Prevention of Temporal Alopecia Following Rhytidectomy: The Prophylactic Use of Minoxidil. a Study of 60 Patients

BACKGROUND: Temporal hair loss that results from traumatized hair follicles following rhytidectomy is an unsightly complication that can distress both the patient and the operating surgeon. Topical minoxidil is a proven therapy for androgenic alopecia and female senile alopecia. It has also been found to be useful in preventing the hair loss that commonly follows hair transplantation. OBJECTIVE: To analyze through a retrospective study the effect of topical minoxidil on the incidence of temporal hair loss following facelift procedures. To our knowledge this is the first study to investigate the role of minoxidil in preventing post-rhytidectomy temporal alopecia. METHODS: The charts of 60 women with a mean age of 58 years who underwent primary cervicofacial rhytidectomy were studied. Either a standard SMAS/flap technique or pliation was done in all cases. Each patient received either 2% or 5% topical minoxidil for 2 weeks before surgery and for 4 weeks after surgery, with a 5-day break period beginning on the day of surgery. Patients were monitored for complications immediately postoperatively and in 3-6 months of follow-up. RESULTS: Almost 80% of the patients underwent SMAS/flap procedures. Transient temporal alopecia was noted in only one patient, 6 weeks after discontinuing minoxidil. This resolved within 4 weeks of its reintroduction. The only other complications noted included minor hematomas (3.3%), skin slough/infection (1.7%), minor transient and localized edema (8.3%), minor ecchymosis (1.7%), a unilateral neuropraxia of the buccal nerve lasting 3 months (1.7%), and a minor temporary unilateral skin depression (1.7%). Side effects of minoxidil were not observed. CONCLUSION: On comparing our findings to results of larger rhytidectomy series in which minoxidil was not used prophylactically, and our experience before using minoxidil, we conclude that minoxidil plays a role in effectively preventing the temporal hair loss that occurs following primary cervicofacial rhytidectomies. We also found that minoxidil did not negatively impact on the risk of hematoma formation, skin necrosis, edema, or ecchymosis. Side effects of minoxidil did not present a problem.     

Diseases on hair follicles leading to hair loss part I: nonscarring alopecias

Hair follicles are unique structures with exceptional regenerative potential. They are believed to be crucial for epidermal homeostasis and reepithelialization after damage to human skin. Like other, more active and quickly proliferating organ systems, hair follicles may be easily disturbed in their normal growth cycle by systemic and local influences, including specific skin diseases. This may lead to hair loss, a very common complaint in men and women. The difficulties in reviewing the diseases of hair follicles lay in the long list of different etiologic factors (infectious, autoimmune, inflammatory, neoplastic, physical, chemical, congenital) and a still missing classification system according to etiopathogenetic principles. In this article (Part I of II), the structure and function of hair follicles, the diagnostic approach to diseases causing hair loss, and the most common nonscarring alopecias (telogen effluvium, anagen effluvium, androgenetic alopecia, and alopecia areata) are reviewed in regard to pathogenesis, clinical findings, and current options of treatment. Part II will focus on scarring alopecias.     

Influence of the anagen:telogen ratio on Q-switched Nd:YAG laser hair removal efficacy

BACKGROUND AND OBJECTIVE: Laser hair removal is believed to affect only anagen hairs. However, proof of this belief in humans is lacking. The objective of this study was to determine the influence of the anagen: telogen ratio on the results of Q-switched Nd:YAG laser hair removal. STUDY DESIGN/MATERIALS AND METHODS: Fifteen subjects had four test sites delineated in one body area. The test sites were chosen by trimming the hair and evaluating the area in 2 weeks. At that time, the anagen hairs were at least twice as long as the nongrowing telogen hairs and, therefore, could be differentiated and counted. Two sites with a low anagen number and two with a high number were chosen for comparison. All sites were then treated with a Q-switched Nd:YAG laser. Follow-up examination was in 1 month. RESULTS: Test sites with a low anagen number demonstrated a low level of hair loss compared with those sites with a high anagen number. A significantly higher percentage of hair loss was noted when comparing the anagen-only with total hair loss. In addition, lasing plus shaving demonstrated more hair loss than lasing alone. These findings indicated that anagen hairs were clearly affected, but the immediate clinical effect on telogen hairs was minimal. CONCLUSION: Q-switched Nd:YAG laser treatment of anagen hairs results in a rapid switch to telogen and a subsequent clinically obvious shedding of the hair shaft. This process causes a greater percentage hair loss at sites with high anagen number. Telogen hairs demonstrate no such effect and remain in their pretreatment phase after lasing.     

U字埋线法颞部除皱术

为了寻求一种简单、有效、创伤痛苦小并无脱发后遗症的颞部除皱术，设计应用皮下埋线法去除颞部皮肤皱纹。用７－０丝线分别于双颞部皮下埋入，于头顶部会师牵拉、提紧、结扎，舒平颞部皱纹。临床应用２３例，除皱效果明显，远期无瘢痕脱发，维持有效时间与颞部切开除皱法相当。该方法为不愿头皮留下瘢痕及脱发，寻求简便、安全、效果明显和要求颞部除皱的患者提供了良好的术式。     

头皮分层切开和帽状腱膜覆盖减张缝合法预防额颞部除皱术后脱发

目的：探讨额颞部除皱术治疗额颞部皮肤老化的缝合方法及临床效果。方法：设计头皮分层切开和帽状腱膜覆盖减张缝合法，头皮的皮肤和皮下组织与帽状腱膜的切开不在同一水平，将形成的后叶帽状腱膜瓣和前叶帽状腱膜深面减张缝合。结果：在过去的5年中，此缝合方法应用于56例额颞部或全颜面除皱术。术后随访证实此缝合方法能长时间地去除额纹，上提眉毛，并可预防术后出现永久性脱发和凹陷性瘢痕。结论：头皮分层切开和帽状腱膜覆盖减张缝合法能有效地维持手术效果，并预防术后出现脱发和凹陷性瘢痕。     

Preservation of the female sideburn

Routine face-lift incisions in the temporal hair line may be unsatisfactory because of one or all of the following reasons: (a) Production of an area of baldness immediately in front of the ear; (b) presence of wide unsightly scar in the temporal hairline; (c) loss of hair in the temporal area; and (d) disfigurement of the temporal hair and sideburn. In order to conceal the deformity, the patient is limited to certain hairstyles. The problem is exaggerated in patients with sparse hair or who undergo a secondary rhytidectomy. A solution is an incision at or in the edge of the hairline in the temporal hairline. The technique has been used in over 200 patients during the past 3 years with excellent results. Specific points including location of incision, caveats in technique, and pre- and postoperative results are discussed.     

Bitemporal Scalp Hair Loss: Differential Diagnosis of Nonscarring and Scarring Conditions

BACKGROUND: Bitemporal hair loss can be a diagnostic challenge because several entities may affect this region of the scalp, including both scarring and nonscarring conditions. Although traction alopecia is the most common cause of bitemporal hair loss, no studies to date have outlined all of the potential causes. OBJECTIVE: We sought to review nonscarring and scarring conditions that have a clinical presentation of bitemporal hair loss, including traction alopecia, telogen effluvium, female pattern hair loss, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, and seborrheic dermatitis. METHODS: A Google Scholar and PubMed literature search were conducted for this review. The keywords used in the search included the following: “traction alopecia”, “telogen effluvium”, “androgenic alopecia”, “androgenetic alopecia”, “female pattern hair loss”, “alopecia areata”, “frontal fibrosing alopecia”, “central centrifugal cicatricial alopecia”, and “seborrheic dermatitis”. The scope of our search included all research articles published from 1957 to February 2019. In total, 94 articles regarding non-scarring and scarring hair loss were selected and included according to topic relevance. Exclusion criteria included articles that did not address the epidemiology and/or clinicopathologic or dermatoscopic findings of non-scarring and scarring forms of alopecia. Inclusion criteria included articles that addressed a clinical presentation of bitemporal hair loss; or addressed epidemiology, clinical presentation, dermatoscopic findings, and/or treatment. RESULTS: Bitemporal hair loss is a common and often distressing condition with a broad differential. CONCLUSION: Clinicians must be aware of the potential causes of bitemporal hair loss. Prompt diagnosis is essential to prevent further hair loss, especially in scarring conditions.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性。方法将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部位递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术。结果A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义（P〈0．05）。结论颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用。     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

Effect of Wax Epilation Before Hair Removal With a Long-Pulsed Alexandrite Laser: A Pilot Study

BACKGROUND: Recent reports indicate that laser hair removal is most effective on anagen hairs. However, no published trials have examined laser epilation after hair cycle synchronization. OBJECTIVE: To evaluate the potential for enhanced laser hair removal after the induction of telogen hairs into anagen by wax epilation. METHODS: We identified four 2.5-cm square areas with equivalent hair length and density on the backs of 13 dark-haired white men. To induce typically telogen hairs into anagen, two areas on each patient were wax epilated. Two weeks later, one waxed area and one unwaxed area were treated with a long-pulsed alexandrite laser. One month after laser treatment, a subjective comparison was made based on hair density, length, and thickness. RESULTS: In 12 of 13 patients, lasered areas that had been pretreated with wax epilation were clearer of hair as compared with areas that had been pretreated by shaving (P=0.0034). No significant difference was noted between waxed and unwaxed control areas that had not been laser treated (P=1.0). CONCLUSION: Wax epilation 2 weeks before laser hair removal improves cosmetic outcomes at 1 month. This effect may be secondary to the recruitment and heightened sensitivity of early anagen hairs.     

Comparison of Dermoscopic Findings in Female Androgenetic Alopecia and Telogen Effluvium and Female Controls in a Tertiary Care Center

BackgroundFemale androgenetic alopecia (FAGA) is a patterned hair loss caused by progressive miniaturization of hair follicles. This leads to reduction in the number and thickness of hairs, especially in the central, frontal, and parietal scalp regions. Telogen effluvium (TE) is characterized by diffuse hair loss within months of a significant systemic stressor because of premature follicular transition from the anagen to the telogen.ObjectiveThis article aims to highlight the dermoscopic differences between TE and FAGA compared to healthy female controls.MethodsA total of 124 female patients, which included 31 women with clinical diagnosis of FAGA, 33 with TE, and 60 controls, were enrolled. Two dermatologists independently assessed each patient clinically as well as with dermoscope, recorded the history and examination findings on a proforma, and made a diagnosis. These dermoscopic images were later revised in photographs on the computer.ResultsThere was a statistically significant difference in hair diameter diversity (HDD) between patients with FAGA versus TE and FAGA versus controls (p<0.0001). The difference in the mean percentage of single PSU in both frontal and occipital areas in FAGA versus controls and FAGA versus TE patients was statistically significant. The vellus hair were significantly higher in the FAGA patients than TE and control.ConclusionDermoscopic features of FAGA and TE will help in early detection on the basis of increased proportion of thin and vellus hairs, HDD, perifollicular discoloration, and the presence of a variable number of yellow dots.