1990
New Publication Aims at Idea Sharing Among Surgeons
Hair Transplant Forum International September 1990, 1 (1) 1
In 1990 Dr O’Tar Norwood started the Hair Transplant Forum International (The Forum) to serve the hair transplant community. In this the inaugural issue of the journal he noted that “In this age of instant communication and exploding information, it is incongruous that it should take so long to exchange information. The purpose of this informal publication will be the rapid dissemination of ideas, questions, concepts, views and opinions. Its course and content will largely be determined by the comments, questions and reactions of its readers”. The Forum rapidly grew and became published six times a year. It has retained its original intent of providing a vehicle for discussion and debate among practitioners. Although not a per reviewed journal, the Forum has published many of the most important articles and studies in the field of hair transplant surgery. As the official journal of the International Society of Hair Restoration Surgery is serves a vital role in the continued evolution and development of the field.
1991
“Guru” Manny Marritt Shares Some Wisdom About Hair Transplantation
Hair Transplant Forum International January 1991, 1 (3) 1-8
The centerpiece of the second issue of the Forum was an interview with Dr Manny Marritt. Dr Marritt was highly respected for his clinical knowledge and use of innovative surgical techniques. In this article he shares insights on the use of minigrafts and micrografts, hairline design, scalp reductions, and the advantages of slits rather than holes as recipient sites. As was typical of Dr Marritt his thinking was always a step ahead. Although, hair restoration surgery has highly evolved since his career his concepts remain influential in the field.
Tumescent Anesthetic for the Scalp
William P. Coleman, Hair Transplant Forum International March 1991, 1 (4) 6
The author presents one of earliest reports of use of tumescent solution in hair restoration surgery. The solution is prepared by adding 12 cc of 2% lidocaine, 1.3 meq of sodium bicarbonate, ad 1 cc of epinephrine 1:1000 to a 250 cc I.V. bag of sodium chloride. The result is a final solution of 1% lidocaine and 1:250,000 epinephrine; the effect is complete long-lasting anesthesia and excellent hemostasis with a low total dose of lidocaine (well below the potential toxic dosage).Although the formula for tumescent solution varies, the practice of tumescence has become routine in the majority of hair transplant practices and has been proven to be safe and effective.
Tissue Expansion Plays Limited, But Vital, Role
Sheldon Kabaker, Hair Transplant Forum International May 1991, 1 (5) 1-3
The author has extensive experience in performing scalp expansion for treatment of cicatricial alopecia and male pattern baldness. He discusses appropriate indications and technical aspects. The ensuing commentary is a discussion of complications.
Hair Transplantation Evolves Internationally
Marcelo Gandelman, Russell Knudsen, et al, Hair Transplant Forum International July 1991, 1 (6) 1-8
The history of development of hair restoration surgery in several countries around the world is reviewed. Included are USA, Canada, Mexico, Brazil, France, and Australia. The contributors describe the preferred techniques in each area and notable contributions by area practitioners.
THE OVERWHELIMING RESPONSIBILITY
Emanuel Marritt, Hair Transplant Forum International September 1991, 2 (1) 6
In this article, the author, one of the most respected early pioneers of mini and micrografting and use of single hair grafts, eloquently expresses the need to see the long view when treating young patients with hair restoration surgery.
Bob Limmer Does It All One Hair At a Time!
B. L. Limmer, Hair Transplant Forum International November 1991, 2 (2) 8-9
This paper is one of the earliest descriptions of using a minigrafts containing 1 -4 hairs as the approach to hair restoration. This technique replaced the previous technique of punch grafts and split punch grafts and was the precursor of the follicular unit transplantation technique that is the hallmark of modern hair restoration surgery.
Refinements in Flaps
Richard W. Fleming and Toby G. Mayer, Hair Transplant Forum International November 1991, 2 (2) 3-4
Drs Fleming and Mayer were masters of performing rotation flap surgery for the treatment of male pattern baldness and were responsible for many refinements of the technique that was most popular during the 1980’s through 1990’s and is still practiced to a limited extent into the 21st century. This article describes their technique.
1992
FROM ACROSS THE GLOBE
Sheldon Kabaker Reinforces Shiell’s Cautions on the use of Flaps by Inexperienced Surgeons, Hair Transplant Forum International January 1992, 2 (3) 9
The author reviews the history of the Juri flap and discusses potential problems with flap surgery. He emphasizes that complications are rare in experienced hands but can be common in inexperienced hands. He emphasizes the need for a surgeon to have a preceptorship with a highly experienced surgeon before starting to perform flap surgeries.
GRAFT HARVESTING… A THIRD GENERATION
Paul Straub, Hair Transplant Forum International March 1992, 2 (4) 2-4
In the early 1990’s donor strip harvesting was introduced as an alternative to punch harvesting. The use of multibladed knives became popular. Typically, one to three narrow strips of donor scalp would be excised, and this strip dissected into grafts of variable size. The wound in the donor area would be sutured. The greatest disadvantage of this approach was the risk of transection of follicles during the strip excision and during the subsequent graft dissection. Gradually the standard approach became excising a single ellipse of donor scalp followed by graft dissection under stereo microscopes. In this article the author elaborates his approach with multiblade harvesting which serves as an example of how this practice was used in the early stages of the development of strip harvesting.
INTERNATIONAL HAIR TRANSPLANT SOCIETY NEEDED NOW
Dowling Stough, Hair Transplant Forum International March 1992, 2 (4) 9
In an open letter to the Forum Dr Dow Stough made a compelling proposal for the formation of the International Society of Hair Restoration (Surgeons [sic]) Surgery. This was the opening to the formation of the society which has become the most important educational organization worldwide in the field of hair restoration surgery.
FRECHET’S FLAP PROCEDURE
RICHARD SHIELL, Hair Transplant Forum International May 1992, 2 (5) 2-4
Dr Richard Shiell describes in detail the triple flap technique developed by Dr Patrick Frechet for correction of the slot deformity that remains after a series of scalp reductions. This approach re-establishes the normal crown whirl architecture. Skill and experience are required. Several practitioners add observations from their own experience with the technique to Dr Shiell’s. The most common (5% reported by Dr Frechet) complication is tip necrosis of the longest flap.
DILATORS vs. NON-DILATORS
Emanuel Merritt and Manfred W.G. Lucas, Hair Transplant Forum International July 1992, 2 (6) 6-7
As the surgical approach to hair transplantation moved away from punch grafts to micro and minigrafts, the use of site dilators to keep recipient sites open emerged as a popular technique. In this article two prominent practitioners debate the pros and cons of dilator use. Gradually, as mini and micrografting evolved into follicular unit transplanting, the vast majority of practitioners have abandoned use of site dilators.
THE ELLIPTICAL METHOD
Hair Transplant Forum International July 1992, 2 (6) 8
Donor strip harvesting performed by removing an ellipse of scalp with a single scalpel blade became the gold standard technique of follicular unit transplantation in hair restoration surgery by the late 1990s. This article presents some of the earliest descriptions of the elliptical harvest technique.
SAY GOODBYE TO POSTOPERATIVE SWELLING
O’Tar T. Norwood, Hair Transplant Forum International September 1992, 3 (1) 13
Postoperaitve swelling of the forehead and face has been a common problem with hair restoration surgery since its inception. Many techniques have been tried to prevent this problem including pre, intra, and post-operative corticosteroids – oral or injected. Head bands, ice packs, and sleeping in an elevated position have also been advocated. None of these techniques has shown a consistent benefit. In 2010 Dr Gholamali Abassi introduced a technique of injecting a solution of dilute triamcinolone, saline, and epinephrine into the recipient area. This was a breakthrough, and the technique prevents almost all post-operative hair transplant swelling. Dr Norwood, who in this paper from 1992, presented a technique of adding triamcinolone to local anesthetic injected into the recipient area as a way to prevent swelling. He reported the technique was highly successful. Dr Norwood deserves credit for originating this important discovery.
1993
An Historical Perspective on the Knife
Dominic Brandy. Hair Transplant Forum International November 1993, 3 (2) 3-4
The author discusses the development of multi-bladed knives for strip graft surgery from the first use in 1969 by Vallis to 1993. The first application in hair transplantation was with a double-blade producing a 6mm strip which was later refined by another surgeon to 4mm spacing and over time triple bladed knives were produced with smaller spacings by a number of different doctors.
Recent Improvements in Donor Harvesting Techniques
Carl B. Shory. Hair Transplant Forum International November 1993, 3 (2) 6-7
In this article is a description of the use of Surgitron High Frequency Radio surgical Instrument (3.8 MHz) from Ellman International for harvesting donor strips. The technique involves using a 2 or 3 prong electrode to make parallel cuts and then removing the strip with iris scissors for further sectioning. The author discusses the advantages and disadvantages of using this instead of a surgical blade. The instrument never really became very popular probably because the disadvantages outweighed the benefits.
Adhesive Application Technique
Robert M. Elliott and Robert H. True. Hair Transplant Forum International November 1993, 3 (2) 10-11
A variety of methods to stabilize hair transplant grafts were used over the years including sutures, steel pins and tissue adhesives. Here the authors describe their own technique of using tissue adhesive. This time consuming process was used in the past for larger grafts to prevent them dislodging but is no longer indicated with follicular unit transplants.
Report on International Meeting Dallas, Texas: April 30th - May 2, 1993
Richard C. Shiell. Hair Transplant Forum International March 1993, 3 (3) 3-6
The 1st ISHRS annual meeting was the largest gathering of hair and scalp surgeons at the time. Twenty-three members were elected to the Board of Governors. Included at the meeting were topics ranging from donor harvesting, pre-op medication, local anaesthesia, graft placing, flaps and reductions and medical management with minoxidil. There are many notable presentations described with highlights mentioned such as Frechet extender, Choi implanters, theory of stem cell location by Inaba, and Jung Chul Kim’s study showing that 70% of hairs regrow if only the upper 2/3 is transplanted.
Beta Blockers
Roy L. Forsythe. Hair Transplant Forum International June 1993, 3 (4) 4
In this brief case report the author describes his experience of an adverse event with epinephrine use in a patient on a non-selective beta blocker.
Beta Blockers Are Still a Problem
James Arnold. Hair Transplant Forum International June 1993, 3 (4) 4-5
Beta blockers work by binding with epinephrine specific receptor sites, termed beta sites, throughout the body. By binding with the beta sites, epinephrine is blocked from having its normal reaction. Some beta receptors are more sensitive than others and are termed beta1 . All others are called beta2. A reaction was reported years previously in patients on propranolol who were exposed to the epinephrine in the anesthetic. The patients developed a brief period of hypertension followed by marked bradycardia. Two papers were found in anesthesia journals describing the hypertension/bradycardia reaction also occurring with beta1 blockers, including atenolol and are referenced in this article.
Hyperfibrotic Transplants
Martin G. Unger. Hair Transplant Forum International June 1993, 3 (4) 8-9
Clinically, the abnormal tissue involved is markedly thickened, elevated, firm, and non-tender, and involves the frontal region after a transplant at least one year prior. This author has treated several such cases where the original transplant was done by another doctor. Resolution in all patients was achieved by U-shaped serial excision.
Thoughts on Progressive Male Pattern Baldnes
Walter P. Unger. Hair Transplant Forum International September 1993, 3 (5) 6-7
Here we see the author discussing the situation where the anticipated hair loss in a patient goes beyond expectations. By the use of alopecia reductions, strip re-harvesting and slit grafting virtually every patient can get a satisfactory outcome.
Isolated Frontal Forelock
Bob Limmer. Hair Transplant Forum International September 1993, 3 (5) 17-19
In this article is a description of repair techniques when a transplanted frontal zone becomes unnatural as the patient ages and further hair loss continues. He also introduces the concept of the isolated frontal forelock either as a repair or as a procedure to use in the patient with extensive hair loss presenting for the first time.
A Scarce Commodity
Manfred Lucas. Hair Transplant Forum International September 1993, 3 (5) 8-9
The author reminds us of the discrepancy between donor availability and advancing baldness. He warns us that we should not try to cover the receding hairline and the vertex with young people if they come to us with a Hamilton-Norwood scale type III vertex. He also clearly demonstrates pictorially why the Rule of Thirds should not be followed.
Stretch back Dead or Swept Under a Carpet of Confusion?
Richard C. Shiell. Hair Transplant Forum International November 1993, 3 (6) 14-16
The author discusses the phenomenon of “stretch-back” following scalp reduction surgeries. In studies of a large series of cases 10-50% loss of the effect of reduction procedures over a short period of time was found. Nordstrom did his own study with tattoo marks and demonstrated stretch-back of 30-50% when the scalp was closed under tension. Others reported little or no stretch back. Martin Unger showed that the key element to prevent this complication was closure without tension.
Care with Choice of Patients for Frechet Flap Procedure
Richard Shiell. Hair Transplant Forum International November 1993, 3 (6) 18-19
The Frechet flap was described in 1990 as a technique that was ideal for the correction of “slot defects” following scalp reduction as long as the area was narrow and marginal relatively hair stable. The author describes his 12-month experience with the flap and describes a higher-than-expected rate of necrosis in the hair-bearing flaps.
1994
Answers to Common Dilemmas Following Alopecia Reducing Procedures
Dominic Brandy. Hair Transplant Forum International January 1994, 4 (1) 5-8
In order to help the surgeon meet the challenges of alopecia reduction procedures, the author answers commonly asked questions. This includes questions such as “How do you handle the parting of the red sea effect?” and “How do you handle the patient who recedes in later life?”
Malpractice: The Legal Aspects of Transplantation
Bob Limmer and Sheldon Kabaker. Hair Transplant Forum International March 1994, 4 (2) 5
Although not an article in the usual sense of journal writing this is an important topic for all doctors to be familiar with to help prevent patient litigation. Here the author describes cases that he has come across in his 14 years as an expert. Apart from complications and unrealistic expectations, several cases came about because of inappropriate marketing such as using terminology such as full head of hair, permanent solution, undetectable, totally natural, and rarely painful. These types of problems are true to this day.
Flaps Are Dying a Natural Death?
Sheldon S. Kabaker. Hair Transplant Forum International March 1994, 4 (2) 6-7
The problems involved in using reductions and flaps for treating baldness are discussed in this article. The various types such as sagittal reduction, Mercedes reduction, Y-shaped reduction, scalp lift, or lateral advancement flap all have inherent problems such as change of hair direction which creates styling issues for the patient. Flaps with added tissue expansion is discussed as a beneficial technological advance. Dr Anderson’s BAT and TAT flaps have the advantage of reconstruction of an entire hairline with appropriate recessions and anteriorly facing hair.
1000 Grafts at the Hairline
Victor Loria. Hair Transplant Forum International May 1994, 4 (3) 2-4
In this article the author describes his technique of grafting 1000 grafts into the first ¾ inch of scalp using NoKor needles for incisions to place micrografts of 1-4 hairs. In the area behind for density minigrafts are placed. This is a fairly new concept of tightly packing grafts into a small area.
Megasessions: Dense Packing
William Rassman. Hair Transplant Forum International May 1994, 4 (3) 5
The concept of megassessions of over 1500 grafts and dense packing is discussed in this article. Guidelines for each step in the process are described.
Laser Hair Transplanting
Walter Unger Hair Transplant Forum International May 1994, 4 (3) 6-7
In this article, Dr Unger describes some initial studies using a CO2 laser to make recipient sites. The advantages of using the laser are described as: less bleeding, perhaps less pain, perhaps less edema, but most importantly being able to produce slits that were 1-2 mm wide to accept slit grafts and thereby avoid the two most significant problems with slit grafting: 1) compression and 2) somewhat lesser density.
Is It X-Factor or H-Factor?
Joseph Greco. Hair Transplant Forum International May 1994, 4 (3) 10-11
The concepts of X-factor (an unknown factor that causes less than expected growth after hair transplants) and H-factor (Human factor causing poor hair growth) are discussed in this article.
Gearing Up for Two Thousand Grafts Per Session and Dense Packing
O’Tar T. Norwood. Hair Transplant Forum International July 1994, 4 (4) 1-2
In this article Dr Norwood summarizes his experience of observing Dr Rassman’s surgical process. The concepts of megasessions and dense packing of the hairline are fairly new concepts with only a few surgeons performing hair transplants in this way. Dr Norwood states that he believes this is the away of the future.
Report on the Toronto Meeting
Richard C. Shiell. Hair Transplant Forum International September 1994, 4 (5) 3-10
This article is a summary of the latest developments presented at the 2nd Annual ISHRS meeting in Toronto, Canada. The meeting included topics such as standardizing terminology and photography, minigrafts, anaesthesia and sedation, laser hair transplants, research (including new drug finasteride), mechanized hair transplantation, and more.
Finasteride … Should We be Worried?
David Whiting. Hair Transplant Forum International September 1994, 4 (5) 14-15
Dr Whiting reports on a study in which patients taking oral finasteride 5 mg per day had significantly increased hair counts and significantly improved clinical change from baseline by investigator rating of global photographs.
Finasteride / Minoxidil Combination
Bessam Farjo. Hair Transplant Forum International September 1994, 4 (5) 16
In this short article the author reports on his experience of using finasteride and minoxidil in combination. Here he presents two case studies to show their benefits in conjunction with surgery.
Eyebrow Transplantation
Marcelo Gandelman. Hair Transplant Forum International September 1994, 4 (5) 17
The author gives us tips on the reconstruction of eyebrows using micrografts including choice of donor sites and possible complications after surgery.
1995
The Front Forelock
Michael L. Beehner. Hair Transplant Forum International January 1995, 5 (1) 1-5
The front forelock method as described here by Mike Beehner, is a technique that has survived every era of our history, and could be achieved with big round plugs, cut to size micrografts, and follicular unit surgery. When the supply cannot meet the demand, this method comes to the rescue, and for most of us is still used regularly to make this patient subset quite happy.
Trouble with Megasessions!
Manfred Lucas. Hair Transplant Forum International January 1995, 5 (1) 6-7
Manfred Lucas never wrote or said anything that was not important. In this article he does not argue against megasessions, but rather cautions against what we call today overharvesting. Just because we can move very large numbers of grafts doesn’t mean we should, as overharvesting, particularly by the FUE method, is today the most common way we harm our patients.
Editorial
O'Tar T. Norwood. Hair Transplant Forum International March 1995, 5 (2) 2
This was the midst of the era of lasers as a site making tool in the field of hair restoration. As we all know, this technique rapidly fell out of favor, but several highly respected and influential surgeons were strong proponents early on. In this editorial, O’Tar Norwood demonstrates his wisdom and foresight as a skeptic of this technology.
“More ‘Problems with Megasessions’”
Marc A. Pomerantz. Hair Transplant Forum International May 1995, 5 (3) 4-5
This was also the era when “megasessions” were becoming popular, and surgeons all over the world were issuing warnings about the dangers of transplanting large numbers of grafts. The definition of megasession has always been quite fluid, and in this thoughtful discussion, Marc Pomerantz refers to “Super Megasessions” of over 2100 grafts, a number that has become quite straightforward in the decades that followed.
The Man Who Went Bald Twice!
Marzola Mario. Hair Transplant Forum International September 1995, 5 (5) 14-15
Only the most confident and honest among us bravely share the cases that didn’t turn out that well. In this article, Mario Marzola, one of the world’s most skilled alopecia reduction surgeons, describes a patient who’s progressive hair loss rendered him bald a second time. While Mario was able to help him surgically again, this article served as a warning that short and long term outcomes were not necessarily the same. Years later Mario famously abandoned alopecia reduction surgery altogether.
Trouble with Megasessions and Dense Packing
William Rassman. Hair Transplant Forum International November 1995, 5 (6) 4-5
Once again, the topic of megasessions is addressed, this time by Bill Rassman, the surgeon perhaps most responsible for promoting large sessions. While acknowledging that poor outcomes are possible and do occur, Bill points out that with proper technique and experience, this is a technique that can be mastered, and a surgeon who cannot get good results should probably stop trying.