Objectives: 1. Evaluate the efficacy of botulinum toxin type A on androgenetic alopecia by analysis of phototrichogram, physician's global assessment, subjective self assessment
2. Evlauate the safety of botulinum toxin type A on androgenetic alopecia by checking laboratory test such as blood test and urin analysis

Introduction: Transforming growth factor beta(TGF-β) induced by dihydrotestosterone has known to inhibit the proliferation of dermal papilla cells of hairs and elongation of hair shaft. Therefore, TGF-β could be a potent biomarker for inducing androgeneitc alopecia and it’s blocker could be effective in preventing androgenetic alopecia.
Botulinum toxin type A (BTX) plays a role in inhibiting the secretion of TGF-β from fibroblasts and dermal papilla cells of hairs.
So, it is import to check the efficay of BTX on androgenetic alopecia clinically.

Materials / method: 22 patients with MPB participated in this study. They received intradermal injection of 30 U BTX every 4 week for total 24 weeks.
The primary endpoint is to evaluate the change of hair counts per ㎠ in target area with phototrichogram analysis and the secondary endpoint is physician’s global assessment(PGA) which compared clinical photos before and after treating. For evaluation of subjective self assessment, the participants scored the 5 questionaries by 7 scale system.
Adverse effects were monitored through the blood test, urine analysis, the subjective symptoms and exam of scalp.

Results: The number of the hairs increased at 24 weeks by 6.61±9.96 per ㎠ compared with baseline. It was statistically significant (p=0.0119). However, hair counts at target area did not change at 12week compared with baseline.
Physician’s global assessment score was 0.06±0.24 (p=1.000) at 12 weeks and 0.33±0.49 at 24 weeks (p=0.0313). PGA score elevated statistically significant at 24 weeks. In subjective self assessment, the participants were overall satisfied with the result. No serious adverse event occurred except temporary local pain on injection site which disappeared in 30 minutes.

Conclusion: Intradermal injection of botulinum toxin type A might be a safe and effective options in the treatment of MPB.
It can be used as adjunctive or alternative therapy for the medical treatment of MPB

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Por favor indique a entidade (pessoa ou empresa): This study was funded by the Daewoon Phamaceutical research grant in 2017

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Objectives: Treat androgenetic alopecias with lesser dependence on minoxidil
Prevent and prolong hair transplantation
Provide definitive protocols for hair restoration and alopecia prevention

Introduction: PRP is now a widely accepted technique for androgenetic alopecia treatment here we try to develop unique methods wherein the anaesthesia along with the topical creams ,we also use vibrational techniques to prevent the vasovagal syncopes and dramatically reduce the pain
We also use the PPP for better results

Materials / method: Patients whole blood
Centrifuge
Prp kits
Prilocaine creams
Vibrational device

Results: We observed
Improvement in hair thickness and volume in 90 percent of the cases
Reduction in hair fall 90 percent of the cases
New hair growth 50 percent of the cases
In all cases we were able to taper off minoxidil
Our study had 289 cases

Conclusion: PRP is now a well documented and accepted technique to treat androgenetic alopecia and we fine tune the technique and provide inputs of our own .

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Objectives: Eyebrows are important facial features owing to their position on the face. Eyebrow hair loss is not conceived as natural hair loss and is not considered cosmetically and socially acceptable. Other methods exist to camouflage the absence eyebrows or to make eyebrows appear fuller, such as with a tattoo or daily makeup application. However, the results are neither natural looking nor permanent, and so not achieving the patient’s satisfaction.

Introduction: Patients seen for eyebrow transplantation have either absent eyebrows, thin eyebrows, or want to fill in a scar within the eyebrows. In our practice, almost all patients are candidates for eyebrow transplantation. The only contraindication is unrealistic expectations. It is of paramount importance to discuss the patient's expectations versus the expected realistic outcomes.

Materials / method: Preoperative evaluation and history taking focusing on the cause and pattern of hair loss and the assessment of possible donor areas. We use the same technique whether there is partial or complete loss or just thinning of the eyebrows.
Ring block anesthesia is given. The recipient sites are made using the smallest blade size for the graft. Incisions are made in an angle as acute as possible to the skin. Proper direction of slits to allow proper direction of hair growth is critical. The grafts are then inserted. Post-operative care includes maintaining the eyebrow area dry for 5 days.

Results: The planted grafts started to fall out around 2 to 3 weeks after the procedure and the eyebrows returned to their pre-procedure form. On average, the grafts started to regrow in around 4 to 6 months with final results noted around 10 months to 1 year.
Complications encountered included lower than expected density and asymmetry. These were treated by a second session. Another less encountered complication was less than ideal angulation, and if problematic to the patient, the implanted hair was removed by follicular unit extraction

Conclusion: It is remarkable how the eyebrows truly do ‘frame the face. Eyebrow transplantation has a high level of patient satisfaction. It is a challenging yet very rewarding procedure for both its artistic and technical demands for the hair restoration surgeon.
Take home message:
Select your patient.
Set proper expectations
Let the patients draw their desired eye brows
Donor area (FUE vs FUG) (Scalp vs Body Hair)
Direction of Hair growth !!
Making slits with acute angle
Avoid Asymmetry

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Objectives: Recently we've seen some different devices focused on treating androgenetic alopecia that aim to increase the hair growth rate and hair density. One of those options called our attention due to the high patient satisfaction and the great results we've come through, using the micro infusion of drugs into the skin with a tattoo machine, where we can stimulate the hair growth by microneedling and deliver some drugs into the papillary dermis to induce a faster hair growth, augmentation of hair caliber and hair density.
Our aim is describe a new therapeutical option with good results.

Introduction: The androgenetic alopecia is the mainly cause of hair follicle miniaturization and baldness in men and women. It can affect negatively the patient quality of life and how the patient correlates in society. The microinfusion of medicaments in the skin (MMS), or MMP the portuguese acronym (Microinfusão de Medicamentos na Pele) is a technique described by Dr. Samir Abache, a Brazilian Dermatologist. This technique comes from the ancient tattooing art that gives us the possibility of sterile medication injection at the papillary dermis stimulating hair growth and augmentation of hair density.

Materials / method: The tattoo machine used has a hand grip, an autoclavable tip with a medication storage and disposable sterile needles. The equipment has an adjustable speed operation and powered by simple source of energy. Minoxidil 0,5%, Finasteride 0,05% and Copper Peptides 1,2% were used in all patients with infusion’s depth of 2mm and 60 RPM speed operation. All 10 patients enrolled at this study were diagnosed with Androgenetic alopecia confirmed by clinical and trichoscopic diagnostic critera. All patients had a poor and unsatisfactory results history of to topical treatment with minoxidil.

Results: This study was performed at the author's private practice where were choosen Androgenetic Alopecia patients with unsatisfactory results to local treatment with minoxidil. All subjects underwent to a monthly MMP section with Minoxidil 0,5%, Finasteride 0,05% and Copper Peptides 1,2% and local daily treatment maintained. The patients were followed up for 6 months and data were analysed by two Dermatologists. After photo and dermoscopy assessment there was a considerably improvement of hair density of all subjects. In a patient's satisfaction scale, 80% were very satisfied and 20% satisfied.

Conclusion: The MMP technique is a procedure that can precisely deliver active medications into the skin with minimal side effects. It is cost effectively and has a wide variety of therapeutic applications to the dermatologist. Further studies are
needed to technically improve the procedure, and better choice of
drugs to be infused as well as and their concentrations and the possibility of skin sensitization.

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Este trabalho não recebeu nenhum patrocínio direto ou indireto. O mesmo está sob a própria responsabilidade do seu autor.

Objectives: To evaluate the results of the new automatic hair implant device.

Introduction: The problem of alopecia affects both sexes at all ages, with sometimes significant psychological sequelae. Along with androgenetic alopecia, there are forms of alopecia which have various origin as traumatic, surgical, pharmacological and others. In 1993 the first biocompatible fiber was developed in Italy.

Materials / method: Biocompatible air are similar to natural hair and they are available in 13 different colors, that can be washed and dried with moderate heat as normal hair, but they cannot be bleached. The fibers can go from a length between 15cm and 45 cm. Besides straight fibers, there are also tight curl, soft curl and waves. The high density variant, that allows to use 3 hairs with the same graft, is also available. The new device allows to implant up to 800 hair/h reducing scalp trauma. The procedure is performed under local anesthesia and enables an immediate aesthetic result without pain and scars.

Results: With this modern technique of hair restoration we have successfully treated diffuse hair loss or hair thinning, both considered for men and for women. Conditions for success are a suitable patient with healthy scalp, a well trained and qualified physician, having respect of implant protocols, after care applications, a correct  identification and a treatment of possible skin reactions.

Conclusion: Nowadays automatic hair implant is a well proved surgical technique that can be also used singularly or in combination with FUE to provide the best final results.

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