Scalp Scars Research Articles

Stem cell therapy prior to follicular unit hair transplantation on scarred tissue: a novel approach to a successful procedure.

Follicular unit hair extraction (FUE) is effective for hair restoration but is less successful on scarred tissue due to reduced vascularity and altered tissue architecture. Stem cell therapy can enhance tissue regeneration, possibly improving FUE outcomes on scarred tissue. This study investigated the impact of stem cell therapy prior to FUE on scarred tissue. Sixty patients with scalp scars from trauma or previous surgeries were divided into two groups. Group A (n = 30) received autologous stem cell therapy followed by FUE, while Group B (n = 30) underwent FUE without prior stem cell treatment. Autologous stem cells were harvested from patients' adipose tissue and injected into the scarred area four weeks before FUE. Outcomes were assessed at 3-, 6-, and 12-months post-transplantation, focusing on hair density, graft survival rate, and patient satisfaction. Histological examinations evaluated tissue regeneration. Group A showed significantly higher hair density (mean increase of 45%) and graft survival rates (87%) compared to Group B (mean increase of 25%, graft survival rate of 60%) at all follow-up points (P < 0.05). Histological analysis revealed enhanced neovascularization and reduced fibrosis in the stem cell-treated group, with 70% more new blood vessels and 50% less fibrotic tissue compared to the control group. Patient satisfaction scores were higher in Group A (average score of 8.5 out of 10) versus Group B (6.0), indicating better aesthetic outcomes and reduced scar visibility. Pre-treatment with autologous stem cell therapy significantly improved FUE effectiveness on scarred tissue, enhancing graft survival, hair density, and patient satisfaction. Further research is recommended to optimize this therapeutic strategy.

Linear Scleroderma en Coup de Sabre Presenting with Stroke and Seizure (P3-5.022)

<h3>Objective:</h3> To describe the neurologic complications and imaging findings in a patient with linear scleroderma <i>en coup de sabre</i> (LScs) and associated Parry-Romberg syndrome. <h3>Background:</h3> LScs is a rare subset of localized scleroderma. Once thought to be an exclusively cutaneous disorder, recent studies suggest that rheumatologic, ophthalmologic, and neurologic symptoms occur in up to 20% of cases. <h3>Design/Methods:</h3> Case report. <h3>Results:</h3> A 32-year-old woman with LScs, associated Parry-Romberg syndrome, migraine, and prior left hemispheric stroke thought to be secondary to vasculitis presented with right arm and leg numbness. She had left hemifacial atrophy. Brain MRI showed an acute ischemic stroke in the posterior limb of the left internal capsule and a chronic T2/FLAIR-hyperintensity in the left frontal lobe immediately beneath the cutaneous forehead and scalp scar. She was previously on mycophenolate for presumed vasculitis, however she had discontinued it due to concern about immunosuppression during the COVID-19 pandemic. Computed tomography angiography, digital subtraction angiography and lumbar puncture were normal. Her stroke was thought to be due to small vessel occlusion. The occurrence of two ischemic strokes ipsilateral to the cutaneous changes and facial atrophy, the ipsilateral MRI findings mirroring the <i>coup de sabre</i> scar, and the occurrence of the new stroke after discontinuation of mycophenolate together suggest an underlying vasculopathy/vasculitis associated with her scleroderma. Her hospital course was complicated by episodes of rapid rhythmic shaking of the right leg with no alteration of awareness, suggesting simple focal motor seizures. She was started on a prednisone with plans for steroid-sparing immunosuppressive therapy (rituximab and mycophenolate). On follow-up evaluation, she was recovering well. <h3>Conclusions:</h3> LScs and Parry-Romberg syndrome are associated with multiple neurologic complications including ischemic strokes, seizures, and headaches. This case highlights the underrecognized relationship between neurologic complications and LScs and suggests an underlying inflammatory process responsive to immunosuppressive therapy. <b>Disclosure:</b> Dr. Greige has nothing to disclose. Dr. Feske has received publishing royalties from a publication relating to health care.

Natural results of scalp micropigmentation: A review.

Scalp micropigmentation has developed rapidly in recent years to the extent that it is now considered a major means of hair loss treatment along with medication and hair transplantation. To deliver correct information in terms of patients' curiosity regarding scalp micropigmentation and the most frequent complaints that doctors receive as well as to rectify misinformation. A review of the literature was performed, and information is herein presented on various scalp micropigmentation procedures, the authors' experiences in this area, and special tips to achieve a natural result. The fundamental knowledge and proper techniques described in this article can aid in achieving more successful scalp micropigmentation results. Scalp micropigmentation is a widely used technique to camouflage various scalp scars and alopecia; therefore, it is important to be aware of the principles and skills necessary to achieve a natural result.

Endoscope-Assisted Fronto-Orbital Distraction Osteogenesis.

Anterior cranial vault fronto-orbital distraction osteogenesis is a promising treatment modality for children with unicoronal craniosynostosis. A minimally invasive, endoscope-assisted approach offers the additional potential benefits of less scalp scarring, decreased blood loss, and decreased scalp dissection. In this article, the authors present a novel technique for minimally invasive, endoscope-assisted fronto-orbital distraction osteogenesis.

Previous fat grafting and hair transplantation using the FUE technique on scalp scars: Update

We developed a narrative literature review on the association of fat grafting and hair transplantation using the Follicular Unit Extraction (FUE) technique in scalp scars. Data were collected from studies found in Medline, Lilacs, and IBECS databases. Bibliographical records of several authors who researched mesenchymal cells in adipose tissue were cited, describing the techniques used. The conclusion was that the two-stage hair transplantation technique, with previous fat transplantation, is effective, according to the reviewed articles.

Repair of Defects in the Scalp and Face With Expanded Superficial Temporal Artery Flaps: A Single-Center Retrospective Study.

Defects resulted from the removal of large scars, benign tumors, severe pigmentation abnormalities, and vascular malformations, etc., in the scalp and face need to be repaired to restore the appearance. Here, the authors introduced the application of various expanded superficial temporal artery (STA) flaps in the repair of above defects. From Jan. 2015 to Dec. 2018, 19 patients with craniofacial secondary defects received the repair with expanded STA flaps in our clinic. The defects were resulted from the removal of scalp scar (n = 6), neurofibroma (n = 4), sebaceous nevus (n = 3), arteriovenous malformation (n = 2), facial scar (n = 2), and port-wine stain (n = 2). The expanded STA flaps included 14 cases of flaps pedicled by parietal branch of STA, 2 cases of flaps pedicled by parietal branch of STA combined with laser hair removal, 1 case of flaps pedicled by frontal branch of STA, and 2 cases of prefabricated expanded skin flap with the superficial temporal fascia in the neck. The two-stage operation and water-filling expansion were accomplished in all patients. All flaps survived well, except one flap with venous congestion, which resolved after blood-letting and application of drugs promoting venous draining. In the three to six months follow-up, the flaps' color, texture, and thickness were satisfying. Individual application of different types of expanded STA flaps could achieve ideal results in repairing craniofacial secondary defects.

Scalp Micropigmentation Procedure: A Useful Procedure for Hair Restoration.

Medical tattooing of the skin to camouflage scars or to mimic hair or nipple/areola regions has gained popularity in Aesthetic Surgery and Dermatology clinics. The SMP procedure was used in 22 patients to correct scalp pigmentary problems between 2017 and 2020. The study included 16 men and 6 women; all female subjects had female pattern hair loss, while one of them also had alopecia areata. There were 10 male patients with male pattern hair loss and 6 of them were corrected using micropigmentation. The rest were subjected to an adjunctive procedure for hair transplantation. There were six male patients that had scalp scars. All patients had three micropigmentation sessions weekly and a fourth touchup procedure that was included one month after the last session. The follow-up period ranged from 7 to 32 months with a mean of 20 months. The amount of fading observed after the follow-up was minimal. There was an allergic reaction in just one patient following the procedure. There were no serious adverse effects or complications due to the procedure. The questionnaire the authors sent the patients at least six months following the procedure showed 80% of the patients (100% of the women) were very satisfied with the result and 100% of the patients would recommend the procedure to others with similar problems. SMP appears to be good solution for patients who don't want the hair transplantation or who underwent previous hair transplantation surgeries with unsatisfactory results. Also, SMP can be used to camouflage any type of scalp scars.

Les chirurgies secondaires après résultats défavorables dans la couverture des pertes de substance du cuir chevelu

The unfavorable results in scalp defects treatment are represented essentially by: local flap necrosis; cicatricial alopecia-calvarial contour defects; wide and poorly positioned scalp's scars. The secondary surgeries dealing with the new scalp defect (necrosis or alopecia) include: readvancement of prior flaps-raising a new local flap-tissu expansion-skin grafts-free flaps, bringing skin, muscle or vascularized bone. Their indications depend on the size of this defect, the presence of pericranium, the vascular condition of the scalp and the general condition of the patient. The secondary calvarial reconstructions are regularly done by alloplastic techniques, but sometimes autologous techniques are used. The presence of well vascularized skin coverage and the absence of local infection are mandatory before this cranioplasty. The scalp's scars can be effectively camouflaged by the classical hair minigrafting techniques. Certain principles must be applied to avoid these unfavorable results: one large axial rotation or transposition flap is better than multiple flaps and numerous scalp incisions, particularly for the beginners; hair growth can hide easily the scars when local flaps are well designed; excessive tension during local flaps closure must be avoided; galeal scoring and skin grafting of the donor site of these flaps are useful for that purpose; secondary tissue expansion can resolve many problems if the design of prior local flaps is correct; primary cranioplasty must be avoided if there is a risk of contamination; when the general condition of the patient is bad, treatment of such defects with simple methods is preferable.

Closure of a full-thickness scalp burn that occurred during hair coloring using a simple skin-stretching method: A case report and review of the literature.

Full-thickness scalp burns secondary to hair coloring are rare; however, such defects can be large and complex reconstruction of hair-bearing tissue may be necessary. Many skin-stretching devices that use gradual traction have been applied to take advantage of the viscoelastic properties of the skin. A 21-year-old female patient was seen with a burn defect on her occipital scalp leading to exposed subcutaneous tissue after chemical application of hair coloring in a salon. The dimensions of the wound were 10 cm×5 cm, and a skin graft or flap would have been necessary to close the defect. Two long transfixing K-wires (1.4 mm) and paired 3-wire threads (23 gauge), which are readily available in most hospitals, were applied over a period of 12 days for trichophytic closure of the defect. The remaining scalp scars after primary trichophytic closure with this skin-stretching method were refined with hair follicle transplantation. This skin-stretching method is simple to apply and valuable for helping to close problematic areas of skin shortage that would otherwise require more complicated procedures. This case shows a relatively unknown complication of hair coloring and its treatment.

A review of 31 cases of Marjolin's ulcer on scalp: Is it necessary to preventively remove the scar?

We aimed to report the clinical features of squamous cell carcinoma (SCC) occurring on scalp scar tissue among a Chinese population, demonstrate its pathological progress, analyse the prognosis-related factors, and share our clinical experience of managing this rare disease in practice. A retrospective study was conducted at West China Hospital from January 2013 to January 2018 aiming to identify patients with a diagnosis of SCC or squamous atypical hyperplasia arising from scalp scars. Their medical records were reviewed, and related data were retrieved. Follow up was conducted, and informed consent was obtained by phone calls in June 2018. Of the 31 scalp Marjolin's ulcer (MU) patients, the average latency period and post-ulceration period were 42.9 years and 37.5 months, respectively. Among them, 30 patients (97%) were diagnosed with cancer more than 5 years after initial injury, and 25 patients (80.7%) experienced a pre-ulceration period longer than 20 years. A negative correlation between scalp MU's post-ulceration period and its pre-ulceration period was identified. Only burn scars caused post-ulceration periods of more than 24 months (7/19). Incomplete healing wounds experienced a significantly shorter latency period (P = 0.004) and longer post-ulceration period than others (P < 0.0001). However, the depth of tumour infiltration and complete tumour resection were the only two independent factors that significantly dictated patients' survival in this study. In conclusion, the scalp scaring tissue experienced a long-term stable period but would transform to malignancy rapidly and progressively once ulceration formed. The underlying malignant transformation mechanism remains unclear. Thus, we recommend scalp scarring tissue to be radically removed.

Nonshaven Follicular Unit Extraction: Personal Experience.

Nonshaven follicular unit extraction (NS-FUE) is the most state-of-the-art surgical technique in the field of follicular unit hair transplantation. It is particularly appealing because donor area shaving, one of the most serious impediments for the patient, can be omitted. In this article, we present our surgical approach for NS-FUE. We selectively used the direct or the pretrimming method of NS-FUE according to indication, determined by considering the location and purpose of transplantation, the condition of the recipient site, and the patient's preference. A total of 658 patients underwent NS-FUE. Of these, 17 had pubic atrichia, 2 had pubic atrichia and also received hairline correction surgery, 6 received eyebrow transplantation, 19 had female pattern hair loss, 362 had male pattern baldness (MPB), 2 had MPB and also required eyebrow transplantation, 3 received hair transplantation for MPB and scalp scar, 9 underwent male hairline correction surgery, 192 underwent female hairline surgery, and 46 received hair transplantation for scalp scar. The average numbers of transplanted grafts were 573 for atrichia, 1300 for atrichia and hairline correction performed successively, 240 for eyebrow transplantation, 996 for female pattern hair loss, 1408 for MPB (with a maximum of 3000), 1050 for MPB and eyebrow transplantation, 998 for female pattern hair loss (with a maximum of 1910), and 141 for scalp scar. On average, the total transection rate was 8.2%, and the calculated density was 2.2.

Application of controllable hair density of eyebrow reconstruction with the treatment of scar baldness during the same operation stage

Objective To explore a method of eyebrow reconstruction which can control eyebrows, and to repair scar baldness in the same operation stage. Methods Operations were performed in two stages. In the first stage, an expander was placed under the scalp at the same side of the defect eyebrow through the direction of the superficial temporal artery. Other expanders were placed around the scar baldness. After the incision healed, water was injected into the expander. During the expansion, the scalp hair density was approaching the uninjured eyebrow side. Then the second stage operation was prepared: an island flap with superficial temporal artery as axial artery was harvested and the expander was extracted. The subcutaneous tunnel was made in the temporal region of the eyebrow defect side. The expanded superficial temporal artery island scalp flap was passed through the tunnel and transferred to the defect eyebrow area to repair the eyebrow. After incising the scar baldness, the left expanded scalp flaps were transferred to cover the wound. Results 12 patients underwent this method of eyebrow reconstruction with scar baldness, all island scalp flaps survived, with no case of flap necrosis. After 6-24 months of follow-up, the hair density of the reconstructed eyebrows was very close to that of the uninjured side, without excessive thickening or excessive rarefaction. The scalp scars were small and can be shaded by the hair. All patients were satisfied with the operation. Conclusions The method of controllable hair density of eyebrow reconstruction with the treatment of scar baldness has good effects on reconstructing eyebrow defect and scar baldness. It is simple, economic and suitable for further application. Key words: Eyebrows; Cicatricial alopecia; Surgical operation; Eyebrow reconstruction

Multi-view stereo in the operating room allows prediction of healing complications in a patient-specific model of reconstructive surgery

Excessive mechanical stress leads to wound healing complications following reconstructive surgery. However, this knowledge is not easily applicable in clinical scenarios due to the difficulty in measuring stress contours during complex tissue rearrangement procedures. Computational tools have been proposed as an alternative to address this need, but obtaining patient specific geometries with an affordable and flexible setup has remained a challenge. Here we present a methodology to determine the stress contours from a reconstructive procedure on a patient-specific finite element model based on multi-view stereo (MVS). MVS is a noninvasive technology that allows reconstruction of 3D geometries using a standard digital camera, making it ideal for the operating room. Finite element analysis can then be used on the patient-specific geometry to perform a virtual surgery and predict regions at risk of complications. We applied our approach to the case of a 7-year-old patient who was treated to correct a cranial contour deformity and resect two large areas of scalp scarring. The simulation showed several zones of high stress, particularly near the suture lines at the distal ends of the flaps. The patient did show delayed healing and partial flap tip necrosis at one of such predicted regions at the 30-day follow up visit. Our results further establish the application of computational tools in individualized medical scenarios to advance preoperative planing and anticipate regions of concern immediately after surgery.

The application of computer-aided designated titanium mesh in repairing skull defects

Objective To explore the clinical value of repairing skull defects with titanium alloy-mesh of computer-aided design. Methods A retrospective analysis was done on clinical data of 86 cases with skull defects who underwent repairing using titanium mesh with two-dimensional or three-dimensional computer-aided design. Results All the incisions achieved primary healing other than one case conducting reoperation due to exposed titanium mesh. Two cases got subcutaneous exudate, one obtained painful mastication and one experienced proliferation of scalp scar. Conclusions With the computer-aided designated titanium mesh, relevant operation can resume the original state to maximum extent, lower surgical risk, decrease post-operational complications and then obtain satisfying clinical effect. DOI: 10.3969/j.issn.1672-6731.2015.01.015

Micropigmentation: Camouflaging Scalp Alopecia and Scars in Korean Patients

Micropigmentation: Camouflaging Scalp Alopecia and Scars in Korean Patients

Micropigmentation: Camouflaging Scalp Alopecia and Scars in Korean Patients

The aim of this study was to identify the usefulness of micropigmentation as a technique for alopecia and scalp scar camouflage in Korean patients. Micropigmentation was performed in 43 Korean patients from November 2011 to October 2012. There were 23 female patients with female pattern hair loss (FPHL), 14 male patients with male pattern baldness, and 6 patients with scalp scars. The results for one patient with FPHL Ludwig stage I were satisfactory according to the physician's assessment, but the patient was dissatisfied because she did not notice any remarkable changes after the procedure. The results for the other 42 patients were highly satisfactory and there were no adverse effects or complications. Micropigmentation appears to be a good method for camouflaging hair loss and scalp scars. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Giant Epidermoid Cyst of Scalp – A Rare Presentation

Sebaceous cysts – more correctly referred to epidermal inclusion cysts, are benign lesions of the skin. They rarely require intervention out of medical necessity, but are removed for cosmetic reasons. Sometimes the cysts become infected, inflamed or grow so large that they interfere with the normal patient’s functioning, then they need to be removed. We encountered a huge epidermoid cyst of the scalp in an elderly male. An intracranial extension of the cyst was ruled out by CECT of the skull. Complete excision of the cyst was carried out by an elliptical incision and the wound was closed in layers by rotation of scalp flaps. The patient was well at one month follow-up and an excellent scalp scar was noticed.

Lichen Planopilaris is a Common Scarring Alopecia among Iraqi Population

Background: Scarring alopecia like discoid lupus erythematosus, lichenplanopilaris and scarring folliculitis are common skin problems where differentiations between them are often difficult in many cases. Objective: To report, study and evaluate cases of lichen planopilaris and characterize the different clinical points in favor of this disease. Patients and Methods: This case series descriptive study was done at Department of Dermatology-Baghdad Teaching Hospital from January 2010 to November 2012. Sixty seven patients were included where histological and dermatological examinations were carried out to all patients regarding all relevant points related to the disease. Punch biopsies were performed from ten patients for histopathological study. Results: The mean age of onset of the disease was 36.7 ± 5 years with a mean duration of the disease being 4.4 ± 3 years. The male to female ratio was 1.4:1. The characteristic lesions were pigmented scarring moth eaten alopecia surrounded by pigmented hyperkeratotic follicular papules involving mainly the fronto-vertical and parietal scalp. Conclusions: Lichen planopilaris is a common cause of scalp scarring alopecia in adult and it has many characteristic clinical features which can facilitate differentiation from other pathologic scalp conditions like discoid lupus erythematosus.

Validation of the Cutaneous Lupus Disease Area and Severity Index (CLASI) using physician- and patient-assessed health outcome measures

The Cutaneous Lupus Disease Area and Severity Index (CLASI) has not been validated using rheumatologist-conducted disease activity and damage assessments, especially cutaneous assessments. Active skin disease and skin damage may have substantial effects on patient-reported outcomes and on body image. We sought to validate the CLASI against: (1) physician-assessed disease activity and damage measures; and (2) patient-reported assessment of quality of life and body image. Cross-sectional data were collected from 31 patients with cutaneous lupus erythematosus. Cutaneous disease activity and damage were measured by using the CLASI. Disease activity (using the Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus [SLE] Disease Activity Index [SLEDAI}), damage (Systemic Lupus International Collaboration Clinics-American College of Rheumatology Damage Index [SDI]), quality of life (LupusPRO), and body image (Body Image Quality of Life Inventory) were obtained. Descriptive statistics and Spearman correlations were ascertained. Mean (SD) age was 42.3 (12.8) years; 97% were women. The mean (SD) CLASI activity and damage scores were 10.5 (7.4) and 9.9 (9.5). Correlations noted were: total CLASI activity and SLEDAI-rash (r = 0.42, P = .02), CLASI-mucosal and SLEDAI-mucosal (r = 0.65, P = .001), CLASI-recent hair loss and SLEDAI-alopecia (r = 0.61, P = .001), and total CLASI activity and LupusPRO symptoms domain (r = -0.38, P = .04). Total CLASI-damage correlated with SDI-scarring/alopecia (r = 0.51, P = .004), SDI-extensive scarring/panniculum (r = 0.55, P = .003), and SDI-skin ulceration (r = 0.36, P = .05). CLASI scalp scarring correlated with SDI-skin scarring/alopecia (r = 0.94, P = .001). CLASI activity on the face and nose was associated with significant concerns on the Body Image Quality of Life Inventory. Limitations include small sample size. CLASI activity and damage scores correlate with physician-assessed cutaneous activity and damage in cutaneous lupus erythematosus in patients with SLE. Cutaneous activity in visible areas may generate body image concerns.

Cyberspace Chat: Scalp necrosis and scarring alopecia caused by chemical burns from hair highlighting procedures

1. Sharon A. Keene, MD (drkeene{at}hairrestore.com) 1. Tucson, Arizona, USA ![][1] The following case report of scalp necrosis and subsequent scarring alopecia caused by a hair highlighting procedure illustrates a serious complication of this commonly performed hair salon