Biomedical subjects

D A Brandy

Publications and source records attributed to D A Brandy.

At least 19 recordsLinked to original sources

PubMed2000

A technique for hair-grafting in between existing follicles in patients with early pattern baldness.

BACKGROUND: When using follicular hair transplantation on patients with early male or female pattern baldness, there can be significant trauma to preexisting hair follicles. This becomes especially important in view of the fact that finastride and minoxidil can stop or slow hair loss. OBJECTIVE: To develop a system that averts damage to preexisting hair follicles in patients with early male or female pattern baldness. METHODS: A Lutex headlight (2.5-3.5x loupe magnification system) is used to make 1.0-1.5 mm spear incisions in between the hair follicles in patients with early male or female pattern balding. Magnification is also utilized during the graft cutting and placement phases of the operation. RESULTS: This headlight-loupe magnification system has dramatically decreased the amount of permanent hair loss and anagen effluvium on 144 patients with early male and female pattern baldness. With less permanent hair loss there is greater density observed with each progressive session. CONCLUSION: Hair surgeons now have a method to consistently and significantly minimize the amount of damage to preexisting hair follicles in patients in the early stages of male and female pattern baldness. This becomes even more important in light of the fact that more and more patients are using finastride or minoxidil to stop the thinning process. Existing hairs can therefore be preserved.

Alopecia↗

PubMed2000

Dispelling the myth of the required high hairline in follicular unit hair transplantation.

BACKGROUND: Hair restoration surgeons have historically taught that the hairline should be placed high on men undergoing hair restoration surgery. OBJECTIVE: To evaluate the position of the anterior-most aspect of the frontal forelock on men experiencing type III-V male pattern baldness. METHODS: Twenty men, ages 20-46 years, with type III-V male pattern baldness were evaluated for the distances between the chin to nose, nose to eyebrows, and eyebrows to frontal forelock. RESULTS: The mean distance from chin to nose was 6.96 cm. The mean distance from nose to eyebrows was 6.55 cm. The mean distance from eyebrows to hairline was 6.8 cm. The distance from chin to hairline was 20.3 cm. Therefore the eyebrows to hairline distance was 33.4% of the whole. CONCLUSION: When using follicular transplantation, it may be appropriate at times to divide the face into thirds at the time of hairline development.

Adult↗

PubMed1998

New instrumentation for hair transplantation surgery.

This article introduces new instrumentation to the field of hair transplantation surgery. These new instruments include differential spear blades for better sharpness and versatility, a graft counter for facilitation of the counting process, a blade holder with a direction guide to help the doctor with proper direction of recipient incisions, a cushioned forceps to soften the trauma to the hair grafts as they are being inserted, a compass to help construct the posterior crown, and a temperature probe that constantly monitors the temperature of the saline solution that is keeping the hair grafts cool. This instrumentation has significantly facilitated and improved the hair transplantation process.

Alopecia↗

PubMed1997

A comparison of the scalp kinetics in scalp-lifting with and without an intact occipital neurovascular bundle.

BACKGROUND: This paper compares the scalp kinetics of the scalp-lifting procedures with and without an intact occipital neurovascular bundle. OBJECTIVE: The objective of this paper is to perform lateral scalp-lifts and observe if an intact occipital neurovascular bundle hampers the amount of scalp advancement. METHODS: Ten consecutive patients had lateral scalp-lifts performed without severing the occipital neurovascular bundle. Advancements were then measured at three points (mid-posterior, above the pinna, and at the temporal recession). The occipital neurovascular bundle was then divided, and the same measurements were made. RESULTS: An intact occipital neurovascular bundle impeded the amount of advancement that could be accomplished with scalp-lifting. The anterior vector was primarily affected. CONCLUSION: In light of the finding that an intact occipital neurovascular hampers the amount of advancement with scalp-lifting, the surgeon must weigh the advantages and disadvantages of both approaches (prior division of occipital neurovascular bundles versus leaving the bundles intact) when deciding upon the appropriate approach for the given patient.

Adult↗

PubMed1997

Chest hair used as donor material in hair restoration surgery.

BACKGROUND: This article describes a technique for transplanting hair from the chest to the balding scalp. OBJECTIVE: The objective is to describe an alternative route of harvesting donor hair in the situation when donor scalp hair is depleted. METHOD: A fusiform donor harvest was removed from the sternal region. The tissue was divided into one- and two-haired micrografts and subsequently transplanted. RESULTS: The technique worked extremely well with good take of the hair grafts. The donor site healed inconspicuously. CONCLUSION: The technique of transplanting hair from the chest to the balding scalp can be a viable alternative when confronted with donor scalp hair depletion.

Hair↗

PubMed1997

The mathematics of hair restoration surgery.

BACKGROUND: Mathematics is prevalent in almost all aspects of life, and so it is with hair restoration surgery. This article explores some of the mathematical relationships that exist in this quickly growing subspecialty of cosmetic surgery. OBJECTIVE: The objective of this article is to demonstrate a few of the mathematical correlations that are present in hair restoration surgery. METHODS: Several subdivisions of this subspecialty are analyzed from a mathematical perspective. RESULTS: Mathematics pervades many of the aspects of hair restoration, from the donor site, to the recipient site, to scalp reduction, to scalp extension, and the list goes on. CONCLUSION: To be able to perform hair restoration surgery in a very precise and accurate way, one should have a good grasp of the mathematical relationships that exist in this field.

Hair↗

PubMed1996

Consecutive wide and long single hair-bearing transposition flaps in combination with hair transplantation for the management of slot formation after alopecia reducing surgery.

BACKGROUND: Because the Frechet-style triple hair-bearing transposition flaps use up a great deal of scalp laxity from both occipitoparietal areas, it is virtually impossible to perform simultaneous donor harvesting for hair transplantation. The flaps in this technique are also prone to tip necroses due to their narrow width and pointed tips. This article presents a sequential protocol that dramatically and easily treats the slot, while simultaneously allowing hair transplantation to be performed to the frontal area. OBJECTIVE: To present a simple method that combines hair transplantation with consecutive wide and long single hair-bearing transposition flaps for the management of slot formation after alopecia reducing surgery. METHOD: A wide and long single hair-bearing transposition flap is first performed. The area directly inferior and contralateral to the side from where the superior flap is transposed is then used for donor harvesting. This method is repeated with each progressive hair grafting session until the desired result is accomplished. RESULTS: In the over 100 cases performed by the author to date, the results have been consistently excellent with complications nonexistent thus far. CONCLUSION: Using consecutive wide and long single hair-bearing transposition flaps is a safer, more aesthetically pleasing, and easier way to manage slot formation when compared with the triple flap technique. Besides these advantages, it affords the surgeon the opportunity to work on the frontal hairline immediately after the flap procedure is performed.

Alopecia↗

PubMed1996

Circumferential scalp reduction with a suture-in-place Silastic-Dacron extender.

BACKGROUND: Circumferential scalp reduction combined with a suture-in-place Silastic-Dacron extender is described as a viable alternative for those surgeons wishing not to perform extensive scalp-lifting. The primary advantage of the Silastic-Dacron extender is that it allows the time interval between surgeries to be shortened to 1 month. OBJECTIVE: To incur the benefits of circumferential scalp reduction (minimal stretch-back and decreased slot formation) and the decreased time between sessions offered by a suture-in-place Silastic-Dacron extender. METHODS: A circumferential scalp reduction is first performed and a tunnel is made under the central bald peninsula. Once this is completed, a 4-cm-wide Silastic-Dacron strip is passed through the tunnel and is sutured to both lateral edges of the galea under tension. The way to determine the proper length of the strip is described. RESULTS: The combination of circumferential scalp reduction with a suture-in-place Silastic-Dacron extender gives results that are comparable to scalp-lifting; however, more procedures are required and not as much upward movement into the crown is accomplished. The memory of the Silastic-Dacron extender has been found to eliminate stretch-back and quickly improve scalp laxity. CONCLUSION: Circumferential scalp reduction combined with a suture-in-place Silastic-Dacron extender is an extremely viable method to treat patients with extensive baldness. The decrease in slot formation and minimal stretch-back afforded by circumferential scalp reduction and the shortened 1-month time interval between surgeries brought about by the Silastic-Dacron extender make this a procedure that hair replacement surgeons should have in their armamentarium.

Alopecia↗

PubMed1995

A scalp garment for prestretching prior to alopecia-reducing procedures.

BACKGROUND: This article demonstrates a scalp stretching device that improves scalp laxity prior to alopecia reducing procedures. This device replaces the former use of vigorous, preoperative scalp stretching exercises. OBJECTIVE: To improve scalp laxity prior to alopecia-reducing procedures by using a device rather than vigorous prestretching exercises, which are physically fatiguing. METHOD: A scalp stretching device was developed that uses the principle of cyclic loading in the immediate preoperative period and the principle of biologic creep during the month prior to the procedure. This device is simply applied by patients at home for 30 minutes per day starting 30 days before an alopecia-reducing procedure. RESULTS: The device demonstrates ease of use for the patients and does not require any physical activity on their part. It accomplishes the same improvement in laxity that prestretching exercises formerly achieved. CONCLUSION: The scalp stretching garment introduced improves the laxity of the scalp prior to alopecia-reducing procedures with no physical exertion being required by the patient.

Alopecia↗

PubMed1995

Use of a stencil for improved accuracy, speed, and aesthetic results in mini-micrografting.

BACKGROUND: Two stencils have been developed that improve the accuracy, speed, and aesthetic of mini-micrografting. The stencil most frequently used is for #15 blade incisions (six- to eight-haired minigrafts); the other is for 1.0-2.0-mm holes (three- to four-haired minigrafts). The slit stencil has 20 recipient sites per square inch; the hole stencil has 40. OBJECTIVE: To improve accuracy, speed, and aesthetic results of mini-micrografting. METHOD: The areas to be incised are markedly preoperatively, utilizing a stencil, which develops a very precise pattern. The slits or holes can then be made very quickly and accurately over these marks. RESULTS: Because bleeding does not obscure the markings, the speed, precision, and the results of the procedures are greatly enhanced. CONCLUSION: The use of stencil improved the accuracy, speed, and aesthetic results of the mini-micrografting procedure. It also helps the surgeon accurately predict the number of minigrafts that will be needed for a specific area.

Equipment Design↗

PubMed1995

A concentric method for mini-micrografting extensively bald patients.

BACKGROUND: A concentric method for mini-micrografting extensively bald patients is described. OBJECTIVE: To demonstrate a method that effectively treats those extensively bald patients who wish to forgo any type of alopecia-reducing procedure posteriorly. METHOD: Initially the hairline is developed. Then the remaining posterior area of alopecia is gradually infringed upon in a concentric fashion. RESULTS: Excellent results are accomplished with this method and, most importantly, the patient looks normal at any point during the treatments. If donor hair becomes depleted or the patient wishes no further treatments, he/she is left with a normal appearance. CONCLUSION: The method of performing mini-micrografts, starting from the front and moving posteriorly in a progressively concentric fashion, creates a very natural result at almost all phases of the surgical hair restoration.

Alopecia↗

PubMed1994

Scalp lifting. Anatomic and technical considerations.

BACKGROUND: Extensive scalp lifting, though offering the potential for tremendous benefit to the patient with extensive male-pattern alopecia, has not been widely accepted or understood. OBJECTIVE: The anatomic and technical features of extensive scalp lifting are discussed. METHODS: The performance of extensive scalp lift surgery must be preceded by a thorough understanding of the specific goals, anatomic considerations, surgical techniques, and specific methods for successful completion of this operation. A knowledge of preoperative preparation, anesthesia, intraoperative methods, undermining, hemostasis, means of scalp advancement, and proper closure are essential for minimizing side effects and complications of this beneficial procedure. One must understand the dynamics of scalp stretching and lifting in order to achieve optimum removal of baldness and to successfully predict the outcome of the operation. CONCLUSION: Present and future advantages of scalp lifting over traditional scalp reduction have been enumerated and discussed.

Alopecia↗

PubMed1994

The use of retention sutures and tensed Silastic-Dacron strips for the prevention of stretch-back after alopecia-reducing procedures.

BACKGROUND: A comparison between using retention sutures (N = 25), a tensed Silastic-Dacron strip (N = 25), or nothing (N = 25) for the prevention of stretch-back (after alopecia-reducing procedures) was performed between 1990 and 1992. OBJECTIVE: The purpose was to determine if retention sutures or a tensed Silastic-Dacron strip placed subgaleally from one donor fringe to the other would reduce the amount of stretch-back after alopecia-reducing procedures. METHOD: A prospective study of a total of 75 patients was performed. The width of the bald area was measured immediately after the surgery and at 3 months with each of the three modalities. RESULTS: Retention sutures resulted in some prevention of stretch-back. Tensed Silastic-Dacron strips totally prevented stretch-back and in some cases made the bald area compressed. CONCLUSIONS: Retention sutures placed through subgaleal tunnels reduces stretch-back after alopecia-reducing procedures. Tensed Silastic-Dacron strips totally prevent stretch-back and in approximately half the cases compress the area of baldness.

Adult↗

PubMed1994

Circumferential scalp reduction. The application of the principles of extensive scalp-lifting for the improvement of scalp reduction surgery.

BACKGROUND. Conventional scalp reduction techniques involve the undermining of bald skin, inducing the problems of stretch-back and slot formation in the majority of patients. Conversely, extensive scalp-lifting, a relatively new technique, never undermines bald skin; therefore, the problem of stretch-back is minimal and slot formation is reduced. This procedure, however, is more intricate, owing to the undermining down to the hairline of the nape. Because not all cosmetic hair replacement surgeons desire to perform this more intricate surgery, the author takes many of the principles of scalp-lifting and applies them to the scalp reduction procedure. With the application of these principles, many of the problems of scalp reduction surgery are significantly reduced and other aesthetic aspects improved.

Alopecia↗

PubMed1994

Utilization of No-Kor needles for slit-micrografting.

BACKGROUND: This article introduces the No-Kor vented needle as an excellent tool for micrograft recipient site development. OBJECTIVE: To show that No-Kor vented needles are better than conventional hypodermic needles (with and without dilators) and Bard Parker blades for micrograft recipient site development. METHOD: Comparisons with hypodermic needles (with and without dilators) and Bard Parker blade incisions are made. RESULTS: When compared with hypodermic needles (with and without dilators, the No-Kor needles show less scarring, allow easier placement, take less surgical time, and are less expensive. When compared with Bard Parker blade incisions, the No-Kor needles demonstrate less scarring, more precision, and less expense. CONCLUSION: The No-Kor vented needle is an excellent tool for the development of micrograft recipient sites. It demonstrates advantages over both hypodermic needles and Bard Parker blades.

Alopecia↗

PubMed1993

A three-step systematic incisional-slit minigrafting approach.

BACKGROUND. Over the past decade, minigrafting has become the cornerstone of effective hair transplantation because the "corn row" appearance commonly seen with larger grafts occurs frequently with smaller grafts. However, there still has not appeared in the literature a sequential, systematic approach that yields consistently good results. This article offers an organized blueprint that not only has given predictable and excellent results, but has expedited the minigraft procedure. OBJECTIVE. To present a three-step incisional-slit minigrafting approach. RESULTS. The method described gives excellent aesthetic results and expedites the procedure.

Hair↗

PubMed1993

Scalp lifting. An 8-year experience with over 1,230 cases.

BACKGROUND: This article reviews the author's 8-year experience with extensive scalp-lifting, which includes 1,230 cases. OBJECTIVE: To overview extensive scalp-lifting paying particular attention to the areas of complications and the ways to reduce them. METHOD: Retrospective analysis of 1,230 cases was done. Necrosis, infection, hematoma, numbness, and scarring were evaluated. RESULTS: 1) Vertical incision occipital artery ligatory should be performed 4 to 8 weeks prior to a scalp lift. 2) Use a delay procedure prior to a frontoparietal advancement flap. 3) Use only lateral lifts on patients with prior punch-grafting. 4) Locate the temporal arteries preoperatively with Doppler ultrasonography. 5) Do not perform frontoparietal advancement flaps on patients with prior punch-grafts. CONCLUSION: Scalp lifting is an extremely effective and expedient method to treat alopecia; however, certain precautionary measures must be taken to obtain excellent, consistent results.

Alopecia↗

PubMed1993

Two new retractors for hair replacement surgery.

BACKGROUND: Two new retractors that facilitate scalp reduction and scalp-lifting surgery are introduced. OBJECTIVE: To improve the accuracy, visibility and speed of alopecia reducing procedures. METHODS: These retractors were developed through trial and error in cooperation with the Robbins Instrument Corporation. RESULTS: The suction retractor has been found to clear the field, elevate the scalp flap, and put the skin on stretch simultaneously. The serrated hook retractor has been found to greatly improve visibility for the cauterization of bleeders. The hook and serrated surface of this retractor prevents intraoperative slippage. CONCLUSION: The two new retractors introduced in this article have been found to improve greatly the accuracy, visibility, and speed of alopecia reducing procedures.

Alopecia↗