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Micrografts and minigrafts in the aesthetic reconstruction of the face and scalp Hair transplantation techniques have advanced to a great extent and hence are being put to use. Replacement of lost hair is especially useful in patient’s who have experienced bad hair transplantation, victims of burn injuries such as fire and chemical accidents or in the kitchen, congenital conditions such as cleft palate and arteriovenosus, those who have undergone surgery for tumor removal or cancer and aesthetic facial reconstruction like forehead lifting or other anti aging therapies. Most often, along with hair transplant on the affected areas of the scalp, sideburns, eyebrows, eyelashes, beard and moustache also need reconstruction. In all the above mentioned reconstruction sites, the use of mini and micrografts have been found to be very useful and results to the satisfaction of the patients have been achieved. A micrograft is a 1-2 hair follicular unit graft and a minigraft is 3-4 haired follicular unit graft and they have found extensive use in male pattern baldness correction. The procedure is basically similar to the scalp treatment but the areas under consideration need certain detailed analysis to regain the natural look of the hairs in that area. With certain precautions and aesthetic monitoring, most of the difficulties can be solved. Dr. Alfonso Barrera has treated many such patients and he suggests the following procedures and precautions to follow while dealing with patients needing facial hair reconstruction. Let us discuss the reconstruction procedure and modifications required according to the individual needs of a patient. The procedure is mostly carried out under local anesthesia in adults and general anesthesia if a child. Drugs such as Midazolam and Fentanyl are given as sedative and Epinephrine and Bupivacaine in combination for localized nerve blocks. The donor area mostly the back of the head is harvested off hair strip 1cm wide and 20 cm long. Under magnification, the donor hair strip is dissected and grafts prepared for final transplantation. The grafts were then stored in chilled saline to prevent drying. Using various sizes of scalpels the surgeon makes insertions in the skin and using a jeweler’s forceps plants the grafts into them. Patients are sometimes administered another combination of drugs such as Lidocaine and Epinephrine to produce temporary swelling of the area to facilitate easier insertion of the grafts. Most of the blades used are so sharp that they make just the necessary slits and so scarring is highly reduced. In a very few patients, pigmentation or pitting of the transplanted areas may occur. Hence while transplanting hair in the fore head region along the hairline, the surgeon takes special care by changing blade size to minimize these errors. In areas such as the eyebrows and eyelashes, moustache and sideburns there is a problem of the hairs transplanted on the sides to pop up from their sites when a new incision is made next to it. To overcome this popping up of grafts, incisions are made as required and then the grafts are transplanted at one go. The angle of hair growth in other parts of the body differs from that of the head. In eyebrows, the angle is acute and hence the hairs have to be placed at an angle. In the moustache and beard areas, the positioning of the hair has to be in such a way that the hair is as close to the surface of the lips as possible and must be able to grow downward. The eyelashes are the most difficult to work on. The eye subconsciously tends to bat it eyelids as a preventive measure for restricting foreign bodies from entering it. Even when under anesthesia, the eye lids continue to bat. This batting is arrested for some time using clamps. Since the eyelids are very thin and fragile, single follicular unit grafts are used. About 10 - 12 grafts are inserted per eyelid in one session. And at least two sessions are required with a gap of 8 – 12 months between each session for final results to be achieved at its best. The angle of hair orientation is very difficult to achieve in eyelashes, The hair on the upper lid must grow up and the lower lid down. Most often the upper lid can be handled better but to prevent the transplanted hairs on the lower lid to grow upwards and touch the cornea is a very difficult process. Hence use of hair curlers to re-orient the hairs is necessary. Another difficulty encountered usually is the donor hair growth. Unlike the eyebrows and lashes, donor hair from the back of the head tends to grow faster and hence the transplanted brows and lashes need constant care via trimming. Hence donor hair is from the eyebrows if available is preferred. Dr. Barrera has suggested another method of eyelash transplant, a method still under evaluation for feasibility. In this method followed for the upper lid, a single long incision is made all along the length of the lid and a long strip of donor hair chiseled according to the desired length is inserted into it. This would result in a single incision multiple hair transplant and the time spent will be considerably less. In all the transplantations care should be taken to insert the graft at optimum depths of the skin so that they do not fall out. Also, the grafted hairs take about 2-3 months to regain their growth and it takes at least a year for the full hair cycle pattern to restore. Because of the number of hairs transplanted per graft is 1-2, sites that are affected by burns are seen to accept them with ease since they are able to grow even when the metabolic rate is low. And the percentage of hairs that grew on these regions is at 85% as compared to the 95% success in male pattern baldness procedures. The procedure of follicular unit grafts is preferred in all the above mentioned areas for its advantages such as use of local anesthesia, least scarring, no fear of infection, hardly any need for expensive equipments and hospital stay and very good results in just one session with a very few patients needing two. One disadvantage is however the need for expert hands and the time spent on each of the process is close to 4 hours. But that is certainly compromised by the excellent final results obtained.
Micrografts and minigrafts in the aesthetic reconstruction of the face and scalp references
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