Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

View Point
2006:72:1;5-7
doi: 10.4103/0378-6323.19710
PMID: 16481702

Synthetic hairs: Should they be used?

Venkataram Mysore
 Consultant Dermatologist and Hair transplant Surgeon, Bangalore, Karnataka, India

Correspondence Address:
Venkataram Mysore
Venkat Charmalaya, Centre for Advanced Dermatology, 3437,1st G Cross, Subbanna Garden, Vijayanagar, Bangalore 560040, Karnataka
India
How to cite this article:
Mysore V. Synthetic hairs: Should they be used?. Indian J Dermatol Venereol Leprol 2006;72:5-7
Copyright: (C)2006 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Artificial hair fibers have recently been marketed in India as an alternative method of hair restoration. However, the subject of artificial hairs is controversial, as FDA in the United States has banned them. Several side effects have been reported after their use and it is therefore important that dermatologists are aware of all aspects about these devices. This article presents the author's viewpoint on the subject and suggests guidelines for using them.
Keywords: Synthetic hairs, Hair implants, Hair transplants

Male pattern baldness causes significant cosmetic disability. Both medical and surgical methods are available for management. The surgical method is the only permanent method of hair restoration, but needs proper training and skilled manpower. Recently, synthetic hairs have become available in India and are being aggressively marketed as a method of treatment.

IMPLANTS vs TRANSPLANTS

At the outset, it is important to distinguish between implants and transplants. Implants indicate implantation of prosthetic hair fibers in contrast with transplants that use patient′s own hairs, usually taken from the occipital area. Prosthetic hair are of two types synthetic fibers (such as monoacrylic, polyacrylic, and polyester); and natural fibers (such as processed human hair). They are implanted into the galea by a knot through an implanter device. The advantages claimed are the relative ease of the procedure, which can be learnt in a few days, relatively bloodless technique, and immediate cosmetic result. However, in contrast to transplants, these fibers do not grow and hence cannot be cut or shaven-in this respect they resemble a wig, which has been fixed to the scalp.

PROBLEMS WITH SYNTHETIC HAIRS

These fibers have had a checkered history. First introduced in 1970s, they soon became the subject of much controversy because of their numerous complications including recurrent infections, rejection, and periodic loss of fibers needing frequent replacement, frequent allergic reactions leading to severe contact dermatitis, irritant effects, fears about carcinogenicity, cicatricial alopecia, granulomatous hypersensitivity, and cyst formation. [1],[2],[3],[4],[5]

In 1983, the US Federal Drug Administration banned the fibers for the following reasons:

1. The fibers presented risks of illness or injury owing to non-biocompatibility of the fibers and non-medical performance of the implant.

2. The fibers presented fraud owing to the following:

a) Deceptive information on the efficacy.

b) Inadequate information on risks from implant.

c) They did not show any benefit for public health.

(The ban on prosthetic hair fibers is established in Section 895.101 of Code 21 of Federal regulations of the FDA, title 21, vol. 8, revised as of April 1, 2004.)

REINTRODUCTION OF HAIR IMPLANTS

Though the ban by FDA is yet to be lifted, the manufacturers are now trying to re-establish the credibility of these fibers and have introduced them in Europe and Australia. Presently, there are two manufacturers: (a) Medicap (Italy), which manufactures Biofibre, which has been available since 1996, and (b) Nido Corporation (Japan), whose fibers are available since 1999. Biofibre′s reapplication for permission by the US FDA is pending, but the company claims that many of the previous problems associated with the fibers have been sorted out.

There are few published data to support these claims. The website of Biofibre (http://www.biofibre.com/) mentions one study, which could be found in the Medline search too. This report assessed 196 patients with 2-year follow-up and found that clinical subjective and photographic objective evaluation show very satisfactory improvement.[6] Adverse events were limited to 1.02% of patients. The study concludes that careful medical follow-up with regular scalp check-up minimizes complications to a very acceptable rate and the overall results are satisfying. However, another recent publication by the same author found the yearly failure rate to be 20%.[7] A study published in 1995 stated "despite an apparently improved complication rate, the new technique of hair fiber implantation remains a doubtful procedure and cannot be recommended in view of possible permanent sequelae."[8]

CURRENT STATUS

In the face of marketing by the companies, and in response to queries from interested patients, dermatologists who treat hair disorders and perform hair transplantation are frequently asked to state their opinion about these fibers. In response to several queries from its members, the International Society of Hair Restoration Surgery considered all aspects of the subject of artificial hairs, and refused to endorse the product, stating that "The International Society of Hair Restoration Surgery does not voice an official position with regard to the use of artificial hair fibers and leaves their use up to the regulatory authority within that country. It is the view of the Society that this is a surgical procedure and as such should be confined to active participation of an experienced, licensed medical doctor in a reputable medical clinic or university setting. As with any surgical procedure, complications may occur which should be handled under a physician′s care."[9]

In view of this, what should be our current position regarding these fibres? It is obvious that the matter is debatable. It is also true that recently introduced fibres represent some improvement over previous fibres and it is important that the fibres are assessed thoroughly. This is particularly so in the present days of high voltage marketing, and also consumer activism. From the data it is clear that though these fibres may be of use in selected patients, such as those with total alopecia without any donor area, more research is needed before these fibres can be accepted as a routine method of treatment. Hence it is vital that dermatologists are fully aware of all the abovementioned aspects of the subject, as they are frequently consulted for opinion on this matter. In particular:

a) Physicians should realize that this technique though simple, can not be a standard method of treatment for hair loss or baldness till further data are available

b) The physician should be aware that the responsibility for a decision to use these fibers at present solely rests with him/her. He should be aware of the possible legal complications that may arise in such cases.

c) It should not be regarded as a replacement for hair transplantation in cases with sufficient donor area. Nor is this an alternative for medical treatment with minoxidil or finasteride, in early hair loss.

In view of the controversial nature of the subject, the author feels that this matter should be taken up by an appropriate body in IADVL and guidelines formulated to ensure proper standard of care for patients and also prevent possible legal complications for the dermatologists.

SUGGESTION

Finally, the author would also like to raise an issue for debate. The technique of artificial hair implantation was demonstrated at the preconference CME workshop of the SAARC dermatology conference, February 2005, held in New Delhi. The author would like to raise the question: should a technique, which is controversial and questionable, be allowed to be demonstrated in an IADVL CME workshop? The author feels that such demonstrations at prestigious national events may be misinterpreted as official approval of such techniques, particularly so by young dermatologists and postgraduate students. The author also feels that such techniques should initially be presented as free communications where they can be discussed freely or as sponsored workshops (where the ethical responsibility of the technique lies totally with the distributor), and not as IADVL CME events. The author welcomes a debate and would like to invite comments by senior dermatologists, on this issue. It is also important for IADVL to state its official position clearly on such issues[10].

References
1.
Hanke CW, Bergfeld WF. Fiber implantation for pattern baldness: review of complications in forty-one patients. J Am Acad Dermatol 1981;4:278-83.
[Google Scholar]
2.
Lepaw MI. Therapy and histopathology of complications from synthetic fiber implants for hair replacement-a presentation of one hundred cases. J Am Acad Dermatol 1980;3:195-204.
[Google Scholar]
3.
Shiell RC, Kossard S. Problems associated with synthetic fibre implants for hair replacement ("NIDO" process). Med J Aust 1990;152:560.
[Google Scholar]
4.
Hanke CW, Norins AL, Pantzer JG Jr, Bennett JE. Hair implant complications. JAMA 1981;245:1344-5.
[Google Scholar]
5.
Peluso AM, Fanti PA, Monti M, Bardazzi F, Tosti A. Cutaneous complications of artificial hair implantation: a pathological study. Dermatology 1992;184:129-32.
[Google Scholar]
6.
Palmieri B, Griselli G, D'Ugo A, Palmieri G, Salti G. Evaluation of polyamide synthetic hair: a long-term clinical study. Panminerva Med 2000;42:49-53.
[Google Scholar]
7.
Morselli M, Palmieri B, Santiago M. Implantation of biocompatible fibers for the temporary correction of scalp scars and androgenetic alopecia. Int J Cosm Aesth Surg 2003;5:175-8.
[Google Scholar]
8.
Lange-Ionescu S, Frosch PJ. Complications of synthetic hair implantation. Hautarzt 1995;46:10-4.
[Google Scholar]
9.
International Society on Hair Restoration Surgery. http://www.ishrs.org/articles/position-2.htm. Last accessed on 5.1.2005.
[Google Scholar]
10.
Shiell R. Response to dissector article. Forum Int Hair Rest 2002;12:130.
[Google Scholar]

Fulltext Views
456

PDF downloads
219
Show Sections