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Summary: Subject: The eyebrow reconstruction should restore an eyebrow with a natural shape and with matching hair direction. Method: We describe the micrograft hair technique for eyebrow reconstruction, using either hair from the opposite eyebrow or hair from the scalp. We illustrate our technique with three clinical cases: a traumatic eyebrow injury, a burn scar and a progressive hair loss. Discussion: We insist on the advantages of this technique which is simple, “taylor-made” and which allows to choose the hair direction according to the eyebrow topography. The micrograft hair technique has many advantages in comparison with scalp strip grafting or hair-bearing island scalp flap techniques. Conclusion: The eyebrow reconstruction using micrograft hair technique is a simple effective technique offering a better cosmetic result than usual techniques by achieving a natural hair direction and density. [Copyright &y& Elsevier]

Redistribution from hair-rich to hair-poor areas is the fundamental principle of baldness surgery. Success of hair transplantation is based on the fact that transplanted hair follicles will behave as they did in their original area and continue to grow. Three basic techniques are employed: scalp flaps, scalp reductions and hair grafts. Each technique has undergone considerable refinements answering to initial wrong results and criticisms. The typical doll-hair tufted effect of old macro-grafts has disappeared with micro-graft shift. The unaesthetic cheese-like Hippocratic crown donor defect aspect ended when harvesting a long strip of occipital hair bearing scalp. The posteriorly directed hair growth has disappeared by using superiorly based flaps. Respective indications and tension-free closure ensure that the incidence of necrosis is low. Limited results of old scalp reductions have decreased by testing preoperative laxity of the scalp and using extensive undermining of the scalp. The future may release on medical treatment avoiding dihydrotestosterone to act on genetically predisposed follicles avoiding miniaturization of the hair and baldness development. However, when baldness has appeared, as the hair follicle’s culture is not actually effective, the state of art is still to plan a surgical strategy using successive stages of this large panel of techniques to reach a natural effect with the best hair orientation and density. [Copyright &y& Elsevier]

Alopecia, although long considered an unavoidable consequence of cancer therapy, currently presents a multifaceted challenge. The knowledge of the physiology of the hair and consequently of the pathophysiology of alopecia has led to show that there is not one but several types of alopecia. Transposed to the world of oncology, different types of alopecia and subsequently molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. Thus, in patients with cancer, alopecia can be iatrogenic (chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy, surgery) or directly the consequence of the disease itself (malnutrition, scalp metastases, paraneoplastic syndromes). Knowledge of the incriminated mechanism(s) could thus make it possible to deploy an appropriate care component, whether on the preventive or curative sides or in terms of supportive care. These are particularly essential regarding the psychological repercussions caused by alopecia, with significant consequences on the quality of life of patients and with a potential impact on treatment compliance. On the preventive side, the last few years have seen the advent of the automated scalp cooling therapy, supported by several randomized clinical trials. On the curative side, several therapeutic proposals are currently deployed or under development in order to provide relevant treatments., (Copyright © 2021 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Advances in treatment of androgenetic alopecia have led to the development of novel medical or surgical therapies adapted to the severity of hair loss and balding. Follicular units or tiny micro-graft hair transplants are a fundamental technical progress. This technique leads to the simple and painless permanent restoration of hair in male and female baldness. It provides the patient with a group of 1 to 3 hairs, emerging from a single orifice. The difference between androgenic receptors of occipital areas and those of other areas explains the permanent nature of the implanted hair growth. The degree of male or female androgenetic alopecia can be determined according to Hamilton's static classification or Ludwig's Classification, or it can be measured and monitored more accurately with Bouhanna's Dynamic Multifactorial Classification. The current indications for micro-graft transplantation are

Many surgical techniques are proposed for the treatment of baldness. We have made a selection of these techniques using criteria of efficacy, good patient tolerance and ease of implementation. Based on a retrospective analysis of 150 patients, we elaborated a strategy for surgical treatment of baldness.

Various non-hormonal therapies, either prescribed systemically such as certain hair-specific vitamins, or applied via the topical route, such as 2% Minoxidil, permit a normalisation of androgenic hair loss. The trichogenic action of these products should be verified in each individual with a comparative study using a trichogram and a phototrichogram. Any alopecia, be it large or small, may cause aesthetic discomfort. Currently, no medical or cosmetic product can give hope for a discernible and definitive hair regrowth. Only a micrograft reimplantation, hair by hair, produces tangible, aesthetically-denser hair in the bald region.

In order to understand the various operative indications in baldness surgery, we describe a dynamic classification of baldness with practical implications. The most predictive factors of this classification are scalp laxity and the height of the crown.

The author presents his indications for the various types of baldness. Grafts, for which the technique used has been recently modified, allow covering small patches of alopecia, especially on the anterior frontal line. High-hinged flaps are used for more advanced baldness. Lastly, scalp lift and scalp expansion allow solving the problem of extensive baldness of the vertex and of the anterior frontal line.

The candidate to cosmetic surgery is not, contrary to a too common idea, a frivolous creature trying to become more beautiful. He is generally a person with a physical disgrace that induces a frustrating sense of inferiority. The role of the surgeon is to help by removal of the disgrace. The operative indication is thus only psychologic and in some extreme cases, difficult to establish, because the surgeon is badly prepared to this role. A study was performed to understand better the motives and psychologic results of cosmetic operations. Sixty-eight candidates were chosen by the surgeon who considered their disgrace operable. All accepted a psychologic analysis. Following this they were divided into 3 groups: "adapted" (39), "worried" (21) and "perturbated" (8), according to the increasing importance of their emotional disturbances. None of these patients was really psychotic. In the great majority of cases (83%), the interviews with the psychologist disclosed parental difficulties during childhood, followed by a sensation of frustration and of insecurity. Of the 64 operated patients, 62 were reviewed by the psychologist. Fifty-four (87%) were satisfied with the result, among which 45 felt improvement in their psychologic state. Eight were disappointed. Among these, 7 had been classified as "worried" or "distressed". Only 2 patients had reasons to be dissappointed, the others focussed a depressive tendency on a minor and temporary unperfection. Cosmetic surgery thus produces the best psychologic results in "adapted" patients, but is also justified in "worried" or "distressed" patients as the majority will benefit from the operation. In these a careful psychologic contact with the surgeon is mandatory to diminish the postoperative emotional disturbances.