毛发移植法修复除皱术后发际位置异常

Clinical study on the application of hair transplantation to correct abnormal hairline position after rhytidectomy

目的探讨毛发移植法改善除皱术后发际位置异常的方法和效果。方法2014年3月至2019年1月,北京大学第三医院成形外科收治61例除皱术后发际位置异常患者,均为女性,年龄28~65岁,平均41岁。其中45例为额部(内镜法)联合中面部除皱术后,11例为额颞部除皱术后(内镜法),5例为中面部除皱术后。除皱术与毛发移植术的间隔为6~79个月,平均18.4个月。根据美学理论重新设计额部、颞部和鬓角的发际位置和形态,采用毛发移植法予以修复。术后随访计算毛发成活率,由患者和1位第3方整形外科主治医师分别评价患者发际线的满意程度和对颞下发际线瘢痕的遮挡程度。结果25例行额颞发际线联合颞下发际线植发,23例行额颞发际线植发,13例行颞下发际线植发。所有患者随访时间12~24个月。额颞部发际线的毛发成活率平均为94.3%[90.8%(51.1/56.3)~98.9%(52.5/53.1)],颞部发际线内切口的颞下区域毛发成活率平均为93.2%[89.1%(31.1/34.9)~98.6%(34.4/34.9)],颞部发际线边缘切口的颞下区域毛发成活率平均为81.2%[60.4%(17.2/28.5)~87.6%(26.8/30.6)]。额颞发际线植发满意程度评价:患者为4.1~5.0分,平均4.5分;医生为4.3~4.9分,平均4.7分。颞下发际线植发满意程度评价分为2部分,发际线内切口评分患者为4.0~5.0分,平均4.4分;医生为4.2~4.9分,平均4.7分;颞下发际线边缘切口评分患者为2.8~4.7分,平均4.0分;医生为3.1~4.9分,平均4.2分。颞下发际线的瘢痕遮挡程度评价:患者为2.6~5.0分,平均3.7分;医生为3.1~5.0分,平均3.9分。结论应用毛发移植技术修复除皱术后的发际位置异常能取得满意的效果。由于颞下发际线的位置和瘢痕上毛发成活率较低,术后毛发遮挡瘢痕的效果一般,再次植发和改进除皱手术切口设计是解决这一问题的方法。

Objective To investigate the technical route and clinical application effects of correcting abnormal hairline position after rhytidectomy with hair transplantation.Methods A total of 61 patients in this group were female.The age distribution was 28 to 65 years.Among them,45 cases underwent forehead(with endoscopy)and mid-face rhytidectomy,11 cases underwent forehead rhytidectomy(with endoscopy).5 cases underwent mid-face rhytidectomy.The interval between rhytidectomy and hair transplantation ranged 6 to 79 months,with an average of 18.4 months.The hairline position and morphology of the frontal,temporal and sideburns were redesigned according to aesthetic theory.Hair transplantation was performed to correct the abnormal hairline.When the patients were followed up,the hair survival rate was calculated.The patient’s hairline satisfaction and the degree of concealment of the infratemporal hairline scar were evaluated by patient and a third party attending plastic surgeon,respectively.Results 25 cases underwent hair transplantation of frontotemporal hairline and infratemporal hairline,23 cases underwent hair transplantation of frontotemporal hairline and 13 cases underwent hair transplantation of infratemporal hairline.All patients were followed up for 12 to 24 months.The hair survival rate of frontotemporal hairline was 94.3%[90.8%(51.1/56.3)to 98.9%(52.5/53.1)]on average.The hair survival rate of the infratemporal hairline,whose incision was inside the temporal,was 93.2%[89.1%(31.1/34.9)to 98.6%(34.4/34.9)]on average.The hair survival rate of the infratemporal hairline,whose incision was on the edge of the temporal hairline,was 81.2%[60.4%(17.2/28.5)to 87.6%(26.8/30.6)]on average.The average satisfaction score of the frontal-temporal hairline for the patients and doctors was 4.5 points and 4.7 points,respectively.The evaluation of the satisfaction of the infratemporal hairline was divided into two parts.The average satisfaction score of the patients with incisions in the hairline was 4.4 points from patients and 4.7 points from doctors.The average satisfaction score of the patients with hairline incisions was 4.0 points for patientsand 4.2 points for doctors.The scar concealment degree of infratemporal hairline scar was 3.7 points for patients and 3.9 points for doctors in average.Conclusions Correcting abnormal hairline position after rhytidectomy with hair transplantation can achieve satisfactory result.Since the position of the infratemporal hairline and the low hair survival rate on the scar,the effect of scar concealing is average.Replanting hair grafts and improving the design of the rhytidectomy incision are the method to solve this issue.