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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 4 | 6 | 10 |
| 2024 Octubre | 86 | 67 | 153 |
| 2024 Septiembre | 109 | 38 | 147 |
| 2024 Agosto | 117 | 74 | 191 |
| 2024 Julio | 111 | 65 | 176 |
| 2024 Junio | 84 | 53 | 137 |
| 2024 Mayo | 81 | 55 | 136 |
| 2024 Abril | 100 | 34 | 134 |
| 2024 Marzo | 70 | 29 | 99 |
| 2024 Febrero | 80 | 43 | 123 |
| 2024 Enero | 57 | 37 | 94 |
| 2023 Diciembre | 94 | 20 | 114 |
| 2023 Noviembre | 86 | 30 | 116 |
| 2023 Octubre | 65 | 25 | 90 |
| 2023 Septiembre | 63 | 32 | 95 |
| 2023 Agosto | 38 | 17 | 55 |
| 2023 Julio | 42 | 68 | 110 |
| 2023 Junio | 39 | 30 | 69 |
| 2023 Mayo | 61 | 35 | 96 |
| 2023 Abril | 63 | 27 | 90 |
| 2023 Marzo | 70 | 25 | 95 |
| 2023 Febrero | 51 | 35 | 86 |
| 2023 Enero | 48 | 27 | 75 |
| 2022 Diciembre | 61 | 50 | 111 |
| 2022 Noviembre | 50 | 35 | 85 |
| 2022 Octubre | 37 | 34 | 71 |
| 2022 Septiembre | 37 | 35 | 72 |
| 2022 Agosto | 48 | 34 | 82 |
| 2022 Julio | 48 | 41 | 89 |
| 2022 Junio | 26 | 19 | 45 |
| 2022 Mayo | 46 | 39 | 85 |
| 2022 Abril | 70 | 57 | 127 |
| 2022 Marzo | 67 | 56 | 123 |
| 2022 Febrero | 46 | 41 | 87 |
| 2022 Enero | 69 | 41 | 110 |
| 2021 Diciembre | 79 | 54 | 133 |
| 2021 Noviembre | 50 | 45 | 95 |
| 2021 Octubre | 64 | 48 | 112 |
| 2021 Septiembre | 48 | 43 | 91 |
| 2021 Agosto | 55 | 30 | 85 |
| 2021 Julio | 28 | 29 | 57 |
| 2021 Junio | 31 | 24 | 55 |
| 2021 Mayo | 42 | 44 | 86 |
| 2021 Abril | 92 | 70 | 162 |
| 2021 Marzo | 44 | 32 | 76 |
| 2021 Febrero | 65 | 44 | 109 |
| 2021 Enero | 25 | 15 | 40 |
| 2020 Diciembre | 19 | 15 | 34 |
| 2020 Noviembre | 25 | 25 | 50 |
| 2020 Octubre | 19 | 12 | 31 |
| 2020 Septiembre | 21 | 12 | 33 |
| 2020 Agosto | 16 | 23 | 39 |
| 2020 Julio | 23 | 18 | 41 |
| 2020 Junio | 27 | 29 | 56 |
| 2020 Mayo | 20 | 16 | 36 |
| 2020 Abril | 26 | 21 | 47 |
| 2020 Marzo | 25 | 14 | 39 |
| 2020 Febrero | 5 | 6 | 11 |
| 2020 Enero | 0 | 9 | 9 |
| 2019 Diciembre | 0 | 2 | 2 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Septiembre | 0 | 3 | 3 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 13 | 13 |
| 2019 Junio | 0 | 9 | 9 |
| 2019 Mayo | 1 | 54 | 55 |
| 2019 Abril | 2 | 31 | 33 |
| 2019 Marzo | 0 | 14 | 14 |
| 2019 Febrero | 0 | 3 | 3 |
| 2019 Enero | 0 | 1 | 1 |
| 2018 Diciembre | 0 | 6 | 6 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 2 | 2 |
| 2018 Febrero | 71 | 6 | 77 |
| 2018 Enero | 45 | 11 | 56 |
| 2017 Diciembre | 92 | 10 | 102 |
| 2017 Noviembre | 57 | 12 | 69 |
| 2017 Octubre | 39 | 8 | 47 |
| 2017 Septiembre | 45 | 13 | 58 |
| 2017 Agosto | 70 | 14 | 84 |
| 2017 Julio | 56 | 14 | 70 |
| 2017 Junio | 67 | 47 | 114 |
| 2017 Mayo | 63 | 13 | 76 |
| 2017 Abril | 52 | 8 | 60 |
| 2017 Marzo | 35 | 46 | 81 |
| 2017 Febrero | 39 | 16 | 55 |
| 2017 Enero | 28 | 12 | 40 |
| 2016 Diciembre | 52 | 12 | 64 |
| 2016 Noviembre | 92 | 7 | 99 |
| 2016 Octubre | 101 | 12 | 113 |
| 2016 Septiembre | 134 | 15 | 149 |
| 2016 Agosto | 66 | 11 | 77 |
| 2016 Julio | 48 | 8 | 56 |
| 2016 Junio | 15 | 8 | 23 |
| 2016 Mayo | 5 | 9 | 14 |
| 2016 Abril | 4 | 4 | 8 |
| 2016 Marzo | 10 | 6 | 16 |
| 2016 Febrero | 12 | 4 | 16 |
| 2016 Enero | 9 | 2 | 11 |
| 2015 Diciembre | 9 | 3 | 12 |
| 2015 Noviembre | 33 | 2 | 35 |
| 2015 Octubre | 14 | 3 | 17 |
| 2015 Septiembre | 10 | 5 | 15 |
| 2015 Agosto | 11 | 1 | 12 |
| 2015 Julio | 71 | 6 | 77 |
| 2015 Junio | 44 | 15 | 59 |
| 2015 Mayo | 80 | 16 | 96 |
| 2015 Abril | 78 | 8 | 86 |
| 2015 Marzo | 57 | 10 | 67 |
| 2015 Febrero | 56 | 11 | 67 |
| 2015 Enero | 51 | 7 | 58 |
| 2014 Diciembre | 52 | 18 | 70 |
| 2014 Noviembre | 44 | 14 | 58 |
| 2014 Octubre | 46 | 15 | 61 |
| 2014 Septiembre | 44 | 21 | 65 |
| 2014 Agosto | 57 | 15 | 72 |
| 2014 Julio | 60 | 19 | 79 |
| 2014 Junio | 80 | 10 | 90 |
| 2014 Mayo | 76 | 13 | 89 |
| 2014 Abril | 61 | 8 | 69 |
| 2014 Marzo | 74 | 22 | 96 |
| 2014 Febrero | 22 | 10 | 32 |
| 2014 Enero | 27 | 8 | 35 |
| 2013 Diciembre | 25 | 11 | 36 |
| 2013 Noviembre | 19 | 9 | 28 |
| 2013 Octubre | 8 | 3 | 11 |
| 2013 Septiembre | 15 | 2 | 17 |
| 2013 Agosto | 12 | 10 | 22 |
| 2013 Julio | 9 | 12 | 21 |
| 2013 Junio | 9 | 13 | 22 |
| 2013 Mayo | 19 | 5 | 24 |
| 2013 Abril | 17 | 12 | 29 |
| 2013 Marzo | 14 | 9 | 23 |
| 2013 Febrero | 39 | 8 | 47 |
| 2013 Enero | 35 | 5 | 40 |
| 2012 Diciembre | 23 | 6 | 29 |
| 2012 Noviembre | 2 | 2 | 4 |
| 2012 Octubre | 0 | 2 | 2 |
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