A 27-year-old man has traumatic absence of the lateral third of the right eyebrow one year after sustaining avulsion and laceration injuries to the forehead and cheek. On current physical examination, there is an avulsion scar in the supraorbital region and a laceration extending from the lateral canthus directly posterior to the temporal scalp, both of which are well healed. The patient would like to undergo reconstruction of the avulsed eyebrow.

Which of the following is the most appropriate reconstructive option?

(A) Composite scalp graft containing hair follicles
(B) Median forehead flap containing hair-bearing tissue from the anterior scalp
(C) Temporal scalp flap based on the ipsilateral superficial temporal artery
(D) Washio flap
(E) Microplug hair transplantation

The correct response is Option A.
In this patient who has absence of the lateral third of the eyebrow resulting from trauma, composite grafting from the scalp is the most appropriate reconstructive option. This technique would be associated with the greatest chance for hair growth in this patient; in addition, the donor scar would be inconspicuous.

Reconstruction with a median forehead flap is a procedure that requires multiple stages and would result in an unsightly donor site scar. Both the temporal scalp flap and Washio flap would be based on the posterior temporal branch of the superficial temporal artery; however, this artery was most likely transected when the patient sustained the facial laceration, eliminating the possibility of using these flaps. Microplug hair transplantation is unreliable over scar tissue, especially traumatized soft tissue and radiated scars.

References
1. Achauer BM. Reconstructing the burned face. Clin Plast Surg. 1992;19:623-636.
2. Achauer BM, VanderKam VM. Burn reconstruction. In: Achauer BM, Eriksson E, Guyuron B, et al, eds. Plastic Surgery: Indications, Operations, and Outcomes. Saint Louis, Mo: Mosby Ð Year Book, Inc; 2000:431-432.

A 35-year-old man with male-pattern alopecia undergoes punch grafting for reconstruction of the anterior hairline. Which of the following best describes the pattern of hair growth seen in the grafted area postoperatively?

(A) Immediate normal growth
(B) No growth for one month followed by immediate normal growth
(C) Immediate hair loss followed by new normal growth after three months
(D) Growth for one month, followed by no growth for three months, and then resumption of new normal growth
(E) Growth for one month, followed by hair loss, and then new normal growth after three months

The correct response is Option E.

Following punch graft transplantation, the patient has hair growth for one month, followed by hair loss, and then new normal growth after three months. Once grafting is completed, there is an initial period of false growth lasting three to four weeks. The hair follicles then pass into the telogen phase, and this newly grown hair is shed. The telogen phase lasts two to three months; following this, normal permanent hair growth begins at a rate of 1 cm monthly. Therefore, a total of approximately six months is required for the onset of permanent hair growth in the grafted area.

References
1. Price VH. Treatment of hair loss. N Engl J Med. 1999;341:964-973.
2. Vallis CP. Hair replacement surgery. In: McCarthy JG, ed. Plastic Surgery. Philadelphia, Pa: WB Saunders Co; 1990;2:1514-1537.