ROBIN UNGER TO LEAD DISCUSSIONS PRP, SCARRING ALOPECIA AND SURGICAL PLANNING FOR THE LONG TERM IN THE YOUNG PATIENTS at the ABCRC 7th Brazilian Congress of Hair Restoration AUGUST 22-25, 2018.

Dr. Robin Unger is honored to have been invited as International Faculty in Iguazu Falls Brazil at the Brazilian Congress.

She will speak on three major topics of interest in the field. PRP, Scarring alopecia and surgical planning in the young patient.

The first talk she will lead centers on the topic of PRP (platelet rich plasma). As one of the first physicians to begin using this technique for hair restoration, she has gathered a lot of information and continues to share that knowledge with others. Although there is much remaining to be learned in this field, PRP has shown great promise in treating hair loss patients. There are many different ways to perform PRP and prepare the blood for injection, these various methods will be reviewed briefly. The last ISHRS meeting in Prague, lead by Dr. Unger and Dr. Puig highlighted the variability in the approach used by leaders in the field. The unique method Dr. Unger uses: PeRP (platelet erythrocyte rich plasma) will be described and some results shown to illustrate the range of efficacy. The procedure does not work for all patients, but has been very successful for the majority treated.

The second topic she will present is especially important currently: how to recognize scarring alopecias and when not to operate. There has been a significant increase in the incidence of various diseases causing hairloss called cicatricial alopecias. These are scarring alopecias caused by inflammation and are not revesrsible if allowed to progress. They include both lichenplanopilaris (LPP) and frontal fibrosing alopecia (FFA). These conditions are particularly difficult to detect if they are in a quiet phase and there is little evidence of activity. In the more active phases they are quite readily identified. Although many hair restoration surgeons are not dermatologists it is important that they understand these diseases, when to refer them to other specialists and know when not to operate. Dermoscopy, which uses a small handheld microscope, is often sufficient to recognize these conditions. However, in some cases a scalp biopsy is needed.

The theme of her third talk is one she has frequently presented: the surgical hair transplant planning for long term in younger patients. The young patient often wants the temple regions filled, a high density hairline and other short term goals addressed. These objectives are understandable, but the patient needs a responsible surgeon who can educate and re-direct their objectives. The short term approach can leave patients with a pattern of hair distribution that is very unnatural as he ages. The limitations of donor hair reserves heavily influence the final results that can be produced. The best approach takes into consideration the future and adjusts today’s goals with tomorrow’s concerns. This includes transplanting into future areas of loss, creating a hairline that has some natural temple recessions and creating the look of early stage MPB.

PRP

As a recognized world expert in the still young field of PRP for hair loss, Dr. Unger is leading the research and furthering our understanding of the role PRP may play in regenerating hair. Although there is much remaining to be learned in this field, PRP has shown great promise in treating hair loss patients. Dr. Unger has joined with Dr. Orit Markowitz and others at Mt. Sinai School of Medicine to evaluate the effects of PRP with the aid of trichoscopy and optical coherence tomography (OCT). These results should be available by early 2019 and hopefully will provide further knowledge and information to doctors and patients interested in this procedure.

There are many different “types” of PRP and many different techniques of performing the procedure. Some doctors report more success and others find the procedure has been less effective for their patients than they had hoped.

Dr. Unger has a unique PRP preparation that she has termed PeRP (platelet erythrocyte rich plasma). PRP is not a procedure that works for everyone or every type of hair loss. It has become one additional important option to present to carefully selected patients. All patients need to be first evaluated with a dermoscopic exam and careful review of other potential causes for hair loss.  

Dr. Unger has found that the procedure is especially successful when applied in patients with a significant amount of miniaturized hair. If the patient is deemed to be a good candidate, one PeRP treatment (as performed by Dr. Unger) is usually sufficient to produce results – and the procedure needs to be repeated approximately every year.