Hair Replacement Surgery

Transcription

1 Hair Replacement Surgery

2 Springer Berlin Heidelberg New York Barcelona Budapest Hong Kong London Milan Paris Santa Clara Singapore Tokyo

3 P. Bouhanna J.-C. Dardour Hair Replacement Surgery Textbook and Atlas Translated by D. Ie Yay With 310 Figures, Some in Colour, and 18 Tables Springer

4 Dr. PIERRE BOUHANNA 14, rue Theodore de Banville Paris France Dr. JEAN-CLAUDE DARDOUR 146, rue de Longchamps Paris France Translator: Dr. DAVID LE YAY 6 Garstons Burwash, East Sussex TN19 7EZ England ISBN DOI / ISBN (ebook) Library of Congress Cataloging-in-Publication Data. Bouhanna, P. (Pierre), [Chirurgie de la calvitie. English] Hair replacement surgery: textbook and atlas/p. Bouhanna, J.-C. Dardour. p. cm. Includes bibliographical references and index. 1. Hair - Transplantation. 2. Scalp - Surgery. 3. Baldness - Surgery. 1. Bouhanna, P. (Pierre), II. Dardour, J.C. III. Title, [DNLM: I. Alopecia - surgery. 2. Alopecia - atlases. 3. Scalp - surgery. 4. Scalp - atlases. 5. Hair - physiology. 6. Hair - atlases. WR c 1996a] RD '779-dc20 DNLM/DLC for Library of Congress This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer Verlag. Violations are liable for prosecution under the German Copyright Law. Springer-Verlag Berlin Heidelberg 1996 Softcover reprint of the hardcover 1 st edition 1996 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: Springer-Verlag, E. Kirchner Typesetting: Thomson Press (India) Ltd., New Delhi SPIN: /3132/SPS Printed on acid-free paper

5 Contents Introduction... 1 Anatomy... 2 Hair... 2 Embryology... 2 Macroscopy... 2 Visual and Textural Characteristics... 3 Colour... 3 Shape... 3 Thickness... 3 Texture... 3 Greasiness Tonicity... 3 Laxity... 4 Mechanical Properties... 4 Resistance and Firmness... 4 Elasticity... 4 Quantitative Data... 4 Density... 4 Total Number of Hairs... 4 Implantation... 4 Interaction of All These Factors... 4 Optical Microscopy... 5 Shaft... 5 Root... 5 Electron Microscopy... 7 Structure of Cuticle... 7 Structure of Cortex... 7 Medulla... 7 Histological Changes in Male Baldness... 7 Chemical Composition... 8 Keratins... 8 Natural Colouration of Hair... 8 Action of External Agents... 9 Water... 9 Permanent Waving... 9 Sun... 9 Temperature Special Features of Hair... 9 Seborrhoea and Dandruff Scalp Microscopy... 10

6 VI Contents Histological Section The Different Layers Implantation of Hair Follicles Scalp Vessels Glands Variations Macroscopy Topography Description Vascularisation Innervation References Biology and Physiology of Hair Growth Adults Growth of Hair: The Hair Cycle Anagenic Phase Catagenic Phase Telogenic Phase Androgenic Alopecia Mode of Action of Androgens on Target Cells Grafts on the Receptor Site and Hair Behaviour Foetuses and Infants Hair Cycles Hair Characteristics Adolescents Old Age References Male Baldness General Features Ratio of Bald to Hairy Areas Laxity of the Scalp Covering Power of the Hair Hair Density Variable Factors Classifications Morphological Classifications Hamilton's Classification Bouhanna's Classification Dynamic Classification of Dardour and Bouhanna Stage Density Laxity of the Scalp Other Factors Aspect of Hair Colour Thickness Rate of Growth in Each Region Considered Examples Comparison of the Classifications of Bouhanna, Hamilton and Dardour... 38

7 Contents VII Temporal Course Juvenile Baldness Late-Onset Baldness Age-Related Changes Factors Determining the Course of Baldness Genetic Factors Age Androgens Other Causes of Alopecia Primary Alopecia in Women Acute Diffuse Alopecia Diffuse Chronic Alopecia Alopecia areata Traumatic Alopecia Without Skin Damage Congenital Alopecia Alopecia with Skin Damage Post-traumatic Alopecia After Burns or Irradiation (Radiodermatitis) References Psychological Aspects Role of the Fur in Animals History and Symbolism of Hair in Different Ages and Countries Present-Day Psychology of Baldness Social Attitudes Cosmetic Effects Medical and Cosmetic Treatment From Antiquity to the Present Day (From Empiricism to Inefficacy) Modern Treatments Seborrhoea and Dandruff Hair Loss Vitamin Therapy and Other General Treatments Lotions Minoxidil Hormonal Treatment in Women References Hair-Pieces Types of Hair Used Natural Hair Artificial Hair Bases for Implantation Wide-Meshed Net Close-Meshed Net "Microskin" Mode of Fixation of the Hair-Piece Adhesives Weaving Microspots... 53

8 VIII Contents Grips Surgical Fixation Advantages of Hair-Pieces Disadvantages of the Procedure Surgical Techniques: History, Anaesthesia and General Principles History Pathogenic Interventions Vertical Reduction Grafts Scalp Flaps Expansion Anaesthesia Local Anaesthesia Esteriform Agents... ' Amide Derivatives Remarks Prevention of Complications and Accidents with Local Anaesthetics Anaesthetic Equipment Infiltration Technique General Anaesthesia General Principles of Scalp Surgery Hair Bulbs Tension of Closure Closure in Two Layers Flaps and Grafts Direction of Implantation of Grafted Hair Scalp Incision Position of Scars Infiltration of the Scalp Stripping the Scalp Marginal Haemostasis Galeotomy Anagenic Defluvium Infection Postoperative Management References Autografts General Principles Definition Classification Harvesting Grafts Factors Influencing the Survival of a Graft Donor Area Measurements and Assessment Quality of Hair Hair Density Diameter of Hair Shafts Frizzy and Wavy Hair.....,., Hair Colour... 73

9 Contents IX Camouflage of Donor Area Recipient Area Anterior Frontal Line Transplantation to the Vertex Complications Common to All Graft Types Complications Resolving Spontaneously Complications at the Anterior Frontal Line Description of the Technique Preparation of the Patient Local Anaesthesia Removal and Placement of Grafts Siting of the Grafts Angulation and Orientation of Grafts Dressing Postoperative Management Different Types of Graft Cylindrical Grafts Instrumentation Techniques of Graft Removal Preparation and Cleaning of Grafts Suture of the Donor Area Forage of the Recipient Site Distribution of Grafts Complications of Cylindrical Grafts Correction of Complications and Poor Results Minigrafts and Micrografts Principle Aims Technique Technical Features in Women Complications Conclusion Fusiform Grafts Aim Technique Complications Conclusion Immediate Long-Haired Autografts of Bouhanna Technique Preparation of the Receptor Region Pre- and Postoperative Management... III Course... III Conclusion... III References Flaps General Principles of Flaps and Application to the Scalp Definition Classification Special Features and Application to Scalp Flaps Limitations Advantages

10 x Contents Different Methods of Assessing Vascular Adequacy Autonomised (Delayed) Flaps Definition Mechanisms Factors Influencing the Vitality of a Flap Local Factors Technical Factors Direction of Hair Growth Description of Technique Preparation of Patient Anaesthesia Incision Dressing Different Types of Flaps Inferior Pedicle Flaps Advantages Disadvantages Superior Pre- and Post-auricular Flaps Advantages Disadvantages Other Types of Flaps Inferior Pedicle Flaps Transverse Flaps with an Inferior Pedicle Temporo-parieto-occipital Flap (Juri) Two Other Flaps ofjuri Superior Pedicle Flaps for Frontal Cover Pas sot Flap Pre-auricular Flap of Nataf Retro-auricular Flap Long Retro-auricular Flap of Nataf and Bouhanna Pre- and Retro-auricular Flaps of Dardour Vertical Mini-flaps of Dardour Vertical Flaps of Bouhanna Statistical Study of Two Types of Superior Pedicle Flaps (Dardour) Statistical Study of Four Types of Superior Pedicle Flaps (Bouhanna) References Reduction Procedures General Considerations Description of Technique Preparation of Patient Local Anaesthesia Incision Resection Drainage Dressing Classical Reduction Procedures Sagittal Fusiform Reductions Median Sagittal Fusiform Reduction Lateral Sagittal or Paramedian Reduction Transverse Fusiform Reductions Mixed Fusiform Reductions

11 Contents XI Giant Reduction Procedures Techniques Originally Described by Marzola and Brandy Dardour's Techniques for Lifting the Scalp Complications Haematoma Necrosis Alopecia Ugly Scars of Several Possible Causes Infection Dehiscence of the Scars Conclusion References Accessory Techniques Pathogenic Procedures Expansion Principles of Technique Description of Technique Choice of Prosthesis and Planning of Expansion Initial Procedure Second Procedure Advantages Disadvantages and Complications Disadvantages Complications Indications Reconstructive Surgery Cosmetic Surgery Conclusions Synthetic Hair Different Types of Synthetic Hair Experimental Study of Nido Synthetic Hair Monitoring of Toxicity Histological Study Macrophotographic Study Discussion Conclusion References Operative Indications Limits of Operable Baldness and Variant Factors When Does Baldness Become Inoperable? Favourable Factors Unfavourable Factors Position of the Fronto-temporal Line Operative Indications When to Operate: Assessment of the Progress of Baldness What to Do Ligation Artificial Hair Grafts

12 XII Contents Reduction Procedures Flaps Skin Expansion Indications Related to the Clinical Stage of Baldness and to the Surgeon Indications (Bouhanna) Minor Baldness (Stage I) Moderate Baldness (Stage II) Severe Baldness (Stage III) Conclusion Indications (Dardour) Severe Baldness (Stage 3) Frontal Baldness Posterior Baldness., Conclusion Variation in Operative Indications Related to Certain Factors Age Heavy Smokers Scalp Elasticity Hair Colour Crinkly Hair Thinned Crown Variation in Indications Related to Patient and Surgeon Variation Related to the Patient Variation Related to the Surgeon Special Cases Frontal Lifting in Bald Men Description of Technique Lifting for Frontal Thinning in Men Correction of Grafted Fronto-temporal Recession by Frontal Lifting Flap-Grafts and Graft-Flaps Alopecia in Women Treatment of Temporal Alopecia Secondary to Lifting Conclusion References Conclusion