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ISHRS Annual Meeting -- October, 2003 Alan J. Bauman, M.D.

Introduction: PREOP Photos 38 y/o Male, NW7 w/ defects x 4:

Left-Occipital Mid-Occipital Right-Occipital Right-Parietal

PHASE 1: Direct extraction of 91 follicular units for restoration of right-parietal defect

Intra-op Donor & 24 hrs post-op Recipient: 24 hrs post-op Donor: 5 days post-op 91 fu’s extracted 78 non-transected 14.3% transection rate

Donor & Recipient areas 6 months post-op with satisfactory coverage of right-parietal defect PHASE 2: Direct extraction of 402 follicular units for restoration of Left, Mid and Right-Occipital defects

Donor & Recipient Areas: Intra-op 24 hrs Post-op 4 weeks Post-op 402 fu’s extracted 346 non-transected 13.9% transection rate

(Final post-op photos will be available Spring 2004)

Traction alopecia, occurring in areas of prolonged tension on hair shafts, is a well-known complication of hairpieces that are repeatedly attached using clips in the same anatomical position on the scalp.

Objective: To illustrate by case report a unique surgical approach to the cosmetic correction of stable, well-circumscribed areas of hairpiece-induced traction alopecia using the technique of direct follicular unit extraction in a 38 year-old NW7 male patient.

Methods: After extensive patient education and informed consent, the planned restoration was performed in two phases spaced six months apart. Follicular unit extraction was performed using 1mm punches to separate individual follicular units from the surrounding donor tissue down to the mid-dermis under turgid tumescence, followed by extraction of the follicular units with forceps and counter-traction. The follicular unit micrografts were microscopically sorted to track transection rates. All harvested tissue was implanted into recipient sites created with a 1.3mm minimal depth (Minde) knife.

Results: After phase 1 of the prescribed treatment sessions, acceptable cosmetic results were obtained in both the donor and recipient areas. Donor and recipient healing of phase two was also acceptable. Final photographic results (hair growth in the recipient area) of phase two are expected to be available in Spring 2004.

Conclusion: As with the success of any hair restoration procedure, patient selection is critical when treating patients using follicular unit extraction techniques. Guidelines for the appropriate application of the technique of follicular unit extraction are still being developed (as are specific nuances of the technique itself). An acceptable result can be obtained if all treatment options (and their associated risks and benefits) are discussed with the patient and properly considered.