密切观察扩张部位,防止扩张皮瓣坏死或感染;眉再造和瘢痕性秃发修复二期术后密切观察再造眉毛头皮条的颜色,避免静脉回流不畅发生。结果:本组12例患者进行了眉再造的全方位密切护理,岛状头皮瓣全部存活,头皮瘢痕全部修复,无一例皮瓣坏死。随访6~24个月,再造眉毛毛发密度与健侧非常接近,眉形自然逼真,手术效果满意。结论:在可调控眉毛密度的眉再造同期治疗瘢痕性秃发术中进行全方位护理是手术成功的重要保障。     

Surgical treatment of secondary cicatricial alopecia of scalp and eyebrow

Secondary cicatricial alopecia occurs as a result of destruction of hair follicles by scar tissue formed in the scalp and eyebrows. It is a permanent condition and regrowth of hairs in the area is not expected. The purpose of the study was to select the appropriate method for treating cicatricial alopecia. 24 patients were admitted to our hospital during the period from June 2006 to July 2007. They were suffering from acquired cicatricial alopecia affecting the scalp and the eyebrow. Their ages ranged from 6-48 years with mean age 26-25 years. They were treated surgically by total excision of the lesions with direct closure of the defect in ten cases, excision of alopecia with advancement flaps with the aid of scalp expanders in seven cases, scalp reduction through serial excision of alopecia in three cases and excision of alopecia and reconstruction of the defect by strip composite hair-bearing scalp grafts in four cases. Our results suggest there are three key factors that decide the surgical methods for treating alopecia: size, location and shape. We also discuss and evaluate the various techniques of reconstruction. Good results were obtained in 18 patients.     

Long-term follow-up and unusual findings after microvascular transfer of hair-bearing skin for pubic hair restoration

Alopecia in the pubic area can be restored successfully with hair transplantation using minigrafts and micrografts or with free tissue transfer of a hair bearing flap. In this report the authors present the successful transfer of hair bearing tissue from the temporoparietal scalp for the correction of a congenital form of alopecia of the pubic region. In addition, they present long term results of this transfer. Auxiliary procedures such as tissue expansion before or after transferring the flap, hair epilation and minigraft and micrograft transplantation could help to achieve a more natural result. Tissue expansion of the donor site could also be performed to enhance the outcome of the procedure. Of note is the rapid rate of hair growth in the transplanted tissue. This type of reconstruction using a hair bearing temporoparietal flap for restoration of hair to the pubic region is a useful method that can yield good results.     

Bilateral eyebrow reconstruction using a unilateral extended superficial temporal artery flap

In cases of the bilateral eyebrow reconstruction in men, two superficial temporal artery (STA) flaps are usually designed for both temporal regions according to the flap movable range and the direction of hair growth. Recently, the authors have successfully reconstructed bilateral eyebrows with normal directions of hair growth using a unilateral STA flap, extended by anastomosis of the STA and the occipital artery, with two hair-bearing skin islands. Using this method, the direction of the hair growth can be optimally selected by changing the direction of the skin islands for each eyebrow. The authors were able to reconstruct symmetric eyebrows with the hair growing laterally and a little upward. The invasiveness, bleeding, and operating time required for this method are less than those for the bilateral STA flap method. For cases in which one temporal scalp could not be used, bilateral eyebrow reconstruction remains possible with this method.     

毛发移植术在治疗小面积外伤性眉缺损中的应用

目的：探讨应用毛发移植技术治疗小面积眉缺损的疗效。方法：18例小面积眉缺损患者,均为单侧眉缺损,眉毛缺损面积为0.5×0.5cm～1.0×1.0cm。在局麻下从耳后发际内或颞部获取单体毛囊,按照原有眉毛的生长方向植入眉毛缺损处。结果：18例患者术后随访3～10个月。未见移植的眉毛明显脱落,植入的眉毛生长良好,需要7天左右修剪一次。两侧眉毛对称。所有患者对术后效果表示满意。结论：应用单体毛囊移植治疗小面积眉毛缺损,能再造出与对侧健康眉毛相似的眉毛,效果良好。     

Hair transplantation to the eyebrow, eyelashes, and other parts of the body

Since its earliest applications, hair transplantation has been used for treating not only the scalp in pattern baldness but also other parts of the body, commencing with eyebrow reconstruction. The earliest micrografts were applied to the eyebrow more than 30 years before their application to the scalp became the standard of care. Today hair transplantation is applied to a number of other areas. The principle behind transplanting these areas is the same-once transplanted, the hairs continue to grow because of the phenomenon of donor dominance. This article reviews the role and technique of hair transplantation to the eyebrows and eyelids, chest, beard and moustache, and pubic escutcheon.     

选择性单株毛发植入在眉毛部分缺损修复中的应用

目的探讨在眉毛缺损修复手术中选择性应用不同直径单根毛发植入的临床效果。方法49例眉毛缺损患者，其中先天性眉毛稀疏37例，外伤后引起的瘢痕性眉缺损12例。在局部麻醉下从枕部靠近后发际线和耳后发际线内获取单体毛囊，粗细毛发分开摆放，应用22G或23G注射针头按正常眉毛方向打孔后将单根毛发植入。在眉头、眉尾和眉毛上缘应用较细的头发，眉中央用较粗的头发。结果术后随访3～10个月，植入的眉毛生长良好，需要5～7d左右修剪1次。两侧眉毛对称。12例患者因移植的眉毛有局部成活不良，在术后6～12个月进行二次手术补植加密。所有患者对术后效果表示满意。结论选择性植入不同直径单根毛发的眉毛缺损修复术，能再造出外观自然、形态逼真的眉毛，效果良好。     

Eyebrow transplantation

The eyebrow has a powerful influence on the appearance of the orbital region. Because the person without eyebrows has an unnatural look, drawing everyone's attention, eyebrow restoration/reconstruction should be viewed as an esthetic surgery performed to improve the patient's appearance and self-esteem. Although hair-bearing pedicled flaps and free composite strip grafts have been the most widely used approaches in clinical practice formerly, follicular unit transplantation (FUT) has gained more and more importance nowadays in eyebrow restoration because of its more rewarding results. The process and results of FUT have been greatly improved thanks to advances in hair transplantation techniques, instrumentation, and practice. In this article, we discuss the restoration of 14 eyebrows in 8 patients (5 males and 3 females) using FUT. The procedure and the results also are discussed here under in light of literature.     

Using Nonscalp Hair in Scalp Hair Restoration—Theory and Execution

Harvesting of beard and body hair follicles for transplantation can be an effective form of treatment for appropriate patients. These patients may have had prior scalp transplantation and require repair but do not have sufficient scalp donor follicles remaining. Other patients will have these hairs mixed with scalp hairs to produce a greater density of hair on the bald scalp. Follicular unit excision (FUE) is preferred for body and beard follicle harvesting. Not all body hair is suitable for transplantation. Only hairs that are similar in appearance and behavior to scalp hair are suitable for transplantation to the scalp. The best nonscalp sources are the beard and anterior torso. Hairs from other body sites may be used for transplantation to the eyebrows. The standard techniques of FUE harvesting and anesthesia must be modified from those used in scalp harvesting to be safe and effective. With proper patient selection and technique, a significant cosmetic benefit can be achieved from these procedures.     

Hair transplantation using a freely transferred nonhair-bearing skin flap

Cicatricial alopecia is a common sequela of burns involving the head region. The authors present a case of an extensive form of cicatricial alopecia in an 18-year-old female patient who sustained a burn to the head at 2 years of age. The patient was treated with combined scalp reduction with the aid of tissue expanders and micrografting of the freely transferred, preexpanded deep inferior epigastric artery nonhair-bearing skin flap. The aim of this article is to show that hair transplantation on the freely transferred nonhair-bearing skin flap may be associated with infection and fat necrosis, and the end result is not satisfactory, as in the cases of hair transplantation on a normal bald scalp.     

Eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap

Although various reconstructive procedures for the eyebrow have been reported, few have proved satisfactory for large-tissue defects. The authors describe two cases of eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap (TPF flap) after malignant tumor resection. The first patient was a 24-year-old man with an adnexal carcinoma of the left eyebrow. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. The second patient was a 48-year-old woman with Bowen's disease of the left eyebrow. Tumor resection was performed on the frontal muscle with a 5-mm surgical margin. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. Both reconstructed eyebrows have maintained their shapes well. There have been several reports of the use of a TPF flap for eyebrow reconstruction, but none have used intermediate hair from the hairline. The authors are convinced that use of intermediate hair from the hairline of the forehead on the pedicled TPF flap is effective for reconstruction of the eyebrow and large defects extending to nonhairy subbrow skin.     

Er:YAG Laser-Assisted Hair Transplantation in Cicatricial Alopecia

BACKGROUND: Autologous hair transplantation and its combination with flap or reduction procedures is a common surgical approach to cover defects in cicatricial alopecias. Due to the poor recipient conditions present in scar tissue, it is crucial to minimize the trauma exerted on implantation holes in order to achieve good transplantation results. OBJECTIVE: We sought to evaluate the "cold"-ablative properties of the Er:YAG laser for the generation of recipient holes in cicatricial alopecia. METHODS: Patients with cicatricial alopecia of diverse etiology were treated with Er:YAG laser-assisted hair transplantation. Mini- or micrografts were inserted into recipient holes ablated with a pulse energy of 900-1200 mJ and a spot size of 1.0-1.6 mm. RESULTS: A fluence of 80-120 J/cm2 and 8-12 pulses gave an almost ideal combination of minimal thermal damage and tissue ablation down to the subcutis. With an apparent mini- and micrograft survival of 95% we achieved good cosmetic results after two to five transplant sessions in all patients. CONCLUSION: The Er:YAG laser is a novel effective tool to ablate recipient holes for autologous hair transplantation in cicatricial alopecia.     

多只扩张器超量扩张修复大面积瘢痕性秃发

目的 探讨应用多只扩张器超量扩张头皮修复大面积瘢痕性秃发的临床效果.方法 Ⅰ期手术：根据秃发区的形状、面积大小,选择多只扩张器,在肿胀麻醉下,置于头部有发区帽状腱膜下,注射壶外置.超量扩张3～6个月,以获得额外有发头皮.Ⅱ期手术：将扩张器取出,切除瘢痕,将扩张后的有发头皮,采用滑行推进皮瓣、旋转皮瓣与易位皮瓣联合运用的手术方式,修复头皮秃发区.结果 23例患者术后秃发区修复效果良好,外观满意.结论 多只扩张器超量扩张可获得大量额外扩张头皮.合理设计皮瓣转移术,最大限度地提高了扩张皮肤的利用率,可修复大面积瘢痕性秃发,修复效果良好.     

Prefabricated hair-bearing temporal flap for two different facial aesthetic subunits reconstruction: case report

Expanded temporal hair-bearing scalp as a pedicled flap was used to reconstruct the upper lip with a moustache and also the ipsilateral eyebrow, on a patient with an old chemical burn of the face. It is a relatively simple method of providing cover of the upper lip and eyebrow with a good density of hair and a natural hair flow. The results were satisfactory and the donor site morbidity was minimal.     

简易毛发移植联合外用米诺地尔酊治疗毛发缺稀的临床观察

目的寻求一种治疗头发、眉毛缺失或稀疏的简单有效的方法。方法在枕后发际内切取一条带毛发的完整头皮,制备成微小单位毛发移植物,用16号空心针头在头发、眉毛缺失或稀疏区皮肤上行简易打孔,以显微镊辅助,把制备好的毛发植于孔隙内。术后7d植发区开始外喷米诺地尔酊,连用3～6个月。结果25例34处头发、眉毛缺失或稀疏患者,通过本方法治疗均取得良好疗效。结论用16号空心针头行简易打孔,移植微小单位毛发,治疗毛发缺失或稀疏,方法简单,取材方便,适合推广;辅助外搽米诺地尔酊,可使毛发成活率更高,毛发生长更为自然。     

Does the Recipient Site Influence the Hair Growth Characteristics in Hair Transplantation?

BACKGROUND: Recently hair transplantation has been widely applied not only to correct androgenetic alopecia, but also to correct hair loss on other parts of the body such as the eyebrows and pubic area. It is believed that the transplanted hairs will maintain their integrity and characteristics after transplantation to new nonscalp sites. OBJECTIVE: To evaluate whether the transplanted hairs maintain their hair growth characteristics after transplantation to a new anatomic site other than the scalp. METHODS: Three study designs were used. Study I: Hair transplantation from the author's occipital scalp to his lower leg was performed and clinical evaluations were made at both 6 months and at 3 years after the transplantation. Study II: After finding changes in hair growth characteristics, transplanted hairs were harvested from the leg and retransplanted to the left side of the nape of the neck (group A). As a control study, occipital hairs were transplanted to the opposite side (group B). Observations were made at 6 months after the operation. Study III: An observational study was done in 12 patients with androgenetic alopecia about 1 year after transplantation of occipital hair to frontal scalp. At each step, survival rates were documented and the rate of growth and the diameter of the shafts were measured for both recipient and donor sites. RESULTS: Study I: Surviving hairs on the lower leg showed a lower growth rate (8.2 +/- 0.9 mm/month), but the same diameter (0.086 +/- 0.018 mm) compared with occipital hairs (16.0 +/- 1.1 mm/month, 0.088 +/- 0.016 mm). The survival rate 3 years after transplantation was 60.2%. Study II: There was no significant difference in the growth rate, shaft diameter, and survival rate between retransplanted hairs (group A) and controls (group B). Groups A and B showed a lower growth rate, but the same diameter, compared with occipital hairs. Study III: There was no significant difference in the growth rate and shaft diameter between the transplanted hairs on the frontal scalp and the occipital hairs. CONCLUSION: These results strongly suggest that the recipient site affects some characteristics of transplanted hairs, such as their growth and survival rates.     

眉缺损的美容修复

目的：探讨眉缺损修复的方法和治疗效果。方法：分别应用同侧颞浅动脉顶支岛状头皮瓣转移、同侧颞浅动脉顶支岛状筋膜－头皮瓣转移加中厚植皮、应用自制的植毛导向器行单毛囊株毛发种植三种方法修复眉缺损21例共29只眉。结果：所有病例中，2例行二次手术，其余均I期愈合。随访6个月至1年，术后3个月眉毛稀疏2例3只眉，其余外观满意。结论：眉缺损的修复应根据眉缺损的原因、缺损的性质、范围以及患者的要求不同而采用合适的方法；单毛囊株种植可使修复后的眉逼真、自然，成活率高，临床值得推广应用。     

Eyebrow, face, and neck lifts for males

Alternate locations to skin excisions adjacent to the eyebrows for correction of eyebrow ptosis have been presented. Excisions in the upper forehead or in the scalp permit flexibility in width and length of skin or scalp to be excised and may be extended laterally to produce a temporal lift which not only improves the lateral canthal area of sagging skin but also may improve the lower eyelid surgical correction results (Figs. 1 and 3). By use of adequate lipectomy and full-width platysma muscle flaps to support the new neck contour, better and longer lasting results have been accomplished. The currently used techniques for eyebrow, face, and neck lifts for males produce better and longer lasting results than could have been accomplished with previously used techniques. The continued search for improvement in techniques by many surgeons in different areas of the world has enabled these longer lasting and better results to be accomplished.