A novel treatment strategy for eyebrow transplantation in an ectodermal dysplasia patient
A 17-year-old Iranian girl who was born in Isfahan, Iran was referred to the private office of the correspondent author in 2009. She had sparse, low density, curly, dry hair. She was born with absent lateral half of eyebrows and low dense hair in medial eye-brows (). She had hypodontia, with the absence of central incisors in the upper and lower arches. In addition, all her teeth were cone-shaped. Her facial appearance was malformed because of the hypoplastic mandibular and maxillary bones. Further signs were mild hypohydrosis and sever xerosis of the skin. Her mother reported several episodes of intractable high grade fevers and pneumonia during her infancy. The patient's older sister had had the same manifestations but in milder degrees and she was also a known case of ED. The sister had also hypodontia and hair impairments. The intelligence quotient (IQ) of both sisters was in normal range and their educational achievements were normal as well. Ophthalmic and auditory evaluation showed no abnormality. Among their family members, only the two sisters suffered from ED and their parents had no signs of this disorder. However, they had relative marriage. In general physical examination, the patient had quite dry and scaly skin. She also had several idiopathic atrophic scars in her facial area. She had dental prostheses for upper and lower mandibular incisors. Histopathology examination of skin biopsy revealed normal epidermis with very sparse primitive sweat glands. Topical emollients and several sessions of fractional Co2 lasers for idiopathic atrophic scars in the face had been used for her skin problems. The patient was so depressed and anxious about her appearance and had about 2 years of partial social withdrawal because of her malformed facial appearance (). She was quite ashamed because of eyebrow hair loss and had been seeking for medical treatment for a long time.\nAfter examination, we advised the patient to undergo a hair transplant surgery. After obtaining an informed consent, we planned to perform FUT for hair transplantation. The patient was sedated by oral benzodiazepines. The donor region for transplantation was the occipital scalp. After tumescent anesthesia, the follicular units were removed from the donor area using an elliptical excision. They were carefully divided into small follicular units under a microscope. The donor tissue was separated into one to two haired follicular units in order to provide a natural appearance.\nWe transplanted the follicular units which contained one or occasionally two hairs into tiny incisions that were previously made by 19-and 20-gauge needling of the eyebrow skin at the same direction of the normal hair growth. We used appropriate lighting and magnification to achieve maximum precision. The whole procedure lasted 3 hours and we transplanted 60-100 hair in each lateral part of the eyebrows. The donor site was sutured with simple separate sutures which were removed after 8 days.\nAfter 3 days, tiny crusts were made around each follicle in the recipient site. The crusts disappeared after 6 days. The hairs began to shed after 2-3 weeks but in three months follow-up most of the hairs were regrown and the patient was quite satisfied with her appearance ().\nThe patient was advised to trim the transplanted hairs regularly once a month. After 6 months and 2 years fallow-up, the density of hair increasingly improved. The improvements were evident by comparing photographs which were taken using the standardized automatic option of a camera (Figures and ). The patient was quite satisfied with her appearance and also liked to have full eyebrow transplantation in order to increase hair density. The dentition was also restored with maxillary and mandibular implant prostheses.\nThe girl's quality of life was measured before and after the treatment by dermatologic quality of life questionnaire (DLQI). The SLQI score significantly improved after treatment. Due to her depressive symptoms and the impairment of her social functions, we advised her to visit a psychiatrist before operation. He prescribed fluoxetine 20 mg daily but because of the improvements after hair transplantation the drug was discontinued.\nHer parents decided to use FUT method for eyebrow transplantation for their other daughter as well.