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Meetings and Studies Review of the 22Nd Annual Scientific Meeting of the International Society of Hair Restoration Surgery October 8-11, 2014 • Kuala Lumpur, Malaysia

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Meetings and Studies Review of the 22Nd Annual Scientific Meeting of the International Society of Hair Restoration Surgery October 8-11, 2014 • Kuala Lumpur, Malaysia Hair Transplant Forum International www.ISHRS.org January/February 2015 Meetings and Studies Review of the 22nd Annual Scientific Meeting of the International Society of Hair Restoration Surgery October 8-11, 2014 • Kuala Lumpur, Malaysia SURGICAL ASSISTANTS PROGRAM Despite the capabilities of Wednesday/October 8, 2014 these bio-enhancements, Aileen R. Ulrich, CMA Hillsboro, Oregon, USA Dr. Cooley drove home the [email protected] important role the assistant The 96 attendees of the Surgical Assistants Program en- plays in preventing what he joyed a fascinating program in Kuala Lumpur. Speakers were feels is the biggest detriment welcomed from many cities across the United States as well to graft survival—physical as from Thailand, Australia, Georgia, the Philippines, and the trauma, especially at placement time. United Kingdom. In the final section of our program, video was used to evalu- As the program chair, I started the morning off with an in- ate different techniques of graft preparation and placement. To troduction to the day’s agenda and encouraged all assistants to prevent desiccation during the slivering process, Patcharee take full advantage of the opportunities available to the surgical Thienthaworn presented a slivering board that allows the strip assistants within the ISHRS organization. The first section of to be submerged in saline while slivering occurs and Roxanna the program covered non-surgical considerations for the surgical Barajas demonstrated her approach and tools used for slivering assistant and our opening speaker, ISHRS attorney Scott Fintzen, the donor strip. For the subsequent phase of graft preparation, emphasized that everything we do should be in the patient’s best Brandi Burgess covered key elements to aid graft dissection be- interest. He affirmed the assistant’s responsibility to understand fore sharing a video of graft cutting using both straight and angled and adhere to his or her scope of practice, and pointed out the forceps. In comparison, Bettina Penalosa then gave an overview potential legal ramifications for assistants practicing outside of their set-up, instruments, and holding solutions concluding that scope as well as their increased vulnerability if they are not with a video of the means used to cut, count, sort, and track graft covered under the physician’s malpractice insurance. Sara Rob- numbers during the hair transplant procedure. While examining erts gave a thorough overview of the clear, concise process and methods for graft placement, Saranya Manochai demonstrated materials used in hiring, training, and communicating expecta- a two-handed style of graft insertion used to minimize graft tions to new staff members. Following Sara, Salome Vadachkoria trauma and Sara Roberts reviewed the use, loading procedure, highlighted strategies to improve surgical flow and increase set-up, roles, and flow between physician and assistant when efficiency during graft preparation and placement. She called to using implanter pens for graft placement. This was followed by our attention how lack of efficiency among team members can Kimberly Wallace and Tina Lardner who presented on the use easily add hours to the overall procedure time when performing of handheld and robotic machines for FUE procedures. They large sessions. Next, Laura Burdine discussed the importance of illustrated differences in instrumentation, patient positioning, infection control and how it relates to satisfied, return patients surgical flow, and the role of the assistant. Felipe Reynoso then who promote our practices through positive word of mouth. gave the closing presentation emphasizing the assistant’s part in She outlined clear methods to prevent cross contamination and becoming familiar with pre-operative and post-operative instruc- surgical site infections. In his presentation on instrument care, tions and the importance of effectively communicating these Kenny Moriarty discussed the proper steps, solutions, and tools directions so that patients are well prepared for their surgery and for cleaning surgical instruments. He also dispelled common know what to expect before, during, and after their procedure. misconceptions regarding surgical steel and mistakes to avoid I would like to personally thank everyone who presented when processing instruments. Our final speaker for this block and attended as well as those behind the scenes who made our was Helen Marzola, who walked us through several potential Surgical Assistant’s program possible and contributed to the emergency situations we may encounter in the hair restoration rich exchange of knowledge, experience, and passion for hair clinic. She emphasized the importance of implementing safety restoration. This is a truly remarkable field of medicine to be measures and ensuring staff preparedness through proper training involved in. I thoroughly enjoyed my year as chair of our Surgi- in all physician offices. cal Assistant’s Program and I look forward to the interchange of In the following segment of our program, Drs. Steven Gabel ideas and educational opportunities that await us at next year’s and Jerry Cooley covered topics related to hair science. Dr. Gabel Surgical Assistant’s Program in Chicago, Illinois, September began with a thought-provoking overview of the anatomy and 9-13. Mark your calendars and plan to attend! physiology of the hair follicle. After discussing and demonstrat- ing the various hair growth cycles, Dr. Gabel emphasized the importance of keeping all viable hair follicles intact, within their follicular unit groupings, when dissecting grafts in order to maximize hair counts and produce optimal patient results. Next, Dr. Cooley artfully explained the role of HypoThermosol, platelet rich plasma (PRP), ACell, and ATP in hair restoration. [ Thursday on page 34 33 Hair Transplant Forum International www.ISHRS.org January/February 2015 THURSDAY/OCTOBER 9, 2014 by fine unpigmented lanugo hair in the fetus/ Paul McAndrews, MD, FISHRS Pasadena, neonate, short (mostly unpigmented) vellus California, USA hair or fine pigmented intermediate hairs [email protected] during childhood, and long, thick termi- The meeting started with a welcome from nal hair shafts in several body sites in the program chair, Dr. Damkerng Pathomvanich, adult—before transforming, aging to either and ISHRS president, Dr. Vincenzo Gambino. miniaturized hairs characteristic of pattern There were rounds of talks on “hairline balding or depigmentation of robust terminal design” in various ethnic groups. Dr. Pathom- hairs. It appears that the melanocyte can be vanich discussed the Asian hairline and the lost without too much negative consequence difference from Caucasians due to differ- to hair fiber production. Much of the recent ences in facial features and contour of the research has focused on both the oxidative skull. Asians have less frontal projection than stress that appears to increase with aging, Caucasians and the hairline appears more flat. and to which the hair follicle melanocytes In Asians, a hairline that is too high doesn’t appears especially sensitive, and the fate of frame the face well as in Caucasians. hair follicle melanocyte stem cell capacity. Dr. Russell Knudsen presented a voiceover The next session, moderated by Dr. Fabio video from Dr. Ron Shapiro that discussed the Rinaldi, was on platelet rich plasma (PRP) hairline in Caucasians. He stated that hairline in hair restoration surgery. Dr. Carlos Puig parameters vary depending on degree of cur- Damkerng Pathomvanich, MD, FISHRS, Chair of presented a very interesting double blind, rent hair loss, potential future hair loss, the Annual Scientific Meeting placebo controlled study on PRP on 39 and donor density. Dr. Melvin Mayer females with female pattern hair loss noted that hairlines in African Americans (FPHL). In the end, the hair mass index are flatter and there is a need to place the (HMI) and hair counts did not show any donor hair down and forward. statistical significance. He ended by say- Dr. Nilofer Farjo discussed how ing PRP may have a role in FPHL but the female hairlines are usually intact so no study population for the next study must design is usually necessary, it is typically be larger to see if there is a statistical a matter of increasing the density in the significance in the end points. existing area. However, when a woman’s The following session, moderated by hairline is too high, it is necessary to bring Advances in Hair Biology Speaker Desmond J. Tobin, PhD, Dr. Paul McAndrews, was on the role of FSM, FRCPath, with panel members Mario Marzola, Francisco it down, and usually female hairlines are Jimenez and Ken Washenik hair transplants in non-AGA and scar- flatter. ring alopecia. Dr. McAndrews discussed Dr. Russell Knudsen discussed hair- the need to make the specific diagnosis lines in transsexuals. Transsexual hair- for symptoms of hair loss, which would line design is often a staged procedure then dictate the appropriate treatments. with at least two sessions required. This Unfortunately, for many forms of hair is because generally the patient wants loss, there is not a perfect treatment. It the transition from the male hairline to was discussed that hair transplants for female hairline to be less obvious to oth- the secondary scarring alopecias are very ers. In this scenario, the temporal hairline Conference attendees appropriate; however, hair transplants for is first lowered to a non-balding male primary scarring alopecias are variable at hairline. Once this has grown, a second session that includes best. The recommendation was to wait for at least 2 years of temporal rounding and sometimes entire hairline lowering is quiescence of the active primary disease and then biopsy the then performed. scalp before considering hair transplant in primary cicatricial The next session’s topic was storage solutions. Dr. John Cole alopecia (and there was some thought to never transplant in stated that the survival rate using normal saline and Ringer’s these cases). Lactate is excellent and very cost effective. He also stated that Dr. Edwin Epstein moderated a session on the management there is no data showing that other, more expensive solutions of donor wound closure.
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