Le domaine de restauration capillaire est une spécialité dynamique qui permet les chirurgiens d’aboutir aux résultats plus esthétiques. La perte de cheveux semble à gêné l’humanité depuis l’aube de l’histoire qui est manifesté dans une ordonnance pour la restauration de cheveux traitée dans le papyrus d’Ebers de l’Egypte ancien en 1200 A.J.
La réussite de greffe de cheveux modern dépend d’un phénomène défini comme la dominance de donneur par Orentreich en 1957. Avec cette phénomène, les cheveux sont extraits de peau poilu de patients souffrant de l’alopécie androgénique (la zone donneuse) et ces cheveux sont implantés dans la partie chauve du cuir chevelu (zone receveuse), ceux-ci continuent à repousser dans sa nouvelle endroit pour aussi longtemps qu'il aurait dans la zone de laquelle ils ont été extraits.
1804
Baromio greffe des zones poilues chez des animaux
1822
J.Dieffenbach effectue l’autogreffe de cheveux dans la peau
1939
Okuda utilise des greffons de punch de 2-4 mm pour la restauration de calvitie
1943
Tamura implante des greffons uniques de cheveux par l’injection pour la restauration de mont du pubis chez les femmes.
1959
Orentreich utilise des auto-greffons de peau poilue pour la réparation de calvitie de type homme
1980’s
Limmer utilise des microscopes pour la création des 1 à 5 petits greffons de cheveux insérés dans des needle slits.
1992
Uebel effectue l’excision de ligne linéaire sur la zone donneuse.
1994
Unger crée les limites de récolte de la zone donneuse en traçant la zone donneuse sécurisée.
1995
Woods récolte des unités folliculaires simples en utilisant plus petit punchs circulaires de 1 mm avec une apparence esthétique acceptable et un taux faible de la transsection.
1997
Bernstein and Rassman describe their follicular unit transplantation technique, contributing the term “follicular unit” to the nomenclature
2002
Rassman and Bernstein describe FUE as a surgical technique in medical literature
Les cheveux varient entre des différents groupes ethniques et des individus. Ils ont deux structures séparées: La follicule scellée dans la peau et la tige du poil visible sur la surface du corps. De plus, il y a différents types de cheveux.
La majorité de tige du poil émerge de cuir chevelu en tant que des groupes de 4 cheveux uniques. Les groupes sont des parties visible superficielle de l’unité folliculaire (FU) et consiste généralement à 1- 4 follicule des cheveux terminaux et une follicule de velus.
La direction de cheveux diffère selon la partie du cuir chevelu dans laquelle les cheveux repoussent. La direction et l’angle de l’incision doivent être adaptés afin qu'ils soient cohérents avec la direction de cheveux dans la zone spécifique de cuir chevelu.
Normalement, la quantité de formation de nouveaux cheveux est égale à la quantité de perte, de ce fait cela maintient une recouverte consistante.
Le cycle du follicule de cheveux passe 3 phrases principales: La phase de repousse active (anagène) ; la phase de repos (catagène) et celle de chute (télogène).
2 phases supplémentaires sont récemment définies dans le cycle folliculaire: la phase de perte (exogène) et la phase de décalage (kénogène). De plus, c’est le type de follicule et sa location physique qui déterminent la longueur de chaque phase folliculaire.
Les maladies qui causent la perte de cheveux sont classées sous 2 facteurs importants: La diffusion ou la localisation de cheveux et l’existence d’une follicule indemne ou sa destruction et son remplacement avec une cicatrice.
Les facteurs provoquent en général la perte de cheveux sont l’inflammation, la génétique, l’environnement et les hormones.
Les androgènes ont de différents effets sur les follicules de cheveux humains dépendant de sa location sur le corps humaine. La testostérone est l’androgène majeur circulant dans les hommes. Quand il est réduit en dihydrotestostérone (DHT) par une enzyme de 5a- réductase, attache au récepteur d’androgène. Dans les follicules de cheveux, 5a-réductase, les récepteurs d’androgènes (AR) et les co-activateurs d’AR peuvent réguler la sensibilité aux androgènes.
Alopécie androgénique connue sous le nom de MPHL, est la cause la plus commune de perte de cheveux et affecte jusqu’à 70% des hommes dans la période d’âge moyen. MPHL se produit en présence des androgènes chez les individus susceptible génétiquement. La hausse récente de niveau de la prostaglandine D2 dans les follicules de cheveux est considérée comme la cause majeure de MPHL.
Le caractéristiques principales de MPHL est la miniaturisation folliculaire par laquelle la durée de la phase de repousse active réduit de 2- 6 années à quelques mois, et que la phase de chute rallonge relativement. Les nouvelles productions de cheveux devient plus court, fines et foncés et dissimule typiquement moins le cuir chevelu. La transition peut être graduelle ou ondulée; cependant, le processus et le degré de MPHL sont imprévisibles.
Chez les hommes, MPHL commence en général par une récession bi-temporaire suivant la calvitie de vertex et la perte de cheveux frontale qui permet à retenir les follicules terminale des cheveux dans la région occipitale de cuir chevelu. Le système le plus utilisé pour traiter MPHL est Hamilton-Norwood Scale.
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