El campo de la restauración capilar es una especialidad dinámica en la que las tecnologías avanzadas permiten a los cirujanos lograr resultados estéticamente más agradables. La pérdida de cabello parece haber preocupado a la humanidad desde los albores de la historia, como se pone de manifiesto en una receta para restaurar el cabello que se incluyó en el año 1500 antes de Cristo en el Ebers papiro del antiguo Egipto.
El éxito del trasplante de pelo moderno depende de un fenómeno descrito por primera vez por Orentreich en 1957 como dominio de los donantes. Con este fenómeno, el pelo tomado de la zona con cabello permanente de los pacientes con alopecia androgenética (zona donante) y se transfiere a las áreas sin cabello (zona receptora) del cuero cabelludo, continúa creciendo en su nueva ubicación durante tanto tiempo como el que tendría que seguir creciendo en la zona de la que fue tomada.
1804
Baromio transplanta cabello en animales
1822
J. Dieffenbach realiza auto-transplante de cabello en la piel
1939
Okuda utiliza 2- injertos de 4 mm para la restauración de la alopecia
1943
Tamura implanta injertos de cabello individuales por inyección para la restauración de la piel que cubre el monte de Venus en la mujer.
1959
Orentreich utiliza auto-injertos con pelo para la corrección de la calvicie de patrón masculino
1980’s
Limmer utiliza microscopios para la creación de pequeños injertos de cabello se insertan en ranuras de agujas.
1992
Uebel realiza la escisión de una tira donante lineal.
1994
Unger crea limitaciones de la zona donante delineando la zona segura de los donantes.
1995
Cosechas Woods, unidades foliculares individuales usando troqueles circulares pequeños (1 mm) conun aspecto estético aceptable y una baja tasa de transección.
1997
Bernstein y Rassman describen su técnica de trasplante de unidades foliculares,contribuyendo el término "unidad folicular" a la nomenclatura
2002
Rassman y Bernstein describen FUE como una técnica quirúrgica en la literatura médica.
El pelo varía según los diferentes grupos étnicos y en cada individuo. Tiene dos estructuras separadas: el folículo incrustado dentro de la piel y la parte del pelo que es visible en la superficie del cuerpo. Además, hay varios tipos de pelo.
La mayoría de los ejes del pelo emerge del cuero cabelludo como agrupaciones de pelo individuales-4. Las agrupaciones son la porción superficial visible de la unidad folicular (FU) y generalmente consisten de una a cuatro folículos pilosos terminales y un folículo velloso.La dirección del cabello difiere según la parte del cuero cabelludo en la que crece.
Por consiguiente, tanto la dirección y el ángulo de las incisiones deben adaptarse a ser coherente con la dirección del pelo en un área del cuero cabelludo específico.
El folículo piloso es un órgano dinámico cuya actividad cíclica requiere la regeneración y el reensamblaje de la porción no permanente del folículo piloso durante cada ciclo.Normalmente, la cantidad de nueva formación del cabello del cuero cabelludo es igual a la cantidad que se pierde, manteniendo así una cobertura consistente.
El ciclo del folículo piloso pasa por tres fases principales: una de crecimiento (anágena) la fase activa: una fase de regresión (catágena) y una fase de reposo (telógena).
Recientemente, se identificaron dos etapas adicionales en el ciclo folicular: la fase de liberación (exógena) y tiempo de retardo de fase (kenogen). Además, es el tipo de folículo y su ubicación física que determinan la longitud de cada fase folicular.
Las enfermedades que causan la pérdida del cabello se clasifican por dos factores importantes: la difusión o la localización de pérdida de cabello y la existencia de un folículo en buen estado o su destrucción y su reemplazamiento por una cicatriz.
En general, los factores que generan la pérdida de cabello son la inflamación, la genética, el medio ambiente, y las hormonas.
Los andrógenos tienen paradójicamente diferentes efectos en los folículos pilosos humanos, estos efectos son supeditados a su ubicación en el cuerpo. La testosterona es el andrógeno circulante en los hombres que cuando se reduce a dihidrotestosterona (DHT) por una enzima 5α-reductasa, se une al receptor de andrógenos. En los folículos pilosos,la enzima 5a-reductasa, los receptores de andrógenos (AR) y coactivadores AR puede regular la sensibilidad de andrógenos. En los receptores del cuero cabelludo sin cabello, la enzima 5α-reductasa y andrógenos se incrementan.
AGA, también conocida como alopecia de patrón masculino, es la causa más común de pérdida de cabello y afecta hasta el 70% de los hombres a mediados de su vida adulta. APM se produce en presencia de andrógenos en individuos genéticamente susceptibles. El aumento reciente del nivel de prostaglandina D2 en los folículos del pelo se ha sugerido como una de las principales causas de la APM.
La característica clave de la APM es la miniaturización folicular mediante la cual la duración de la fase de crecimiento activo se reduce de 2-6 años a unos pocos meses, y la etapa de reposo es relativamente alargada. Las nuevas generaciones de pelo en consecuencia son más cortos, más finos, y de color más claro y normalmente ocultan el cuero cabelludo en menor medida. La transición puede ser gradual o puede venir en oleadas; Sin embargo, el curso y el alcance de la APM son impredecibles.
En el varón, el patrón generalmente comienza con recesión bi-temporal, seguido por la calvicie vértice y la pérdida de cabello en la zona media-frontal, permitiendo la retención de los folículos pilosos terminales en la región occipital del cuero cabelludo. El sistema más comúnmente utilizado para evaluar la APM es la escala Hamilton-Norwood.
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