Sheldon S. Kabaker

Correction of the High Female Hairline

OBJECTIVES To review a technique and to make quantitative analyses of the senior authors 20-year experience with his preferred technique to correct the high female hairline. METHODS A retrospective review of 29 female patients who underwent the hairline-lowering procedure performed by the same surgeon (S.S.K.). We analyzed preoperative and postoperative standardized photographs by taking measurements from the medial and lateral canthi to the anterior hairline. Facial height, from the menton to the hairline, was also measured. We calculated mean values and then used a 2-tailed, paired t test to evaluate for statistical significance. Patients also underwent evaluation for satisfaction, complications, and aesthetic result. We reevaluated the measurements from the profile view and compared them with the original data. RESULTS The photographed midfrontal hairline position was vertically lowered on average 1.3 cm in patients who underwent a single-stage procedure (P < .001). In retrospect, the analysis was flawed compared with clinical experience. Therefore, the profile views were evaluated, and the correlating true curvilinear advancement was an average of 2.1 cm. Three complications occurred, including 1 major effluvium, 1 minor effluvium, and 1 scar that required revision. Patient satisfaction was extremely high. CONCLUSIONS Advancement of the female hairline by incorporating an irregular trichophytic incision and a posterior scalp advancement flap is an effective and safe technique that has been used by the senior author for more than 2 decades. The average advancement was 2.1 cm in this study. The technique is immediately effective, well tolerated by patients, and associated with minimal complications. Although it is associated with a potentially visible incision, this technique can be used to make the scar virtually invisible.

Scalp Extension in the Treatment of Male Pattern Baldness

In order to clinically assess the efficacy of tissue extension applied to scalp reduction, a prospective study was performed on 24 patients who underwent tissue extension between scalp reductions in the treatment of male pattern baldness. The accelerated rate of reduction provided by tissue extension was found to be most efficient when the extension was performed for 31 days or less after scalp reduction. The complication rate was low, while patient acceptance was high. Tissue extension is a valuable technique in scalp reduction for male pattern baldness with potential clinical applications to other situations where the harvesting of surrounding local tissue is indicated.

Core curriculum for hair restoration surgery, recommended by the International Society of Hair Restoration Surgery (ISHRS).

BACKGROUND Because hair restoration surgery (HRS) has changed so significantly, the International Society of Hair Restoration Surgery (ISHRS) presents the recently developed Core Curriculum for Hair Restoration Surgery (CCHRS). Physician competence in HRS demands a sound understanding of all of the alternate pathologic causes of hair loss, as well as their risks and treatments. OBJECTIVE The CCHRS defines the knowledge, didactic information, medical insights, and surgical techniques that are essential to physician competence in the correct diagnoses and treatment of hair loss problems, in a manner consistent with patient safety and sound esthetic results. The ISHRS hopes that all existing surgical and dermatology training programs that teach HRS procedures will find the CCHRS useful in developing their curriculum relative to HRS and that this will facilitate the development of a new standard of training within the profession. METHODS Developed and reviewed by a committee of experienced hair restoration surgeons. RESULTS The CCCHRS clearly defines the diagnosis and treatment of hair loss as a multidimensional specialty requiring knowledge of several medical disciplines, including genetics, endocrinology, dermatology, and surgery. CONCLUSION The ISHRS believes that the CCHRS is an important contribution to physician education in HRS and that a clearly defined core curriculum will facilitate achieving contemporary results and higher patient satisfaction.

The management of hair loss from trauma

The scalp may be involved in traumatic injury, resulting in significant disfigurement and psychologic morbidity. Scarring alopecia is seen after burn injuries, avulsion injuries, accidents, and treatment of tumors. Historically, hair restoration procedures have included scalp reduction, pedicle flaps, expanders, and hair transplantation. This article describes the special techniques required to restore a patients appearance when treating these injuries, while emphasizing the versatility of scalp expansion, advancement flaps, and follicular unit hair transplantation.

Has Technology Killed the Flap

For over 25 years, scalp flaps have had a role in the treatment of male pattern baldness. Advantages of these procedures include rapid achievement of final results and hair density. Despite the technological advances made in other hair restoration procedures, scalp flap surgery continues to be indicated for motivated individuals who are appropriate candidates.