Case and Research Letters
Body-Hair Transplant for Cicatricial Alopecia
Reconstrucción de alopecia cicatricial mediante trasplante de pelo corporal
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Meyer-Gonzalez, C. Bisanga" "autores" => array:2 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Meyer-Gonzalez" "email" => array:1 [ 0 => "tmeyer@aedv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Bisanga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Virgen de la Victoria, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Trasplante de Pelo, BHR Clinic, Bruselas, Belgium" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción de alopecia cicatricial mediante trasplante de pelo corporal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 633 "Ancho" => 1717 "Tamanyo" => 162990 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Appearance of the frontotemporal region after the first conventional hair transplant. (B) Appearance of the donor strip in the parietotemporal region.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hair transplantation is a continuously evolving field. Since 1959, when Orentreich<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> described the phenomenon of donor dominance in androgenic alopecia, thus paving the way for body-hair transplants, new techniques have not ceased to appear. During the last 15 years, the perception of hair transplantation as an aggressive technique with an artificial result has finally disappeared thanks to the use of follicular units, which have made the technique minimally invasive with mostly acceptable results.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 30-year-old man with Norwood class III alopecia who underwent hair transplantation at another center in 2008 with the strip method, by means of which he received 3800 follicular units in the frontoparietal region. The follicular units were harvested from the parieto-occipital region.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He consulted 1.5 years after the intervention for assessment of the reconstruction of the donor strip scar (3<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm) and reinforcement of the frontal area behind the hairline (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">We considered the possibility of using the occipital region as the donor strip. However, the low follicular density (50<span class="elsevierStyleHsp" style=""></span>units/cm<span class="elsevierStyleSup">2</span>) at this site led us to repopulate the frontal area using a combination of follicular units from the occipital region and chest. This approach provided a reasonable number of follicles.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Follicular units were obtained using a 0.8-mm punch after applying local anesthetic with 2% lidocaine with 1:100,000 epinephrine. A total of 335 follicular units were obtained from the chest (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A) and 600 from the parieto-occipital region.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Once the recipient site had been anesthetized, the incisions were made in the scar area using a 19G needle, and the body hair follicular units were implanted at a density of 17<span class="elsevierStyleHsp" style=""></span>units/cm<span class="elsevierStyleSup">2</span>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Of the 335 follicular units obtained, 100 were implanted in the scar of the parietotemporal area to evaluate the response (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B), and the remaining body-hair units plus the 600 units from the parieto-occipital region were implanted in the frontal region.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Evaluation at 4 and 6 months after treatment revealed that more than 80% of the units had survived in the scar; the hair was practically indistinguishable from the scalp hair in terms of thickness and length (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and B). The donor area on the chest healed correctly without visible scars or keloids, thus leaving the patient with a very satisfactory cosmetic outcome.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Cicatricial alopecia resulting from burns, surgery, injury, or radiotherapy is an excellent indication for hair transplantation.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> Our patient developed an iatrogenic parietal scar after a “megasession” of follicle donation, possibly because the donor strip was larger than generally recommended in order to harvest as many follicles as possible. The therapeutic alternatives we considered to rebuild the scar were implantation of a tissue expander and direct closure, which the patient rejected, or a follicular unit transplant on the scar.</p><p id="par0050" class="elsevierStylePara elsevierViewall">One of the precautions to be taken into account when performing a hair transplant on a scar is that the density in units/cm<span class="elsevierStyleSup">2</span> must be less than on an area of normal skin (30–40<span class="elsevierStyleHsp" style=""></span>units/cm<span class="elsevierStyleSup">2</span>), because of the risk of follicles competing for the reduced blood flow through the scar tissue.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conventional hair transplantation, the donor strip is limited to the scalp. However, the follicular unit extraction technique enables body hair to be transplanted to the scalp: instead of removing the strip, the follicular units are extracted individually using circular punches measuring 0.7–1<span class="elsevierStyleHsp" style=""></span>mm in diameter. The punch holes heal by second intention within a few days.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Transplantation of body hair follicular units has been described in the literature,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> which addresses the concept of “recipient-dominance”. In other words, the body hair that is transplanted takes on the characteristics of the hair at the receptor site<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,8,9</span></a>; better results are achieved with follicular units from the beard and chest.</p><p id="par0065" class="elsevierStylePara elsevierViewall">While it is true that the chest is prone to keloids and that this should be taken into account and the patient informed, there have been no reports of keloids in white patients after follicular unit extraction using a punch.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Transplantation of body hair follicles is still a controversial technique with few published case reports. Nevertheless, we present this case of cicatricial alopecia, because, although the density obtained to cover the scar is not yet sufficient, we did observe a good growth rate for the body hair. We believe that it is important for the dermatologist to be aware of the usefulness and potential of hair transplantation, since we are often faced with patients who have not been adequately informed about the technique or who have even been discouraged by the specialist.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Meyer-González T, Bisanga C. Reconstrucción de alopecia cicatricial mediante transplante de pelo corporal. Actas Dermosifiliogr. 2012;103:163–164.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 633 "Ancho" => 1717 "Tamanyo" => 162990 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Appearance of the frontotemporal region after the first conventional hair transplant. (B) Appearance of the donor strip in the parietotemporal region.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1853 "Ancho" => 1195 "Tamanyo" => 238721 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Donor strip on the chest after follicular unit extraction. (B) Implantation of follicular units of body hair in the scar.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 828 "Ancho" => 2252 "Tamanyo" => 229853 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Six months after the procedure: (A) frontal region; (B) area of the scar.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autografts in alopecias and other selected dermatological conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. 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Na" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "795" "paginaFinal" => "799" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12269871" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000002/v1_201304241253/S1578219012000716/v1_201304241253/en/main.assets" "Apartado" => array:4 [ "identificador" => "6169" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000002/v1_201304241253/S1578219012000716/v1_201304241253/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000716?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 13 | 22 |
| 2024 October | 86 | 67 | 153 |
| 2024 September | 109 | 38 | 147 |
| 2024 August | 117 | 74 | 191 |
| 2024 July | 111 | 65 | 176 |
| 2024 June | 84 | 53 | 137 |
| 2024 May | 81 | 55 | 136 |
| 2024 April | 100 | 34 | 134 |
| 2024 March | 70 | 29 | 99 |
| 2024 February | 80 | 43 | 123 |
| 2024 January | 57 | 37 | 94 |
| 2023 December | 94 | 20 | 114 |
| 2023 November | 86 | 30 | 116 |
| 2023 October | 65 | 25 | 90 |
| 2023 September | 63 | 32 | 95 |
| 2023 August | 38 | 17 | 55 |
| 2023 July | 42 | 68 | 110 |
| 2023 June | 39 | 30 | 69 |
| 2023 May | 61 | 35 | 96 |
| 2023 April | 63 | 27 | 90 |
| 2023 March | 70 | 25 | 95 |
| 2023 February | 51 | 35 | 86 |
| 2023 January | 48 | 27 | 75 |
| 2022 December | 61 | 50 | 111 |
| 2022 November | 50 | 35 | 85 |
| 2022 October | 37 | 34 | 71 |
| 2022 September | 37 | 35 | 72 |
| 2022 August | 48 | 34 | 82 |
| 2022 July | 48 | 41 | 89 |
| 2022 June | 26 | 19 | 45 |
| 2022 May | 46 | 39 | 85 |
| 2022 April | 70 | 57 | 127 |
| 2022 March | 67 | 56 | 123 |
| 2022 February | 46 | 41 | 87 |
| 2022 January | 69 | 41 | 110 |
| 2021 December | 79 | 54 | 133 |
| 2021 November | 50 | 45 | 95 |
| 2021 October | 64 | 48 | 112 |
| 2021 September | 48 | 43 | 91 |
| 2021 August | 55 | 30 | 85 |
| 2021 July | 28 | 29 | 57 |
| 2021 June | 31 | 24 | 55 |
| 2021 May | 42 | 44 | 86 |
| 2021 April | 92 | 70 | 162 |
| 2021 March | 44 | 32 | 76 |
| 2021 February | 65 | 44 | 109 |
| 2021 January | 25 | 15 | 40 |
| 2020 December | 19 | 15 | 34 |
| 2020 November | 25 | 25 | 50 |
| 2020 October | 19 | 12 | 31 |
| 2020 September | 21 | 12 | 33 |
| 2020 August | 16 | 23 | 39 |
| 2020 July | 23 | 18 | 41 |
| 2020 June | 27 | 29 | 56 |
| 2020 May | 20 | 16 | 36 |
| 2020 April | 26 | 21 | 47 |
| 2020 March | 25 | 14 | 39 |
| 2020 February | 5 | 6 | 11 |
| 2020 January | 0 | 9 | 9 |
| 2019 December | 0 | 2 | 2 |
| 2019 November | 0 | 2 | 2 |
| 2019 September | 0 | 3 | 3 |
| 2019 August | 0 | 1 | 1 |
| 2019 July | 0 | 13 | 13 |
| 2019 June | 0 | 9 | 9 |
| 2019 May | 1 | 54 | 55 |
| 2019 April | 2 | 31 | 33 |
| 2019 March | 0 | 14 | 14 |
| 2019 February | 0 | 3 | 3 |
| 2019 January | 0 | 1 | 1 |
| 2018 December | 0 | 6 | 6 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 1 | 0 | 1 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 0 | 2 | 2 |
| 2018 February | 71 | 6 | 77 |
| 2018 January | 45 | 11 | 56 |
| 2017 December | 92 | 10 | 102 |
| 2017 November | 57 | 12 | 69 |
| 2017 October | 39 | 8 | 47 |
| 2017 September | 45 | 13 | 58 |
| 2017 August | 70 | 14 | 84 |
| 2017 July | 56 | 14 | 70 |
| 2017 June | 67 | 47 | 114 |
| 2017 May | 63 | 13 | 76 |
| 2017 April | 52 | 8 | 60 |
| 2017 March | 35 | 46 | 81 |
| 2017 February | 39 | 16 | 55 |
| 2017 January | 28 | 12 | 40 |
| 2016 December | 52 | 12 | 64 |
| 2016 November | 92 | 7 | 99 |
| 2016 October | 101 | 12 | 113 |
| 2016 September | 134 | 15 | 149 |
| 2016 August | 66 | 11 | 77 |
| 2016 July | 48 | 8 | 56 |
| 2016 June | 15 | 8 | 23 |
| 2016 May | 5 | 9 | 14 |
| 2016 April | 4 | 4 | 8 |
| 2016 March | 10 | 6 | 16 |
| 2016 February | 12 | 4 | 16 |
| 2016 January | 9 | 2 | 11 |
| 2015 December | 9 | 3 | 12 |
| 2015 November | 33 | 2 | 35 |
| 2015 October | 14 | 3 | 17 |
| 2015 September | 10 | 5 | 15 |
| 2015 August | 11 | 1 | 12 |
| 2015 July | 71 | 6 | 77 |
| 2015 June | 44 | 15 | 59 |
| 2015 May | 80 | 16 | 96 |
| 2015 April | 78 | 8 | 86 |
| 2015 March | 57 | 10 | 67 |
| 2015 February | 56 | 11 | 67 |
| 2015 January | 51 | 7 | 58 |
| 2014 December | 52 | 18 | 70 |
| 2014 November | 44 | 14 | 58 |
| 2014 October | 46 | 15 | 61 |
| 2014 September | 44 | 21 | 65 |
| 2014 August | 57 | 15 | 72 |
| 2014 July | 60 | 19 | 79 |
| 2014 June | 80 | 10 | 90 |
| 2014 May | 76 | 13 | 89 |
| 2014 April | 61 | 8 | 69 |
| 2014 March | 74 | 22 | 96 |
| 2014 February | 22 | 10 | 32 |
| 2014 January | 27 | 8 | 35 |
| 2013 December | 25 | 11 | 36 |
| 2013 November | 19 | 9 | 28 |
| 2013 October | 8 | 3 | 11 |
| 2013 September | 15 | 2 | 17 |
| 2013 August | 12 | 10 | 22 |
| 2013 July | 9 | 12 | 21 |
| 2013 June | 9 | 13 | 22 |
| 2013 May | 19 | 5 | 24 |
| 2013 April | 17 | 12 | 29 |
| 2013 March | 14 | 9 | 23 |
| 2013 February | 39 | 8 | 47 |
| 2013 January | 35 | 5 | 40 |
| 2012 December | 23 | 6 | 29 |
| 2012 November | 2 | 2 | 4 |
| 2012 October | 0 | 2 | 2 |
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