217: Hair Transplantation Flashcards
What is the Safest Donor Area (SDA) in hair transplantation?
The Safest Donor Area (SDA) is defined as an area within the zone of rim hair that contains ≥ 8 hairs per 4-mm circle. It allows for the excision of 3-5 strips, each 10 mm long, producing 1500-2750 follicular units (FUs) depending on the density of the donor hair.
What are the ideal hair characteristics to consider during patient selection for hair transplantation?
- Assess the current and anticipated future size of the donor and recipient areas, which depends on:
- Professional experience
- Family history of hair loss
- Patient’s age
- Evaluate hair characteristics.
What are the major intraoperative risks associated with hair transplantation?
The major intraoperative risks include:
- Lidocaine toxicity
- Respiratory depression secondary to sedatives or narcotics
- Excessive intraoperative bleeding.
How is the recipient area designed in hair transplantation?
The recipient area is designed by:
- Drawing the proposed hairline with the frontal recipient
- Ensuring the midline, anteriormost point of the hairline is as superior as acceptable to the patient
- Determining lateral borders by outlining the supratemporal humps.
What are the advantages and disadvantages of strip harvesting in donor site excision?
Advantages of Strip Harvesting:
- Allows for large numbers of grafts to be taken from the densest region of the SDA while retaining a single linear scar.
- Produces a smaller total incision length and area of scar compared to FUE.
Disadvantages:
- Can result in larger numbers of grafts without exceeding the limits of the donor area.
- Higher follicular transection rates.
- Scarring can make subsequent FUE sessions more challenging and limited.
What are the common side effects following hair transplantation?
Common side effects include:
- Minor bleeding
- Scalp hypoesthesia
- Edema
- Crusting
- Pruritus
- Postoperative telogen effluvium.
What is the follow-up procedure after hair transplantation?
Follow-up procedures include:
1. Day after surgery
2. 8-12 days: to remove sutures
3. 4-6 weeks: check healing
4. 9-12 months: assess surgical results and determine need for further treatment.
What complications can arise from alopecia scalp reduction?
Complications from alopecia scalp reduction may include:
- Postoperative bleeding
- Infection
- Nerve damage
- Persistent hair thinning or loss in fringe areas
- Disorientation of hair direction
- Stretch back
- Poor scars.
A patient with Type V male pattern baldness (MPB) requires a hair transplant. What considerations should be made for follicular unit excision (FUE) in this case?
For Type V MPB, more than 6000 FUE grafts are needed, which must be harvested outside the Safest Donor Area (SDA). Additionally, transection rates are higher in FUE, and it can be used to complement strip harvesting.
You are designing the recipient area for a hair transplant. How should the frontal hairline and lateral borders be determined?
The frontal recipient area should have the proposed hairline drawn, with the midline, anteriormost point of the hairline placed as superior as acceptable to the patient. The lateral borders are determined by outlining the supratemporal humps.
A patient undergoing hair transplantation has a strong dislike for linear scars. Which donor site excision method is most suitable for them?
Follicular unit excision (FUE) is most suitable as it does not leave a linear scar. It is useful for patients with a strong dislike or fear of linear scars, those with short hairstyles, or those prone to wider scars.
What are the major intraoperative risks associated with hair transplantation?
The major intraoperative risks include lidocaine toxicity, respiratory depression secondary to sedatives or narcotics, and excessive intraoperative bleeding.
A patient presents with postoperative telogen effluvium after a hair transplant. What is this condition, and how does it manifest?
Postoperative telogen effluvium is a side effect of hair transplantation characterized by temporary hair shedding in the transplanted or surrounding areas.
What are the key characteristics of the Safest Donor Area (SDA) in hair transplantation?
The Safest Donor Area (SDA) is within the zone of rim hair containing ≥ 8 hairs per 4-mm circle. It allows for the excision of 3-5 strips, each 10 mm wide, producing 1500-2750 follicular units (FUs) depending on donor hair density.
What are the advantages of strip harvesting over follicular unit excision (FUE) in hair transplantation?
Strip harvesting allows for large numbers of grafts to be taken from the densest region of the SDA while retaining a single linear scar. It produces a smaller total incision length and scar area compared to typical FUE using a 1 mm diameter punch.
A patient complains of scalp hypoesthesia and pruritus after a hair transplant. What are these symptoms classified as?
Scalp hypoesthesia and pruritus are classified as minor side effects of hair transplantation.
What are the potential aesthetic complications of hair transplantation?
Aesthetic complications include visible scarring, hypertrophic and keloid scarring, unnatural appearance, and poor density.
How should the donor area be determined for hair transplantation in males and females?
In males, the donor area should lie in the middle of the densest zone of fringe hair and extend into the temporal region. In females, it ends posterior to the ears. This ensures the greatest likelihood of transplanted hair being permanent.
What are the follow-up steps after a hair transplant surgery?
Follow-up steps include a check the day after surgery, suture removal at 8-12 days, healing assessment at 4-6 weeks, and surgical results evaluation at 9-12 months to determine the need for further treatment.
What are the medical complications that can arise from hair transplantation?
Medical complications include wound infection, wound dehiscence, neuralgia and neuromas, arteriovenous (AV) fistulas, central recipient area necrosis, and folliculitis.
A patient with a short hairstyle is considering hair transplantation. Which donor site excision method is most appropriate?
Follicular unit excision (FUE) is most appropriate for patients with short hairstyles as it does not leave a linear scar.
What are the complications associated with alopecia/scalp reduction procedures?
Complications include postoperative bleeding, infection, nerve damage, persistent hair thinning or loss in fringe areas, disorientation of hair direction, stretch back, and poor scars.
What is the ideal shape of a follicular unit (FU) for transplantation?
The ideal follicular unit (FU) has most of its epidermis removed and is tear-shaped, with the tapered end near the epidermis and the bulkier end in the subcutaneous tissue.
What are the advantages of body FUE compared to scalp FUE?
Body FUE has the highest growth rates in the beard and chest areas, although the hair has different curl and caliber/coarseness compared to scalp hair.
A patient undergoing hair transplantation has a history of hypertrophic scarring. What aesthetic complication should be anticipated?
The patient may experience hypertrophic or keloid scarring as an aesthetic complication of hair transplantation.
What are the risks of harvesting follicular units (FUs) outside the Safest Donor Area (SDA)?
Harvesting FUs outside the SDA increases the risk of transection and reduces the likelihood of transplanted hair being permanent.
What is the purpose of excising an area of alopecia or future alopecia in scalp reduction procedures?
The purpose is to repair aesthetically unsatisfactory hair transplanting, excise areas of cicatricial alopecia, or advance the hairline.
What are the signs of central recipient area necrosis after a hair transplant?
Signs include tissue death in the central recipient area, which may result in scarring and poor aesthetic outcomes.
How does follicular unit excision (FUE) differ from strip harvesting in terms of scarring?
FUE does not leave a linear scar, making it suitable for patients with short hairstyles or those prone to wider scars, whereas strip harvesting results in a single linear scar.
What are the key steps in designing the recipient area for a hair transplant?
Key steps include drawing the proposed hairline for the frontal recipient area, placing the midline anteriormost point as superior as acceptable, and outlining the lateral borders using the supratemporal humps.
What are the common side effects experienced after a hair transplant?
Common side effects include minor bleeding, scalp hypoesthesia, edema, crusting, pruritus, and postoperative telogen effluvium.
What factors should be assessed when selecting a patient for hair transplantation?
Factors include the current and anticipated future size of the donor and recipient areas, professional experience, family history of hair loss, and the patient’s age.
What are the benefits of using follicular unit excision (FUE) for patients with a tendency to heal with wider scars?
FUE is beneficial as it does not leave a linear scar, making it suitable for patients prone to wider scars.
What are the risks of excessive intraoperative bleeding during hair transplantation?
Excessive intraoperative bleeding can complicate the procedure, increase recovery time, and potentially lead to poor graft survival.
What is the significance of the density of donor hair in determining the number of follicular units (FUs) produced?
The density of donor hair determines the number of FUs produced, with each 10 mm strip yielding 1500-2750 FUs depending on density.
What are the potential complications of wound dehiscence after a hair transplant?
Wound dehiscence can lead to infection, delayed healing, and poor aesthetic outcomes.
How can strip harvesting and FUE be used together in hair transplantation?
Strip harvesting can be used to harvest large numbers of grafts, while FUE can complement it by harvesting additional grafts from areas unsuitable for strip harvesting.
What are the advantages of using the densest zone of fringe hair as the donor area?
Using the densest zone of fringe hair provides the greatest likelihood that transplanted hair will be permanent.
What are the signs of folliculitis after a hair transplant?
Signs of folliculitis include inflammation, redness, and pustules around the transplanted hair follicles.
What are the risks of using sedatives or narcotics during hair transplantation?
The risks include respiratory depression, which can be life-threatening if not managed properly.
What are the benefits of using a small, sharp cylindrical punch for FUE?
A small, sharp cylindrical punch (0.8-1.22 mm) minimizes scarring and allows for precise harvesting of individual follicular units.
What are the potential outcomes of neuralgia and neuromas after a hair transplant?
Neuralgia and neuromas can cause chronic pain and discomfort in the donor or recipient areas.
What is the purpose of assessing surgical results 9-12 months after a hair transplant?
The purpose is to evaluate the success of the procedure, assess hair growth, and determine the need for further treatment.
What are the risks of using body hair for FUE in hair transplantation?
Body hair has different curl and caliber/coarseness compared to scalp hair, which may affect the aesthetic outcome.
What are the potential complications of arteriovenous (AV) fistulas after a hair transplant?
AV fistulas can lead to abnormal blood flow between arteries and veins, potentially causing swelling and other vascular issues.
What are the benefits of removing most of the epidermis from a follicular unit (FU) during transplantation?
Removing most of the epidermis creates a tear-shaped FU, which improves graft survival and integration into the recipient area.
