Great strides have been made in hair restoration over the past 20 years. A better understanding of natural balding and non-balding patterns along with more respect for ageing has helped guide proper hairline design. Additionally, the use of smaller grafts has created a significantly improved natural appearance to the transplanted grafts. Inconsistent growth and survival of follicular grafts, however, has continued to be a problem that has perplexed hair restoration surgeons. This review attempts to explore the stresses affecting grafts during transplantation and some of the complexities involved in graft growth and survival. These authors reviewed the literature to determine the primary scope of aspects influencing growth and survival of follicular grafts. This scope includes patient selection, operating techniques, graft care, storage solutions and additives. The primary focus of the hair restoration surgeons should first be attention to the fundamentals of hair care, hydration, temperature, time out of body and gentle handling. Factors such as advanced storage solutions and additives can be helpful once the fundamentals have been addressed.

Hair transplantation has come a long way from the days of Punch Hair Transplant by Dr. Orentreich in 1950s to Follicular Unit Hair Transplant (FUT) of 1990s and the very recent Follicular Unit Extraction (FUE) technique. With the advent of FUE, the dream of 'no visible scarring' in the donor area is now looking like a possibility. In FUE, the grafts are extracted as individual follicular units in a two-step or three-step technique whereas the method of implantation remains the same as in the traditional FUT. The addition of latest automated FUE technique seeks to overcome some of the limitations in this relatively new technique and it is now possible to achieve more than a thousand grafts in one day in trained hands. This article reviews the methodology, limitations and advantages of FUE hair transplant.

Patients with hair loss are seeking treatment at a younger age and during earlier stages. Not all need hair transplants. Because of the lack of assured management and the fear of side-effects, patients are turning to ineffective alternative remedies from self-claimed experts. In this report, we discuss the available treatment options and how best they can be used in combination to produce satisfactory results. The traditional approach consists of administration of drugs such as minoxidil and finasteride. We propose a hypothesis that nutritional supplements, 2% ketoconazole shampoo and low-level laser therapy along with finasteride 1 mg used once in 3 days with 2% minoxidil used everyday, given in a cyclical medicine program may be useful to manage hair loss and achieve new hair growth. The scientific rationale for such an approach is explained. The need for further studies to establish the efficacy of the regime is stressed upon.

Swelling or oedema of forehead or eyelids is a common consequence of hair transplantation surgery. However, this results in increased morbidity and absence from work due to unaesthetic appearance. To study various physical and therapeutic modalities to reduce or completely prevent the occurrence of such oedema. Three hundred forty hair transplant patients were recruited in the study and were categorized into 8 groups depending upon the intervention employed. There were 32 dropouts in the study due to various reasons. Patients who were administered steroid with tumescent solution had the highest number of patients without oedema, with only 3 out of 117 patients developing oedema. Physical measures like position of head during sleeping, application of occlusion bands or ice packs did not show satisfactory results. Addition of triamcinolone to tumescent anaesthetic solution is a very effective technique of preventing post-operative swelling.

Background : Botulinum toxin has been utilised successfully in many facial and extra facial regions to limit superfluous movement. Scars, whether traumatic or disease-related, are treated with many modalities. Objective: To assess the available literature concerning the prophylactic use of botulinum toxin for the improvement in the cosmetic outcome of scars induced by surgery and to examine its role in the treatment of established scars alone, as also combined with other modalities. Material and Methods : The results of the prophylactic use of botulinum toxin to limit the resultant scarring from surgery are examined by a literature review. The primary and adjunctive use of botulinum toxin in the treatment of post acne and post surgical and traumatic scars is explored by case examples. Results : Literature review and personal experience shows good Improvement in the appearance of scars with the use of botulinum toxin alone or with other adjuvant modalities in the treatment of scars. Conclusion : Botulinum toxin would appear to be useful both in the prophylaxis and treatment of certain types of scars.

Background : Chemical reconstruction of skin scars (CROSS) is a technique using high concentrations of trichloroacetic acid (TCA) focally on atrophic acne scars to induce inflammation followed by collagenisation. This can lead to reduction in the appearance of scars and cosmetic improvement. Aims : The aim of this pilot study is to investigate the safety of the CROSS technique, using 100% TCA, for atrophic ice pick acne scars. Settings and Design : Open prospective study. Materials and Methods : Twelve patients with predominant atrophic ice pick post acne scars were treated with the CROSS technique, using 100% TCA, applied with a wooden toothpick, at two weekly intervals for four sittings. Efficacy was assessed on the basis of the physician's clinical assessment, photographic evaluation at each sitting and patient's feedback after the fourth treatment, and at the three-month and six-month follow-up period, after the last treatment. Results : More than 70% improvement was seen in eight out of ten patients evaluated and good results (50 - 70% improvement) were observed in the remaining two patients. No significant side effects were noted. Transient hypopigmentation and hyperpigmentation was observed in one patient each. Physician's findings were in conformity with the patient's assessment. Three months after the last treatment, one patient noted a decrease in improvement with no further improvement even at the six-month follow-up period. Conclusion : The CROSS technique with 100% TCA is a safe, efficacious, cost-effective and minimally invasive technique for the management of ice pick acne scars that are otherwise generally difficult to treat. In few patients the improvement may not be sustained, probably due to inadequate or delayed collagenisation.

Background : Despite the many advances, scarring, particularly acne or pimple scarring, does not have a satisfactory treatment. A new armamentarium in this field is this recently devised matrix-tunable radiofrequency technology, which utilizes radiofrequency emission in the treatment of acne scars. Aims : To evaluate the efficiency of the new matrix-tunable radiofrequency technology in patients with acne scars of varying sizes. Settings and Design : A prospective study of 30 randomly selected patients with acne scars was carried out. Materials and Methods : Thirty healthy patients with different types of acne scars - ice pick, box and rolling type - were randomly selected. The scars were either shallow or deep, varied in size from 2 to 20 mm and ranged in number from 10 to 50. These patients were first treated with broad-spectrum antibiotics and local exfoliating agents (topical tretinoin 0.025%) and then subjected to matrix-tunable radiofrequency technology. Each scar was treated at intervals of 1 month. A maximum of four such sittings were carried out. Patients were followed-up every 15 days. Results were noted at the end of 2 months and 6 months. Improvement was assessed by using the visual analog scale (VAS) at 2 months and 6 months, and results were noted in terms of percentage improvement of the whole face by calculating an average of percentage improvement on the basis of interviews of the patient and his/her accompanying relatives. The visual analog scaling was performed by means of high-resolution digital photographs taken at the baseline and at each subsequent visit. Results : The VAS improvement in scars ranged from 10 to 50% at the end of 2 months to 20 to 70% at the end of 6 months. Of the 30 patients of acne scars, the cosmetic result was excellent (>60% improvement) in four, good (35-60% improvement) in 18 and moderate to poor (<35% improvement) in eight. A few patients reported burning sensation and a mild sunburn-like sensation for about 1 h after treatment. The patients reported a pinkish tone for 2-3 days. Importantly, with the help of some slight make up, all the 30 patients could return to work the following day. Conclusion : Matrix-tunable radiofrequency technology is a safe and economically viable option for the dermatologists for the treatment of acne scars, because of the effective results coupled with a low downtime.

Finasteride is an important drug for the management of androgenetic alopecia. However, there are concerns about the possible side effects of the drug such as impotence. Recently stray reports have appeared about the occurrence of male breast carcinoma in patients who received the drug. These have been looked in to by Medicines and Health care products Regulatory Agency (MHRA). This article summarizes the MHRA report.

Large scalp defects pose a challenge for the surgeon. Here, we present a 31-year-old male patient with a soft tissue defect on the temple with exposed bone. To allow reconstruction, we placed a self-filling osmotic expander in the subgaleal pocket for 12 weeks. The final volume of the tissue expander was 300 mL. In the last step, a rotational flap was created after removal of the tissue expander from its pocket. Thereby, a tension-free suturing was possible. The post-surgical healing was uncomplicated. Osmotic tissue expanders are a valuable tool for the closure of large tissue defects without the necessity of repeated filling procedures.

Treatment of alopecia is often challenging for the clinician as it includes a spectrum of lesions ranging from congenital to acquired causes. We present three cases of congenital circumscribed alopecia, present since birth, clinically diagnosed as nevus sebaceous. Histopathological examination of the excised tissue showed syringocystadenoma papilliferum with dermatophytosis in one and nevus sebaceous with dermatophytosis in the other two cases. Although complete excision is the treatment of choice for these lesions, an antifungal agent is needed to eradicate the concurrent superficial mycosis. A careful histopathological examination of the lesional skin helps in identifying such unexpected dual lesions that would need further treatment.

Basal cell carcinoma (BCC) is the most common malignancy of the skin, accounting for approximately 70-80% of all cutaneous cancers. The commonest site of basal cell carcinoma is the face; 80% arise above a line from the corner of the mouth to the ear lobe. The lifetime ultraviolet radiation damage is the most important factor in its pathogenesis, and the vast majority is observed on sun-exposed skin. BCCs can develop in sun-protected areas, but its occurrence is rare. Here we are reporting a case of rare site of BCC with review of literature in a 65-year-old male who presented with a lesion over anterior chest wall. A clinical diagnosis of BCC was made and patient was subjected to excision biopsy. Biopsy revealed it to be a BCC and it was treated with a Dufourmentel flap.

Giant lipomas are benign soft tissue tumours. They are found relatively rarely on the posterior part of the neck. Bleeding pressure ulcer in this giant tumour is a rare presentation. Surgical interventions in these tumours are very challenging because, sometimes, extension to the spinal cord and malignant change may occur, especially in old age. Knowledge of the anatomy and meticulous surgical techniques are needed for such giant lipomas.

Subcision is a simple and safe office surgery procedure for treatment of depressed acne scars. It can easily be combined with other treatments such as laser, dermaroller and scar revisions for maximum efficacy.