Laser Hair Transplantation: State of the Art?

It 'been a recent upsurge of interest in "laser hair transplantation" with the parallel increase in the use of lasers for a variety of cosmetic surgery. Lasers generate great enthusiasm by both doctor and patient, but that sometimes exceeded the fair value of the laser surgical instrument. An obvious example is the use of CO2 laser as a nonselective, destructive way to remove tattoos which left scarring and cosmetic deformity worse than the tattoo itself. This was subsequently replaced by pulsed lasers with specific pigment absorption (such as Nd: YAG, Ruby and Alexandrite lasers) operating on the principle of selective photothermolysis that truly benefit from treatment of these lesions. Super-and ultra-pulsed CO2 lasers are now used to replace "cold steel" in the creation of sites of transplantation of hair. But before we rush to use laser surgery for hair restoration, we must first of logic and reason of this program and then gently with the carefully controlled studies so that our patients only benefit from its use. The following discussion will address various aspects of today's laser technology in the context of recent advances in techniques of hair transplantation. The intention is to challenge the theoretical basis for the use of lasers existing loans to the question about their benefits, and propose future areas of laser research. WHAT IS A LASER hair transplant? First, it is important to clarify what is meant by "laser hair transplant." The current role of lasers is to just create holes or cracks (recipient sites) for the grafts are inserted. To consider this a "laser transplant" is to ignore the myriad of other factors that contribute to making the procedure successful. For the laser are involved in other major components of the transplant, such as collection, dissection of the graft, or placing, "laser hair transplantation" should be replaced by a "laser site created" to reflect more accurately its current role in the proceedings. A painless procedure? The claim that the transplant is a painless laser process is misleading. The lasers currently in use is "ultra – or super – CO2 laser pulses. Unlike lasers that operate from these laser selective photothermolysis to create a hole just vaporizing tissue. Since the pulse (the time is the radius at a given time) of these new lasers is extremely short, there is not much heat transfer or damage surrounding tissues. "Despite the tissue that the laser works is that nonselectively destroyed. For this reason, the laser is extremely painful, if not a local anesthetic is completely rigid application before it is used. This is not the laser is painless. The pain-free environment created by the pre-anesthesia used in all transplant procedures. Bloodless SURGERY next argue that the laser is relatively bloodless, minimize the main physiological predominantly determine the success of transplantation, namely oxygenation. The transplantation of human hair should aim to maximize the flow of blood to the implanted hair follicles, rather than reduce, and all the compromises that correct unfair oxygenation could jeopardize the survival of the transplant. Preliminary results suggest that when the laser sites, compared to the traditional, with surgery, some patients have shown less gives some laser hair grafts [1]. "Dr. Unger notes that the traditional slit-shaped dimensions with the laser, we are close to an unacceptable width of thermal damage. "Living by Khan is similar, and expresses particular concern about the growth, when the distance between the laser points are 1 mm [2]. When using the technique expanded micro-grafting, the spaces between ympäri often in this series, and the cumulative thermal damage produced in large meetings can be fatal. E 'therefore extremely important to objectively measure the effect of laser coagulation effects on supply of blood and graft survival in the definition of micro-grafting broad, since this seems to be the trend of the future [3]. As with electrosurgery, laser specifications may be changed so that there are relatively more cutting coagulation. It seems reasonable that the work will be focused in this direction, as this will reduce the thermal damage, while at the same time take advantage of the laser? Ability to make a quick, uniform fields. PROBLEMS WITH HEMOSTASISThe coagulation effect of the CO2 laser can increase the visibility during the procedure, but the application of two coats of traction on the skin and the judicious use of epinephrine may also provide hemostasis and to allow adequate visibility for both Site-targeted creative and input of graft without blood. Production Techniques cold steel errors in the recipient in the form of slits, 2-6 mm in length, or type 1. 5-5 mm in diameter, to significantly compromise the flow of blood to the recipient site, and reduce graft survival when transplants are too tight. The laser has a negative impact of the closure microvasculature. The weak growth, with older techniques have taught us that it is extremely important to preserve vascularity of the recipient, and this lesson should not be wasted when trying to increase the visibility with the laser critical, particularly when it can be done by easier. Connective tissue INTEGRETY Another problem created by the laser is to destroy the dermal collagen and elastic fibers. This effect on the recipient tissues caused a decrease in the normal elasticity of the skin and, consequently, the transplants have a greater tendency to fall out of the laser-made sites. Of course, one must ask whether it is safe graft remains sufficient to ensure optimal growth. The work has shown Beeson laser sites have more scars and necrosis 3 days after surgery and fibrosis at 2 months that the sites are made of steel [3]. The elasticity of normal skin site allows the recipient to reap the follicular and small plants in a safe place. This results in the vicinity of the sides of the plants in the dermis in the recipient, with the objective to minimize the dead space and microscopic hematoma formation, and facilitate healing. In a new approach to hair restoration surgery recently described in International Journal of Hair Restoration Surgery [4], where the actual follicular units are used as a plant, the recipient of small wounds, such as 1st 0-1. 3 mm in length, can accommodate up to four hairs. This is achieved using the anatomical proximity of each course, and throw the skin between the time of dissection. In this situation, the protection of the recipient skin elasticity is demonstrated by the fact that patients undergoing hair transplantation procedures shower and wash the area gently transplant the day after surgery without the risk of losing their grafts. Moreover, the rapid recovery may be oozing crust formation and reduction over the same period of 24 hours. When the healing is complete, there is no clinical evidence of scars, even when the scalp is shaved. LASER: new technologies for an old-style laser TECHNIQUEThe great advantage that it is assumed to have over traditional slit and punch grafting is that it can create a slit-shaped (which is more natural that looks like a hole created by a handful), while at the same time Remove the fabric like a punch to make more room for the plant, in fact, have the best of both worlds. In older technologies, which were not transplants "anatomy" of hair and has reached over a number of follicular units required recipient site because there was too much, which leads to poor healing and graft compression. The follicular transplantation, or large cracks or type must accept donor grafts. With the identification of the patient? The natural hair groupings, the prosthesis can be pre-cut to an excess of tissue among the groups, in small follicular units that can be placed in very small areas, to solve both receivers are bulky and compression. Therefore, the claim that the laser has the advantage of eliminating the recipient tissue, while the creation of a slit is not relevant in follicular transplantation. The direction of t
he laser LASER RESEARCH Future research should focus on a technology that can "read" the follicular groups "on the spot." In the field of laser donors would cut away the tissue between the follicular units with the effect of reducing the volume of transplanted skin, while maximizing the amount of hair transplanted, the production of a hair of the same groups are found in nature. In the area of the recipient, laser current use is limited to areas relatively devoid of hair, because the beam damage adjacent follicles. It is also limited in their ability to review an area already transplanted unless substantial distance between the left previous grafts. On the contrary, however, sites with a small tool steel can easily avoid existing or hair transplants, and if a follicle was "impressed" would be more likely to survive the trauma or regenerate its growth from the center. Much of today laser research has been devoted to the production of a laser scanner that has the ability to quickly produce uniform in both fields in a grid-type models or random assignment, without regard to the position of the hair [5]. To be of general value, the laser must be able to identify the existing hair and make Web sites only, in the meantime, the spaces, which require a technology that is not available. Another challenge for the laser scanner would be to compensate for variations in laser effects due to the intrinsic curvature of the skull. Not only the change of contour for the enhancement or defocus the beam by changing the actual distance, but also change the incident angle of the light source and, finally, the direction of the hair. These adjustments are now performed manually, but it is crucial to the success of a cosmetic result. There are also large variations in thickness of the scalp from one patient to another and in different regions of the scalp. The laser must be able to have at least as sensitive to human transplant can "feel" and these differences may limit the depth, savings and damage to major blood vessels and nerves. To obtain a more natural looking, modern laser should generate only one case of the model rather than an organized pattern. Finally, artistic nuances that are used to create a sensitive hair, a widow? S peak, the turbulence of the crown, or reconstruction of the temple (with sudden changes of direction principle) would be difficult to program the laser and can still be done manually. A look at current research into transplantation of human hair in the world indicate that in the near future, significant advances in surgical hair restoration can be found in the manual to automate processes, rather than by itself, the laser surgery. Mechanics tools currently being developed will streamline the entire process from harvesting the donor strip to create websites with simultaneous insertion of implants. The role lasers will play in this process is not yet clear. CONCLUSIONSAs improves laser technology, laser sites become smaller, and the problem of thermal injury is an appropriate way, the advantage to quickly produce a large number of homogeneous areas to make the laser a more valuable tool. When the laser was focused on the sector of donors, able to cut the skin from "read" the space between the natural hair units with minimal thermal damage, which will significantly change the process of transplantation and to create a topic more convincing for its use. And until such time as the laser scanner can be designed to avoid existing hair, this tool is not very versatile. We hope that this level of sophistication is not "light years away. Until then, we must be cautious and give time for science to achieve with our enthusiasm. Only when the laser power has been used successfully in all the critical elements, we can rightly use the term "laser hair transplantation. REFERENCES1. Unger WP. More information about the laser used. Hair Transplant Forum Int 1995, 6:15-16. 2nd Arnold JE. Report on the meeting ASHRS Orlando. Hair Transplant Forum Int 1995, 6:4-5. 3rd Rassman WR, Carson S. Micro grafting in large quantities. Dermatological Surgery 1995, 21:306-311. 4th Bernstein RM, Rassman WR, Szaniawski W, Halperin AJ. Follicular transplantation. Int J Aesthetic Restorative Surg 1995, 3:119-132. 5th Unger WP. Laser Hair Transplantation. Int J Aesthetic Restorative Surg 1995, 3:137-142.