Androgenetic Alopecia From A to Z: Vol.3 Hair Restoration Surgery, Alternative Treatments, and Hair Care

Foreword
Foreword
Preface
Acknowledgments
Contents
Part VIII: Hair Restoration Surgery (HRS): Lessons from the Past and Basic Principles
The Unregulated Field
Behind Closed Doors
Is HRS a Cosmetic Procedure?
Steps Forward
Who Cares About the Past?
A Few Principles to Begin with
International Society of Hair Restoration Surgery (ISHRS)
Mission, Vision, Core Purpose, and Values of the ISHRS
ISHRS as a Nonprofit, Scientific Organization
American Board of Hair Restoration Surgery (ABHRS)
Mission, Vision, Core Purpose, and Values of the ABHRS
Becoming an ABHRS Diplomate
Fourteen Things That Make HRS a Unique Procedure
Everything You Need to Know About HRS in One Paragraph
84: The History of Hair Transplantation
84.1 The “Prehistory” of HRS
84.2 Initial Steps in the Right Direction
84.3 HRS in AGA: How It All Began
84.4 Evolution of HRS After Orentreich
84.4.1 A Sinful History
84.4.2 Techniques that “Defy” Common Sense
References
85: Punch Grafts: Holes in the Head
85.1 The Lesser of Two Evils
85.2 Reinventing the Wheel Gone Wrong
85.3 What Happened to the Punch Graft Technique Patients?
References
86: Scalp Reduction
86.1 Can 1 + 1 = 3?
86.2 A Historical Perspective
86.3 The Alopecia Reduction Technique
86.4 Complications of AR Procedures
86.5 Cosmetic Issues with AR Procedures
86.6 The Absurdity of ARs
86.7 The Cost of Absurdity
86.8 AR and Modern HRS
References
87: Scalp Expansion
87.1 Volumetric Expansion
87.1.1 Preoperative Volumetric Expansion
87.1.2 Intraoperative Volumetric Expansion
87.2 Nonvolumetric Expansion
87.3 Advantages and Disadvantages of Scalp Expansion
87.4 Scalp Expansion and Modern HRS
References
88: Scalp Lifting
88.1 Scalp Lifting Technique
88.2 The Absurdity of Scalp Lifts
References
89: Scalp Flaps
89.1 The Dawn of an Absurdity
89.2 The Juri Flap Technique
89.3 The Issues with Flaps
89.4 Understanding the Absurdity
References
90: Laser-Assisted HRS
90.1 Why Lasers?
90.2 Technical Details on Lasers and HRS
90.3 The Absurdity of Lasers
90.4 The Endgame of Lasers
References
91: Strip Excision Technique
91.1 One Small Incision, One Giant Leap for HRS!
91.2 Important Parameters of the Strip Excision Technique
91.2.1 Hair Follicle Trauma in the Donor Area
91.2.2 Single-Bladed Knife Vs. Multibladed Knife
91.2.3 Tumescent Anesthesia
91.2.4 Micrografts and Minigrafts
91.2.5 Microscopes and Magnifying Loupes
91.2.6 Graft Storing
91.2.7 Miniholes–Microholes
91.2.8 Dilators
91.2.9 Not the End of the Road Yet!
References
92: Follicular Unit Transplantation (FUT)
92.1 What Is a Natural Follicular Unit (FU)?
92.2 What Is the Follicular Unit Transplantation Technique (FUT)?
92.3 What Is the Follicular Unit Strip Surgery (FUSS)?
92.4 A Historical Perspective
92.5 Why Are FUT Results More Natural?
92.6 Details of the Follicular Unit Implant, the Basic Building Block
92.7 Drawbacks of the FUT Technique
92.8 Author’s Notes
References
93: Follicular Unit Excision (FUE)
93.1 An Early “Disclaimer”
93.2 A Historical Perspective
93.3 Childhood Illnesses
93.4 The Follicular Holocaust
93.5 Tools of the Trade
93.6 Divide and Conquer
93.7 The Prerequisites and the Right Process
93.7.1 Technical Aspects and Preparation Steps (Fig. 93.12)
93.7.2 Incision/Scoring Steps
93.7.3 Extraction Steps (Fig. 93.15)
93.7.4 Collection Steps
93.8 Recent Nomenclature of FUE
93.9 Advantages and Disadvantages of FUE
93.9.1 Advantages for the Surgeon
93.9.2 Advantages for the Patient
93.10 Drawbacks of the FUE Technique
93.10.1 Drawbacks for the Surgeon
93.10.2 Drawbacks for the Patient
93.11 Candidacy for FUE
93.12 Contraindications for FUE
93.13 Considerations and Controversies in FUE
93.13.1 Harvesting Rationale and Pattern
93.13.2 The Surface Area That Is Safe to Harvest from and Respecting the Donor Area Limits
93.13.3 Creative and Wishful Thinking
93.13.4 Graft Injuries
93.13.5 FUE Vs. FUSS Grafts
93.13.6 Effect of FUE on the Donor Area and the Plague of Overharvesting
93.13.7 Safety of FUE Megasessions
93.13.8 FUE Delegation and Other Ethical Considerations
93.14 Conclusion
93.15 Author’s Notes
References
94: Βody Ηair Τransplantation FUE (ΒΗΤ FUE)
94.1 A Historical Perspective
94.2 Indications for BHT FUE
94.3 Technical Details of BHT FUE
94.4 Candidacy for BHT FUE
94.5 Benefits of the BHT Technique
94.6 Challenges with the BHT Technique
94.7 Complications of the BHT Technique
References
95: Patient Selection in HRS
95.1 Major Criteria
95.2 Minor Criteria
95.3 What Else Should an HRS Surgeon Know?
95.4 Which Patients Should Not Undergo HRS?
95.5 Patient Selection
95.5.1 Medical Red Flags
95.5.2 Objective Red Flags
95.5.2.1 Details on Some Objective Red Flags
95.5.3 Subjective Red Flags
95.5.4 Body Dysmorphic Disorder (BDD)
95.6 An Unpleasant Truth About HRS
References
96: Initial Interview, Evaluation, and Consultation
96.1 Same or Different Aims?
96.2 Medical History
96.3 Goals, Expectations, Incentives, and Fantasies!
96.3.1 Some Are too Bald, and Others Are too Young
96.4 Physical Examination
96.5 How to Build Correct and Accurate Expectations
96.6 How to Estimate Properly Recipient Area Requirements
96.7 Informed Consent
96.8 Preoperative Workup
96.9 Photography
96.10 After the Medical History and Physical Examination
96.11 Author’s Notes
References
97: Overview of Anesthesia in Hair Restoration Surgery
97.1 Anesthesia in HRS Operations
97.2 Safety in HRS
97.3 Techniques of Regional Anesthesia
97.3.1 Field Blocks in HRS
97.3.2 Peripheral Nerve Blocks in HRS
97.3.3 Tumescent Anesthesia in HRS
97.3.3.1 Conscious Sedation
97.3.4 How to Reduce Pain from Injections
97.3.4.1 Local Analgesia
97.3.4.2 Ice Packs
97.3.4.3 Buffering the pH and Warming of the Anesthetic
97.3.4.4 Adjunctive Injection Techniques
97.4 Complications from Local Anesthetics
97.4.1 Adverse Reactions
97.4.2 Lidocaine in HRS
97.4.3 Bupivacaine in HRS
97.4.4 Local and Systemic Adverse Effects of Anesthetics
97.5 Epinephrine-Induced Complications
97.6 Other Techniques for the Management of Intraoperative Bleeding
97.7 Author’s Notes
References
98: Overview of Safe Donor Area
98.1 How Safe Is Safe Enough?
98.2 The Size and Shape of the Safe Donor Area
98.3 Author’s Notes
98.4 SDA in FUE: What Is the Deal?
98.5 Evaluating of the Donor Area
98.6 Laxity = Glidability + Elasticity
98.7 How Much of the SDA Can Actually Be Moved During One FUSS Session?
98.8 How Much Surface of the SDA Can Actually Be Moved in a Lifetime?
References
99: The Intricate Details of the Donor Area
99.1 The Density of the Donor Area
99.1.1 Follicular Density (FD)
99.1.2 Calculated Density (CD)
99.1.3 A Mathematical Approach to the Density Issue
99.1.4 Hair Density (HD)
99.2 Tools for the Measurement of Density and Other Parameters
99.3 Features of the Donor Area Hair
99.3.1 Hair Caliber
99.3.2 Hair Length
99.3.3 Hair Curl or Wave
99.3.4 The Color Contrast Between Hair and Scalp Skin
99.3.5 Hair Shine
99.4 How the Removal of the Strip Graft Affects the Density of the Donor Area
99.5 When One Hair Follicle Is Worth Two: The “Rule of 50%”!
99.6 How Is the Donor Bank Affected by Harvesting?
99.7 Author’s Notes
References
100: Techniques of Dissection and Closure of the Donor Area
100.1 Harvesting Key Points
100.1.1 Positioning
100.1.2 Exposure
100.2 Anesthesia and Tumescence
100.2.1 Line of Incision
100.2.2 Depth of Scoring Incision and Relevant Tools
100.2.3 Type of Scalpel
100.2.4 Angle of Incision
100.2.5 Natural Dissection Plane
100.2.6 Hemostasis and Debris Cleaning
100.3 Donor Closure: Things Change
100.4 Suture or Staples?
100.4.1 Staples
100.4.2 Suturing
100.5 One or Two Layers?
100.6 Collateral Damages
100.7 Trichophytic Closure Technique
100.8 Author’s Notes
100.9 My Personal “Stepwise FUT Approach”
100.9.1 Natural Dissection Plane
References
101: Donor Area Complications
101.1 Donor Area Complications
101.2 Cosmetic Complications
101.2.1 Wide/Visible Scarring (FUSS Only)
101.2.2 Too Deep Incisions
101.2.3 Too Wide Donor Strips
101.2.4 Too High Closing Tension Along the Suture Line
101.2.5 Poor Wound Edge Approximation
101.2.6 Too Deep and Wide Suturing
101.2.7 Loss of Hair Follicles Along the Incision Margins
101.2.8 Noncontour Incisions
101.2.9 Too Low Incision
101.2.10 Too High Incision
101.2.11 Not Removing the Previous Donor Scar
101.2.12 Idiosyncratic Reasons
101.2.13 Poor Patient Compliance
101.2.14 Keloid Scars and Hypertrophic Scars (FUSS and FUE)
101.2.15 Donor Area Effluvium
101.2.16 Donor-Area Complications Specific to FUE
101.3 Medical Complications
101.3.1 Bleeding and Hematoma
101.3.2 Wound Dehiscence
101.3.3 Wound Necrosis
101.3.4 Neuralgia, Anesthesia, Hypoesthesia, and Neuroma
101.3.5 Arteriovenous Fistula and Aneurism
101.3.6 Local Infection or Reaction
101.3.7 Folliculitis
101.3.8 Seborrheic Dermatitis Reaction
101.3.9 MRSA Scalp Infection
References
102: The Surgical Zones of the Recipient Area
102.1 Definition of the Recipient Area
102.2 Definition of the Four Major Surgical Zones in HRS
102.2.1 Frontal Area
102.2.2 Midscalp
102.2.3 Vertex and Crown
102.2.4 Areas of Evolving AGA
102.2.5 Other Scalp Landmarks and Terms
102.3 The Surface Area of the Four Fundamental Surgical Zones in FUT
References
103: Graft Survival Considerations and Strategies
103.1 Graft Survival: A Matter of Life and Death!
103.2 Factors Affecting Graft Yield
103.3 Factors Affecting Graft Survival
103.3.1 Graft Size
103.3.2 Dehydration or Desiccation: The No. 1 Killer of Grafts!
103.3.3 Storing Temperature
103.3.4 Physical Sharp Trauma (Follicular Transection)
103.3.5 Physical Blunt Trauma (Follicular Crushing)
103.3.6 Out-of-Body Time
103.3.7 Ischemia-Reperfusion Syndrome
103.3.8 Graft Popping
103.3.9 Too Deep Sites
103.3.10 Too Shallow Sites
103.3.11 Bending and Piggybacking
103.4 How to Maximize Graft Survival
103.5 What Else Can Cause Decreased Survival?
103.6 It All Boils Down to What?
References
104: Recipient Area Injury and Relevant Parameters
104.1 Scalp Vascularization
104.2 How Does the Recipient Area Get Injured?
104.3 Tools for Site Creation
104.3.1 Microblades
104.3.2 Standard Needles
104.3.3 Micropunches
104.4 Are These Tools Truly Different?
104.5 Problems Due to Unsuitable Tools
104.6 Author’s Notes
References
105: Overview of Graft Insertion Techniques
105.1 Basic Principles
105.2 Techniques of Graft Insertion
105.3 Stick-and-Place Technique (S&P)
105.4 Graft Insertion into Premade Incisions (GIPI)
105.5 Hair Implanters
105.5.1 Characteristics of Implanters
105.5.2 Implanter Technique
105.5.3 S&P Implanter Technique
105.5.4 Implanter GIPI Technique
105.6 Which Technique Is Superior?
105.7 Author’s Notes
References
106: The Density and Coverage of the Recipient Area
106.1 Cosmetic Density
106.2 Density and Graft Survival
106.3 Dense Packing
106.4 Is Dense Packing Necessary in Modern FUE?
106.5 Author’s Notes
References
107: Transplanting into Hair-Bearing Recipient Areas
107.1 Thinning and “Thickening”
107.2 When Can One Transplant Between Existing Hairs?
107.3 Shock Loss: Shocked Patient!
107.3.1 A Typical Story
107.4 Rescue Techniques for Pre-existing Hair in the Recipient Area
107.5 Author’s Notes
References
108: Hairline Design and Grafting
108.1 What Makes the Hairline So Important?
108.2 What Are the Features of the Hairline?
108.3 Designing the Hairline
108.3.1 Height
108.3.2 Shape and Contour
108.3.3 Type of Grafts
108.3.4 Challenges with Single-Hair FUs
108.3.5 Angle and Direction
108.3.6 Curl
108.3.7 Microirregularities and Macroirregularities
108.3.8 Depth
108.3.9 Design of Lateral Margins
108.4 Temporal Hairline
108.5 Frontal Tuft
108.6 Pitfalls in Creating a Frontal Hairline
108.6.1 Too-Dense Hairline Border
108.6.2 Wrong Angle of Grafts
108.6.3 Wrong Type of Grafts
108.6.4 Too-Low Hairline
108.6.5 Too-High Hairline
108.6.6 Too-Round Hairline
108.6.7 Too-Flat Hairline
108.6.8 Too-Straight Hairline Border
108.6.9 Concave Contour Hairline
108.6.10 V-Shape Contour
108.7 Author’s Notes
References
109: Midscalp Design and Grafting
109.1 Grafting Between Midscalp Hair
109.2 Graft Types in the Midscalp
109.3 Graft Angle in the Midscalp
109.4 Graft Distribution in the Midscalp
109.4.1 Frontal Forelock Design
109.4.2 Lateral Crease
109.4.3 Weighting Technique
109.5 Author’s Notes
References
110: Crown and Vertex Design and Grafting
110.1 Anatomy of the Crown
110.2 Crown Area Unique Features
110.2.1 Anatomical Reasons
110.2.2 Cosmetic Reasons
110.2.3 Lack of Specific Guidelines for Crown Restoration
110.3 When Is it Safe to Transplant the Crown?
110.3.1 What about Hair Growth Medications?
110.4 Technical Issues when Transplanting the Crown
110.5 Author’s Notes
References
111: Megasessions: Is More, Better?
111.1 What Constitutes a Megasession?
111.2 Advantages of Megasessions
111.2.1 Social and Practical Reasons
111.2.2 Medical Reasons
111.2.3 Donor Area Reasons
111.2.4 Recipient Area Reasons
111.2.5 Graft Distribution Reasons
111.2.6 Telogen Effluvium
111.2.7 Financial Reasons
111.2.8 Long-Term Convenience
111.3 Drawbacks
111.3.1 Social Reasons
111.3.2 Medical Reasons
111.3.3 Donor Area Reasons
111.3.4 Recipient Area Reasons
111.3.5 Practical Reasons Concerning FUSS in Particular
111.3.6 Telogen Effluvium
111.3.7 Financial Reasons
111.3.8 Post-op Care
111.3.9 Reasons Concerning the Surgical Team
111.3.10 Short-Term Inconvenience
111.4 FUE Megasessions: A Very Different Animal
111.5 Some Further Thoughts on the Matter
References
112: Second Session and Subsequent Sessions
112.1 Adding Density
112.2 Candidates for a Second Session
112.3 When Is the Time Right?
112.4 Controversy on Additional Sessions
112.5 Author’s Notes
References
113: The Combo Technique: Joined Forces
113.1 Principles of HRS Revisited
113.2 Why Isn’t a Single Technique Enough for Everybody?
113.3 Historical Background of TCT
113.4 Rationale for TCT
113.5 Indications for TCT
113.5.1 Medical Reasons
113.5.2 Social Reasons
113.6 Operative Considerations
113.6.1 Virgin Scalp Indications for TCT
113.6.2 Nonvirgin Scalp Indications for TCT (Besides the Ones Mentioned Above)
113.7 Categories of TCT
113.8 Virgin Scalp Indications for TCT
113.8.1 Operative Considerations
113.9 Nonvirgin Scalp Indications for TCT (Besides the Ones Mentioned Above)
113.9.1 Operative Considerations
References
114: Postoperative Care and Follow-Up
114.1 Immediate Postoperative Care
114.1.1 Wound Moisture
114.1.2 Pain Management
114.1.3 Edema
114.1.4 Bleeding
114.1.5 Graft Dislodgement
114.1.6 Itching
114.1.7 Shampooing and Hygiene
114.1.8 Removal of Sutures/Staples
114.1.9 Return to Work/Activities/Sports
114.1.10 FUSS
114.1.11 FUE
114.1.12 Sun Exposure
114.2 Late Postoperative Care
114.2.1 Folliculitis–Cysts
114.2.2 Scabs and Crusting
114.2.3 Hypoesthesia
114.2.4 Central Scalp Necrosis
114.2.5 Postoperative Effluvium (Shock-Loss)
114.2.5.1 Shedding of Transplanted Hair Follicles
Delayed Growth of Transplanted Hair Follicles
114.2.5.2 Shedding of Pre-existing Hair in the Recipient Area
114.2.5.3 Shedding of Pre-existing Hair in the Donor Area
114.3 Author’s Notes
References
115: Hair Restoration Surgery in Female Patients
115.1 Disclaimer
115.2 HRS in Women vs. Men
115.3 Differential Diagnosis of Female Hair Loss
115.4 Candidacy for HRS
115.5 Differences of HRS in Women vs. Men
115.5.1 Anatomical Differences
115.5.1.1 Hairline Design
115.5.1.2 Hairline Preservation
115.5.1.3 Resident Hair in the Recipient Area
115.5.1.4 The Density of the Female Donor Area
115.5.1.5 Smaller Donor Area
115.5.1.6 Body Hair FUE
115.5.2 Technical Differences
115.5.2.1 Donor Area
115.5.2.2 Recipient Area
115.5.2.3 Better Coverage
115.5.2.4 Delayed Growth
115.5.2.5 Telogen Effluvium
115.5.2.6 Edema
115.5.2.7 Paresthesia
115.5.2.8 Other Exceptional Circumstances in Women
115.6 Indications for HRS in Women
115.6.1 General Surgical Design
115.6.2 Typical FPHL
115.6.3 Too High Hairline
115.6.4 Wide Forehead
115.6.5 Scars from Previous Cosmetic Surgery
115.6.6 Scarring-Traumatic Alopecias
115.6.7 Contraindications for Female HRS
115.7 Author’s Notes
References
116: Medical Treatments and HRS
116.1 Minoxidil in Hair Restoration Surgery
116.2 Finasteride in Hair Restoration Surgery
116.3 The Strategy for the Use of Medical Treatment in HRS
116.4 Treatment “Background” of Patients Before HRS
116.5 When to Prescribe Treatment Instead of HRS?
116.6 Effect of Medical Treatment on HRS Planning
116.7 Medical Treatment and Malpractice
116.8 Author’s Notes
References
117: Corrective and Repair HRS
117.1 Difference Between HRS vs. Repair HRS
117.2 Profile of the Repair HRS Patient
117.3 Problems Requiring Corrective HRS
117.3.1 Recipient Area
117.3.2 Donor Area
117.4 Repair Techniques Overview
117.5 Repair HRS in the FUE Era
117.6 Author’s Notes
References
118: Scalp Micropigmentation
118.1 Tattooing and Medicine: A Colorful Story!
118.2 Histology of Tattooing
118.3 Scalp Tattooing
118.4 Scalp Micropigmentation (SMP)
118.5 SMP Technical Details
118.6 Semipermanent or Temporary SMP
118.7 Indications of SMP
118.8 Density SMP
118.9 Scar Camouflage SMP
118.10 Shaved-Look SMP
118.11 Adverse Effects of SMP
118.12 SMP vs. Tattooing
118.13 Tattoo Removal vs. SMP Removal
References
119: Synthetic Hair Fiber Implantation: Fishing Lines on the Head
119.1 How It All Started
119.2 What Were the Problems?
119.2.1 Implantation Techniques
119.2.2 Histopathology of Artificial Hair Fibers [6, 21, 22]
119.3 Complications
119.3.1 Early Complications (Occurrence up to 4 Weeks) [24–30]
119.3.2 Late Complications (Occurrence After 4 Weeks) [24–30]
119.3.2.1 Local
119.3.2.2 Systemic
119.4 Management of Complications [34, 35]
119.5 Modern Synthetic Hair Fibers: History Repeating
119.5.1 Japanese Fibers
119.5.2 Italian Artificial Hairs
119.6 Publications on New Synthetic Hair Fibers
119.6.1 Concerning Peer-Reviewed Publications
119.7 Technical Details of Implantation of Newer Synthetic Fibers
119.8 Histopathology
119.9 So What Is the Truth?
119.10 FDA’s Rejection of Revoking the Ban on Prosthetic Hair Fibers
119.11 Why Some Doctors Choose Synthetic Fibers?
119.12 Why Some Patients Choose Synthetic Fibers?
119.13 Author’s Notes
References
120: Future Trends in HRS
120.1 Hair Follicle Bisection
120.2 Robots and HRS
120.3 Platelet-Rich Plasma Growth Factors (PRP)
120.4 ACell MatriStem™
120.4.1 FUSS Donor Harvesting
120.4.2 FUE Harvesting
120.4.3 Body Hair Transplant Harvesting
120.4.4 Graft Coating
120.4.5 Plucked Hair Transplantation
120.4.6 Use in AGA Treatment
120.4.7 Repair of Old Strip/FUSS Scars
120.5 Hair Follicle “Autocloning”
120.6 Holding and Graft Storage Solutions
References
Part IX: Alternative and Potential Future Treatments of AGA/FPHL
121: Low-Level Laser Therapy (LLLT) and AGA
121.1 Why Use a LASER?
121.2 LASERs in General
121.2.1 High Level Vs. Low-Level Lasers
121.2.2 Collimated and Coherent (LASER) Vs. Noncoherent Light (LED)
121.3 General Principles of LLLs Action
121.4 Applications of LLLT
121.5 LLLT Mechanism of Action
121.5.1 Subcellular Actions of LLLT
121.5.2 Cellular Actions of LLLT
121.5.3 The Arndt–Schultz Law or Biphasic Dose–Response of LLLT
121.6 Mechanism of Action of LLLT on Hair Follicles and How It All Started
121.6.1 Theories on the Mechanism of LLLT on Hair Growth
121.7 LLLT and Early Hair Growth Reports
121.8 LLLT and Alopecias
121.9 LLLT and Treatment of AGA/FPHL
121.9.1 LLLT Studies After FDA Clearance
121.10 Systematic Reviews and Meta-analyses on LLLT and Hair Growth
121.11 LLLT Safety and Related Adverse Effects
121.12 LLLT Devices and the FDA: An Inconvenient Truth
121.12.1 What Is the FDA 510(k)-Clearance Process?
121.13 LLLT Protocol of Use
121.14 Patient Selection
121.15 LLLT in the Future
121.16 Author’s Notes
References
122: Genetic Engineering and Gene Therapy
122.1 What Is Genetic Engineering?
122.2 Why the Hair Follicle?
122.3 Technical Issues
122.4 Stages of Genetic Engineering One by One
122.4.1 Steps a and b: Gene Identification and Isolation
122.4.2 Step c: Targeting the Organ’s Stem Cells
122.4.3 Step d: Transfer and Proliferation
122.4.4 Step e1: Delivery of Genes to the Cell
122.4.4.1 Devices for Transdermal Absorption
122.4.5 Step e2: Delivery of Genes to the Nucleus
122.4.6 Step f: Integration of Genes into the DNA
122.4.7 Step g: Predictable Result
122.4.8 Step h: Prolonged Action
122.4.9 Step i: Short- and Long-Term Safety
122.5 Which Challenges Remain Ahead?
122.6 What Is the Conclusion?
References
123: Stem Cells and Hair Follicle Cloning/Engineering
123.1 What Are Stem Cells?
123.2 How Could We Use Stem Cells in Hair Follicle Disorders?
123.3 A Legal Framework
123.4 Basic Embryology and Anatomy of Hair Follicles
123.5 Levels of Complexity
123.6 Tiny But Mighty
123.7 What Kind of Hair Follicles Do We Need to Create?
123.8 Growth Factors and Stem Cells
123.9 Mesenchymal Stem Cell Therapy and Adipose Tissue-Derived Stem Cells
123.10 Hair Growth-Promoting Effects of ADSCs
123.11 Latest Research on Humans
123.12 Neogenesis of Hair Follicles by Tissue Engineering
123.13 Folliculo-Neogenesis in Humans
123.14 Issues Remaining to be Solved
123.15 Where Can We Go from Here?
123.16 Role of Bulge Stem Cells in Tumorigenesis [1, 2]
123.17 Where Are We Standing Now?
123.18 But, Is Folliculo-Neogenesis the Answer?
123.19 Reminding Some Basic Knowledge on Hair Loss
123.20 So Why Are We Aiming for Stem Cell “Therapies?”
123.20.1 Concept of De Novo Folliculo-Neogenesis
123.20.2 Concept of Follicular Cell Implantation to Vellus Hair Follicles
123.21 Legal Framework and Caution in Stem Cell Therapies
123.22 Conclusion
References
124: Platelet-Rich Plasma (PRP)
124.1 Platelet-Rich Plasma (PRP): What Is It?
124.2 General Applications of PRP
124.3 PRP and Regulatory Issues
124.4 PRP’s Mechanism of Action
124.5 More PRP Is Not Better PRP
124.6 PRP and the Hair Follicle
124.7 PRP and AGA/FPHL
124.8 PRP and ΑGΑ/FPHL Meta-analyses
124.9 PRP Contraindications and Safety in ΑGΑ/FPHL
124.10 Contraindications for PRP [130]
124.11 Are All PRPs Created Equal?
124.12 PRP Unanswered Questions on ΑGΑ/ FPHL
124.13 Things to Consider About PRP in the Treatment of ΑGΑ/FPHL
124.14 Conclusion
References
125: Microneedling
125.1 General Mechanism of Action
125.2 Proposed Mechanisms of Action on Hair Follicles
125.3 Microneedling Procedure for Alopecia
125.4 Microneedling and AGA/FPHL
125.5 Adverse Effects
125.6 Regulatory Issues
125.7 Author’s Notes
References
126: Exosomes
126.1 What Are the Exosomes?
126.2 How Exosomes Work
126.3 How Are Exosomes Produced and Purified
126.4 Exosomes and Stem Cells
126.5 Exosomes, Skin Functions, and Alopecias
126.6 Exosomes and Hair Growth
126.7 In Vitro Studies
126.8 Animal Studies
126.9 Human Studies
126.10 Legal Framework and Caution in Exosome Therapy
126.11 Challenges of Exosomes in Hair Growth Therapy
126.12 Exosome Unanswered Questions on ΑGΑ/FPHL
References
Part X: Coverage and Hair Care
127: Concealing of Hair Loss and Cover-Up Products
127.1 How Do These Concealers Work?
127.2 Hair Powders
127.3 Fluids and Pastes
127.4 Spray-On Products
127.5 Microfiber Products
127.6 Hair Crayons or Sticks
127.7 Benefits of Hair Loss Concealers
127.8 When More Is Too Much
127.9 Concealers and Daily Routine
References
128: Wigs and Hair Prosthesis
128.1 Some History
128.2 Wigs in Dermatology
128.3 Wigs Today
128.4 Modern Trends on Wigs and ΑGΑ
128.5 Impression Management
128.6 The Fear of Exposure
128.7 A Key Distinction
128.8 Classification of Wigs
128.8.1 Types of Wigs According to Size
128.8.2 Types of Wigs According to Hair Fiber Type
128.8.2.1 Synthetic Fibers
128.8.2.2 Natural Fibers/Human Hair
128.8.3 Types of Wigs According to the Base Material
128.8.4 Types of Wigs Based on the Insertion of Fibers
128.8.5 Attachment/Fixation Methods
128.8.5.1 Fixed Adhesion
128.8.5.2 Temporary Adhesion
128.9 Wig Care and Replacement
128.10 Scalp Hygiene
128.11 Inconvenient Truths About Wigs in AGA
128.12 Cost
128.12.1 Unnatural Appearance
128.12.2 Progression of AGA
128.12.3 Feeling Trapped
128.12.4 Discomfort–Stress–Embarrassment
128.13 “Tricks of the Trade”
128.14 Conclusion
References
129: Shampoos and AGA/FPHL
129.1 Key Issues
129.2 Needs and Requirements of ΑGΑ/FPHL Patients from Shampoos
129.3 Conclusions and Instructions
129.4 Instructions for Proper Hair Washing
129.5 Extra Tips
References
Index