Mowlavi Arian, Majzoub Ramsey K, Cooney Damon S, Wilhelmi Bradon J, Guyuron Bahman
Laguna Beach, Calif.; Cleveland, Ohio; and Springfield, Ill. From private practice, the Division Plastic and Reconstructive Surgery, Case Western Reserve University, and the Plastic Surgery Institute, Southern Illinois University, School of Medicine.
Plast Reconstr Surg. 2007 May;119(6):1891-1895. doi: 10.1097/01.prs.0000259191.59277.7a.
Incisions made perpendicular to the hair follicles during anterior frontal hairline brow lifts or forehead shortening procedures help produce an inconspicuous forehead scar. The success of this "hidden" incision relies on the anteriorly directed frontal hairline follicles and their growth vector. The authors hypothesized that a similar incision could be made perpendicular to the hair follicles in the temple region during rhytidectomy. A well-designed anterior hairline beveled incision over the temple would allow for improved leverage during soft-tissue repositioning and a concealed hairline incision in the temple region.
Anterior temporal hairline strips 4 cm in length at the level of the lateral canthus were excised from 16 fresh cadavers. Hairline follicles (n = 227) were assessed for direction and angle of growth after appropriate tissue preparation and staining (hematoxylin and eosin). The hair follicle angle was analyzed microscopically as it approached the epidermis.
The anterior temporal hairline follicles were oriented at a mean angle with the epidermis of 16 +/- 3 degrees anteriorly and inferiorly.
The anterior temporal hairline follicles of the scalp are oriented anteriorly and inferiorly with the epidermis, providing the surgical rational for using a beveled hairline incision angled 30 to 45 degrees to the external skin surface to undercut the distal flap. This incision is perpendicular to and transects the temporal hair follicles during rhytidectomy, permitting hair growth through and anterior to the scar. This modified anterior temporal hairline incision reduces visibility of the scar at the hairline for patients in whom scar show and hairstyle versatility are important concerns.
在前额发际线提升或前额缩短手术中，垂直于毛囊做切口有助于形成不明显的前额瘢痕。这种“隐藏”切口的成功依赖于向前的前额发际线毛囊及其生长方向。作者推测，在除皱术中，可在颞部区域垂直于毛囊做类似的切口。精心设计的颞部前方发际线斜切口可在软组织重新定位时提供更好的杠杆作用，并在颞部区域形成隐蔽的发际线切口。
从16具新鲜尸体上切除外眦水平处4厘米长的颞部前方发际线条带。在适当的组织处理和染色（苏木精和伊红）后，评估发际线毛囊（n = 227）的生长方向和角度。在毛囊接近表皮时，在显微镜下分析毛囊角度。
颞部前方发际线毛囊与表皮的平均角度为向前下方16±3度。
头皮的颞部前方发际线毛囊向前下方与表皮呈一定角度，这为使用与皮肤表面呈30至45度角的斜行发际线切口来剥离远端皮瓣提供了手术依据。在除皱术中，该切口垂直于颞部毛囊并将其横断，使毛发能够穿过瘢痕并在瘢痕前方生长。对于瘢痕显露和发型多样性是重要关注点 的患者，这种改良的颞部前方发际线切口可减少发际线处瘢痕的可见度。
