There is more than one way to manage hair loss surgically. Apart from hair transplantation, there are other techniques which have been used by many to treat baldness. This article attempts to review the surgical methodology and philosophy that have acted as guiding lights in the approach to surgical treatment of baldness over the years and reviews the current role of other techniques in the armamentarium of hair restoration surgeons today.

Background: While photo-aging is believed to be preventable by the complete blockage of ultraviolet rays, there is no epoch-making method except sing fillers or autologous fat injection, for rejuvenating the skin once it has aged. Objective: Our group developed a new method for rejuvenating aged skin by the direct intradermal injection of basic fibroblast growth factor, the first method of its kind in the world. In this paper we report the results of long-term follow-up observations and alterations in skin viscoelasticity before and after this treatment. Materials and Methods: A single dose of growth factor was injected directly into aged skin of the dorsal surface of the hand intradermally. The skin viscoelasticity of 50 treated cases was measured by a cutometer just before the treatment and at 1, 3, 6, and 9 months after treatment, respectively. Results: We observed the following rejuvenating effects: improved skin softness, gradual improvement of turgor, improved thickness of atrophied skin, and greatly improved viscoelasticity which reveals the improvement of biomechanical properties of the treated aged skin. According to the comparisons of viscoelasticity between pre- and post-treatment, the rejuvenated changes of R2 and R7 values were comparable to an age difference of more than 20 years. Conclusion: This method was confirmed to have excellent effects in rejuvenating aged skin safely and reliably including biomechanical properties. With this advance, we expect conventional non-physiological skin rejuvenating treatments to be replaced by a much more fundamental method using one-time injections of the growth factor.

Background: Hydrolipoclasy is an alternative technique less invasive than liposuction. Hydrolipoclasy uses normal saline or hypotonic solution and ultrasound waves that act directly on local adiposity. In the literature there are few reports of morphostructural changes on adipose tissue. Materials and Methods: This study was aimed to evaluate the amount of fat cells injured immediately after treatment and after three days and also cell migration to the area treated using 8 pigs as experimental models, as well as cellular changes by transmission electron microscopy (TEM). Results: The Wilcoxon test was conducted, and a difference was found between the treated side and the corresponding control side on the number of viable cells. The treated side showed a smaller number of viable cells compared to the control side both immediately after treatment and 3 days later. Also occurring 3 days after treatment was the migration of lymphoid cells and fibroblasts, which shows the local inflammatory process and conjunctive neoformation. Soon after treatment there was fluid accumulation within adipocytes. Conclusions: The results shown in this paper demonstrate Ultrasonic Hydrolipoclasy as a viable alternative for the treatment of localized fat deposits without the side effects of traditional surgical procedures. Better results are expected when hypotonic solution is used, since it penetrates into the cell.

Background: Maspin is a member of the serpin family of protease inhibitors and is thought to inhibit carcinoma invasion, metastasis, angiogenesis and induce apoptosis. Aim: The aim of this work is to investigate maspin expression in cutaneous basal and squamous cell carcinomas by means of immunohistochemistry. Materials and Methods: This study was carried out on 43 patients, 25 basal cell carcinoma (BCC) and 18 squamous cell carcinoma (SCC) together with ten apparently healthy volunteers as a control group. Results: There was a significant difference between the malignant and control groups regarding maspin expression since all control cases showed maspin expression compared to 60.5% (26/43) positivity in malignant cases. Maspin positive expression tended to be of higher percentage in SCC (77.8%) compared to BCC (48%) (P = 0.06) and the strong intensity of maspin was also significantly in favour of SCC compared to BCC (P = 0.02). The staining of both the cytoplasm and nuclei was seen in 27.7% of SCC and 12% of BCC and was significantly in favour of older age group (P = 0.02) and the adenoid variant (P = 0.04) of the latter. Conclusions: Maspin is associated with terminal squamous differentiation. Nuclear staining of maspin is seen in both BCC and SCC with a suggested tumour suppressor role in BCC.

Introduction: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is one of the most common causes of primary amenorrhoea and is associated with vaginal atresia and absent uterus despite the presence of normal ovaries and external genitalia. Various techniques have been used, with many disadvantages, to create a neovagina. Aims and Objectives: Our aim is to create a neovagina with a simple and safe method. Materials and Methods: We have operated 18 cases of MRKH syndrome with the Sheares' method of vaginoplasty, in which the space between the two labia is dilated with a Hegar's dilator along the vestigial Mullerian ducts. Thus, two tunnels are created and the central septum is excised to form a single vagina. A mould covered with amnion is placed in the neovagina. All cases are followed up for six months. They have all had a good length of vagina with regular manual dilatation. Conclusions: The Sheares' method of vaginoplasty is an easy and safe method to create a neovagina with least complications, like injury to urinary bladder, rectum or bleeding.

Background: Skin tightening is a desirable outcome for skin flaccidity. Objective: We evaluated the applicability, safety, capacity and intensity of skin tightening with the subdermal 1,064 nm Nd: YAG laser application to the upper arms, and compared the results with liposuction. Materials and Methods: Patients with lipodystrophy and mild-to-severe skin laxity of the arms were included (n=28). In half of patients, a single treatment with a subcutaneous laser and liposuction was performed, while the other 14 had a regular liposuction. Treatment parameters, adverse effects and photographic documentation were recorded. Results: Aesthetic improvement and skin retraction was superior by laser lipolysis. The procedure was well tolerated without significant complications. Conclusions: The subdermal laser-assisted liposuction using a 1,064 nm Nd: YAG laser achieves improved skin tightening.

A 23-year-old woman presented with large exophytic genital wart arising from perineum, vulva, introitus of the vagina, and inner aspect of thighs. Patient developed severe itching and formication (insect-crawling sensation) in the lesions for past 1 week, though careful examination did not reveal any insects. Considering that the disease was causing psychological stress and physical symptoms, radiofrequency excision was planned. However, during the procedure, several maggots appeared from the crypts. The procedure was abandoned and maggots were removed manually. Subsequently external giant warts were removed using radiofrequency device. There was no recurrence of excised warts during 3 month follow-up. To our knowledge, this is the second reported case of maggots in genital warts.

Granular cell tumour (GCT), also known as Abrikossoff tumour, is an uncommon neoplasm, probably of neural origin derived from Schwann cells. It usually presents as a subcutaneous solitary asymptomatic nodule. It has been the subject of much debate in the literature concerning the tumour origin and the association with other malignancies. We report a case of subcutaneous GCT in the lumbar region in a 31-year-old Caucasian male. Although they are a rare entity, GCTs should be considered in the differential diagnosis of the subcutaneous soft tissue tumours. Surgical removal with wide margins is the treatment of choice as malignant changes have been reported after long-term follow-up.

Injection lipolysis or lipodissolve is the practice of injecting phosphatidyl choline/ sodium deoxycholate (PDC/DC) compounds in the subcutaneous fat. Though this practice is being used extensively for nonsurgical contouring of body and dissolving localized collections of excess fat, it's use as a treatment modality for lipomas needs further evaluation. We present a case where this technique was used for treating a lipoma, with no recurrence after 9 months of follow up. Injection lipolysis as a treatment modality for lipomas needs to be evaluated for safety and efficacy in trials on larger population. This could prove to be a very valuable adjunct to the current practice of excision, if done by a trained person in a properly selected patient. Also the side effects and the controversies regarding this procedure have been discussed in detail in the present paper.

Reconstruction of old full-thickness conchal defects is rarely described in the literature. This article describes a simple technique for reconstruction of old through-and-through small defects of the concha. The anterior part of the defect is covered with hinge flap taken from the posterior surface of the ear. The resultant final posterior defect is covered with local transposition flap from the adjacent skin.

Endometriosis is a common gynaecological condition that usually presents as an abdominal lump. It can be a diagnostic dilemma and should be considered as a differential diagnosis for lumps in the abdomen in females. We discuss a case of abdominal wall endometriosis following caesarean section, which was misdiagnosed as a desmoid tumour.

Lasers have opened a new door for the treatment of various disorders. Treatment of soft tissue intraoral mucosal growth by laser has profound effect on the patient acceptability taking the functional and aesthetic factor into consideration. The patient is able to get the outdoor treatment without the phobia of local anaesthetic and is out of the clinic in few minutes in contrast to the traditional method of surgical excision. Very few cases have been reported in literature regarding treatment of mucosal growth by soft tissue lasers. We present a case of recurrent pyogenic granuloma in a patient treated with an alternative approach, that is, diode laser, without the use of anaesthesia, sutures, anti-inflammatory drugs, or analgesics. The diagnosis of this lesion is equally important for correct treatment planning.

Sebaceous gland carcinoma is an aggressive, uncommon, cutaneous malignancy. This tumour can arise anywhere in the body; approximately 75% of these tumours arise in the periocular region. The diagnosis and management of these malignancies often tend to get delayed because they are frequently mistaken for more common benign entities. Surgery has been and remains the primary treatment modality for sebaceous gland carcinomas. The resultant surgical defects following tumour excision generally tend to be full thickness and reconstructions of such defects pose significant challenges. These defects are conventionally reconstructed by the traditional bridging (eyelid sharing) procedures, that is, the Cutler-Beard flap and its modifications. The 'Switch flap' is an alternative eyelid sharing procedure; however, it is not very widely practiced. We recently used this procedure to reconstruct a large full-thickness upper eyelid defect with a satisfactory cosmetic and functional outcome.