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Background: Aplasia cutis is a rare developmental anomaly usually involving the calvarium, associated with a variable extent of defective formation of the scalp. Adams-Oliver syndrome is a condition mainly characterized by the congenital absence of skin, known as "aplasia cutis" which is usually limited to the vertex scalp and transverse limb defects., Case Report: A 17-day-old term female neonate was referred to us with an infected scalp lesion of the vertex. The lesion which is about 10 × 9 cm had signs of infection with necrotic eschar. We started the neonate on systemic parenteral antibiotics with local dressings. On day 3 of conservative management, the neonate had exsanguination due to bleeding from the midline with severe hemodynamic compromise requiring cardiopulmonary resuscitation. After controlling the bleeding with local tamponade and resuscitating the child, she was taken for early surgery. Debridement and bipedicled rotation flap of the scalp to cover the raw area was performed. On day 18, the flap started showing signs of necrosis. The neonate was taken up for debridement, and subsequently, maternal allograft of split-thickness skin was placed as a temporary wound cover. Meanwhile, the wound showed progressive epithelialization. At 1 year, the patient continued to have a non-healing area, which was later successfully covered with a split-thickness skin graft. We plan to revaluate the need for cranioplasty at around 3-4 years of age., Discussion: We discuss the dilemmas and challenges involved in the successful management of a neonate with Adams-Oliver syndrome with infected aplasia cutis and an episode of life-threatening exsanguination., Conclusion: Aplasia cutis is a rare developmental anomaly usually involving the calvarium, associated with defective formation of the scalp to a varying extent and severity, requiring various timely strategies.

Background: Aplasia cutis congenita (ACC) is a rare dermatologic disorder. The cause is unknown. It is a heterogeneous group of disorders whose common characteristic is focal absence of skin. It is a congenital absence of epidermis. In the majority of cases, this is limited to the scalp, although other areas may also be involved. The lesions are non-inflammatory and well demarcated. These lesions can be circular, linear, oval or stellate and range in size from 0.5 to 10 cm. Treatment has been controversial.

Background: Aplasia cutis congenita (ACC) is a rare condition commonly affecting the scalp in which there is a focal deficiency of cutaneous tissues of varying severity ranging from an absence of skin through to full thickness defects involving deeper elements such as bone and dura. Lesions of the scalp can be associated with complications including infection, hemorrhage, thrombosis, and seizures. Opinions in the current literature regarding management of this condition are varied with both conservative and surgical management advocated. Conservative treatment consists of regular wound dressings and systemic antibiotics, while surgical management commonly involves skin grafting and local flaps., Methods: A retrospective case review was performed to audit the outcomes of patients with ACC of the scalp managed at the Women's and Children's Hospital (WCH) in Adelaide, Australia from 2002 to 2012. Cases were identified from admission coding diagnoses and data was retrieved from patient case notes., Results: Seventeen cases of ACC were identified. The most common location involved was the scalp vertex. Thirteen patients were managed conservatively and 4 had primary surgical intervention. Of the cases that were managed with primary surgery, 2 had complications. None of the conservatively managed patients had complications in the acute setting., Conclusions: At the WCH, we advocate adopting a conservative approach to management of ACC of the scalp. Defects can be successfully managed with a combination of regular dressings and systemic antibiotics. Regular wound monitoring is essential to detect any complications early to instigate appropriate treatment and determine the need for emergency surgical management.

Finlay-Marks syndrome (scalp-ear-nipple syndrome), is the infrequently reported association of scalp aplasia, malformed ears, and breast abnormalities varying from small nipples to complete absence of breasts. Other manifestations are variable and some of them resemble ectodermal dysplasia and include dystrophy of nails and teeth, sparse hair, decreased sweating, and cutaneous syndactyly of digits. Renal anomalies have been reported in some patients leading to hypertension and renal insufficiency. Most reported patients have been sporadic but familial occurrences following an autosomal dominant pattern of inheritance have been reported. We report on two affected siblings, of whom one died in the neonatal period due to renal failure. Two affected siblings born to non-affected parents may suggest an autosomal recessive inheritance., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: Evaluation of management strategies for scalp arterio-venous malformation (AVM)., Materials and Methods: A retrospective analysis of data of 31 patients with scalp AVM was carried out at all India Institute of medical sciences New Delhi between 1997 and 2010. All the patients except one underwent digital substraction angiography. Depending upon the size of AVM, we classified them in to three groups. Group 1 (small) size up to 4.9 cm, group 2 (medium) size 5-9.9 cm and group 3 (large) size more than 10 cm. Patients in group 1 and 2 underwent direct excision. Patients in group 3 underwent pre-operative embolization followed by surgical excision. Five patients refused any treatment. Patients were analysed to look into results, complications and recurrence in follow up., Results: There were 11 patients in group 1, 12 in group 2 and 8 in group 3. There were 18 males and 13 females with mean age of 25 years ranging from 13 to 55 years. The mean duration of symptom was 7.2 years. Angiography was performed in 30 patients. Superficial temporal artery (80.6%) was the most commonly involved. 18 patients underwent direct excision, 6 underwent embolization followed by excision and 2 underwent embolization. One patient in surgery group and two patients in embolization group had recurrence. One patient expired due to complications of hypotensive shock secondary to exsanguinating haemorrhage from AVM., Conclusion: Surgical excision has excellent outcome in treatment of scalp AVM. Pre-operative embolization reduces vascularity and helps in easy identification of AVM during surgery thus achieving complete excision. The size of AVM has no correlation with the number of feeding vessels. There are high chances of recurrence in large AVM after embolization.

The objective of this study was to evaluate the feasibility and clinical effect of repairing scalp defect after the excision of cutis verticis gyrata using expanded scalp skin flaps. For this purpose, 8 patients with cutis verticis gyrata were subjected to scalp skin expander implantation under the skin. After saline injection and scalp expansion for 2-3 months, the cutis verticis gyrata was excised and the expanded scalp flaps were applied to recover the skin defect. As a result, the flaps and hair grew well without contractures and significant scarring, suggesting that this method is useful for surgical correction of cutis verticis gyrata.

Aplasia cutis congenita is a rare scalp defect with occasional absence of underlying bone and dura. Patients with small defects respond well to conservative management. However, larger defects often can pose management and technical challenge. Successful management of a large, composite aplasia cutis congenita defect using Integra dermal regeneration matrix is presented. At 16 months, the patient showed a stable and supple scalp with evidence of calvarial regeneration.

Aplasia cutis congenita (ACC) is a congenital defect consisting of a circumscribed absence of skin that usually involves the scalp. The etiology is uncertain, and several teratogenic agents such as methimazole have been involved. We report two cases of ACC and other anomalies in newborns exposed to methimazole during pregnancy., (© 2011 Wiley Periodicals, Inc.)

Background: Aplasia cutis congenita (ACC) is a rare congenital disorder characterized by absence of skin and adjacent tissue that usually affects the scalp, but any part of the body may be affected. Although ACC is more often superficial and small, it can be large and involve the underlying structures such as skull and dura, thus increasing the risk of hemorrhage, infection, and mortality. Controversy exists regarding nonsurgical versus surgical intervention for this condition. This study reviews indications and modalities for treatment of this rare congenital anomaly., Results: Management of this anomaly depends on size, location, and structures at risk. Small lesions with intact underlying structures and lesions affecting extremities are treated in a conservative fashion with dressings and ointments followed by delayed scar excision. Aplasia cutis congenita scar excision often requires complex tissue rearrangement, tissue expansion, or skin grafting. Larger ACC lesions or lesions with exposure of vital structures require early surgical intervention. Initially, exposed vital structures and bony ridges can be protected using conservative measures. Delayed definitive repair can then be performed using scalp flaps, split- and full-thickness skin grafts, cultured epithelial autografts, delayed split rib cranioplasty, tissue expansion, and composite cranioplasty., Conclusions: Aplasia cutis congenita should be individually evaluated based on size, depth, location, and tissues involved. Using conservative and surgical modalities, one can achieve complete closure of the defect, thus avoiding risks of infection, hemorrhage, and further trauma.

We report the case of a newborn baby with a large congenital skull defect owing to Adams-Oliver syndrome. An initial attempt at conservative treatment failed and led to disruption of the leptomeningeal membrane and prolapse of the brain. After local debridement, delayed and stepwise surgical closure was complicated by cerebrospinal fluid leakage, which required the insertion of a cerebrospinal fluid shunt. This case report highlights the potential serious risks of nonsurgical management of largely extended congenital skull defects., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Adams-Oliver syndrome is a rare congenital anomaly characterized by aplasia cutis congenita (ACC) and variable degrees of terminal transverse limb defects. We report on a neonatal case with the sporadic form of the disease with minimal expression, illustrating the wide spectrum of clinical expression in Adams-Oliver syndrome. We also review the literature and highlight the different pathogenetic hypotheses of this syndrome., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Aplasia cutis congenita is a rare, sporadic congenital malformation characterized by skin defects, sometimes extending to the underlying bone. We report a case of a boy born with a large rhomboid scalp and skull defect measuring 8 × 12 cm with no other anomalies. Conservative treatment led to the complete epithelization of the skin defect with secondary closure of the cranial vault without need for surgical intervention., (© 2010 Wiley Periodicals, Inc.)

The authors report a case of Adams-Oliver syndrome in an 11 months child. This child was referred to our unit at the age of six months with right hand brachydactyly and alopecia on the vertex. We decided not to treat hand malformations, given the lack of functional impact. Alopecia of the vertex was corrected by tissue expansion of the scalp, with a satisfactory cosmetic result at five months., (Copyright © 2010. Published by Elsevier SAS.)

Amniotic rupture sequence is associated with defects of variable severity and at different sites. Analysis of the literature reveals difficulties in the classification, which, in addition to uncertainties surrounding its causes, make diagnosis of unusual presentations rather difficult. We present an unusual case of a thoracoabdominal restrictive band from the umbilicus to a low-set posterior hairline with severe trapezius contracture, sternoclavicular dislocation, and no associated craniofacial or limb abnormalities. Amnion rupture sequence with adhesion band seems to be the most probable cause of this rare combination of anomalies.

Aplasia cutis congenita (ACC) belongs to a heterogeneous group of conditions characterized by a congenital absence of skin, usually on the vertex of the scalp. It can occur as an isolated defect or can be associated with a number of other congenital anomalies. Two cases of systemic ACC of a more severe and extensive type were recently reported. Here, we describe the third case of systemic ACC and review the available literature. A female infant was born with an extensive defect of the skin, a skull defect, imperforate hymen, and some other anomalies. She died soon after birth probably due to asphyxia and dehydration. We also compared the pathologic findings of the current case with those of the other two previously reported cases. This case suggests that systemic ACC might be recognized as a new syndrome. A limitation is that there is only 1 case, and it is difficult to gain a deeper understanding of its etiology and diagnostic criteria., (Copyright 2010 Elsevier GmbH. All rights reserved.)

Introduction: Cutis verticis gyrata (CVG) is a rare and slowly progressive deformity of the scalp with thick gyrated skin folds and ridges which are similar to gyri of the brain cortex. Those folds can lead to local skin infections, to a social and cosmetic complain. CVG can be classified into two forms: primary (essential and non-essential) and secondary. To date, fifteen operated cases of primary essential CVG have been reported in the medical literature., Case Report: We report the case of an 18 year-old male patient with a primary essential CVG. There were several large skin folds in the sagittal axis on the vertex region, and in the coronal axis on the occipital region. He did not present any cutaneous complication. His main complains was the unaesthetic aspect of his scalp with a psychological complex. The disease had occurred during puberty. We present the excision pattern and the results with a six months follow-up., Conclusion: CVG can be treated surgically with resection of the thickened excess skin in coronal and sagittal axis. Scalp lift must be effective all over the different areas of the scalp. The scalp flaps must have a reliable vascularisation. Combined incisions of the galea help to treat the residual folds. The excision pattern must be reproductible, as this disease is progressive., (2009 Elsevier Masson SAS. All rights reserved.)

Objective: Large scalp defects in which the pericranium has to be resected can be reliably reconstructed using Integra. In the present study, we retrospectively analysed the long-term outcome of our patients., Methods: Nineteen patients were included who had received Integra dermal regeneration template for treatment of full thickness scalp defects after resection of various malignant tumours. All patients were followed up with a mean follow-up time of 31 months (14-72)., Results: All transplants were on almost equal levels with the surrounding skin. Cosmetic results were acceptable and scars were stable. Nodal ultrasound status was negative in all patients. During the follow-up period of up to 72 months, no local recurrences were observed. One patient with a leiomyosarcoma received radiotherapy after transplantation. In the irradiated area, multiple small regular-shaped round ulcerations and later on partial necrosis of the transplant occurred when the patient developed renal failure 29 months after the initial operation. Five patients died of disease not related to the primary skin tumour. All other patients are alive and free of disease without any complications., Conclusion: After reconstruction of full thickness scalp defects with Integra, the cosmetic results are appealing and we observed no local recurrences during the follow-up period.

An understanding of the anatomy of the layers of the scalp helps to interpret the radiology and therefore differentiate between various pathologic processes. This article describes the anatomy of the scalp and highlights the common, and some less common, pathologies that occur. Computed tomography, magnetic resonance imaging, and ultrasound can all help to categorize a lesion in the scalp.

Adams-Oliver syndrome is a rare congenital disorder that includes congenital scalp and skull defects, variable degrees of terminal transverse limb anomalies, and cardiac malformations. Cutis aplasia occurring in 75% of patients is a potentially life-threatening condition. Large skin defects that cannot be closed primarily present a management dilemma, and may require skin grafting or flaps, or a combination of both operative and conservative modalities. The authors' experience in management of huge scalp and bone defects with the Integra Dermal Regeneration Template and regular dressing changes showed good scalp repair and no serious complications attributed to this approach.

Aplasia cutis congenita (ACC) is an uncommon condition in which localized or widespread areas of skin are absent or scarred at birth. There is no single underlying cause of ACC, as it simply represents a physical finding that reflects a disruption of intrauterine skin development. Here we report three cases of ACC of the scalp with three different etiologies: congenital rubella syndrome, trisomy 13 and fetal valproate syndrome. The aim of the present report is to increase awareness of these skin defects and emphasize the importance of underlying etiologies.

We report on a patient with Adams-Oliver syndrome, a condition characterized by scalp and limb defects. In addition we noted in our patient a significant delay in the bone age and an abnormal distal phalanx in one of her fingers manifesting clinically as a broad finger tip. Both these features hitherto unreported add to the phenotypic spectrum of the condition. The underlying etiopathogenesis of this condition has remained in the domain of hypothesis, with none being conclusive. Based on the characteristic features of AOS and our report of delayed bone age, we postulate a role played by the bone morphogenetic protein pathway in the causation of this enigmatic condition. In the background of this postulation and the report of an unusual hand anomaly, a literature review on the various pathogenetic mechanisms and anomalies of the hand reported in AOS is presented., (2009 Wiley-Liss, Inc.)

We have earlier described a syndrome characterized by microcephaly, cutis verticis gyrata, retinitis pigmentosa, cataracts, hearing loss and mental retardation (Mendelian inheritance in man (MIM) no: 605685) in two brothers from a non-consanguineous Lebanese family. In view of the rarity of the disorder and the high rate of inbreeding in the Lebanese population, we assumed an autosomal recessive trait inherited from a common ancestor. A genomewide scan was performed. The single locus on the long arm of chromosome 8 that showed homozygosity by descent comprised the gene responsible for Cohen syndrome (CS), VPS13B. We then sequenced VPS13B in the patients and found a homozygous splice site mutation. Several possible explanations for the overlap between CS and the clinical features observed in our patients are discussed. Our data highlight the potential of high-resolution homozygosity mapping in small populations with a high rate of inbreeding.

Aplasia cutis congenita is a rare disorder characterized by absence of skin. Lesions typically occur on the vertex and are sometimes small, but they can affect deep tissues such as the skull bone and dura. Mortality is related to the depth and size of the lesion and can amount to a rate of more than 50% when full thickness is involved. The treatment remains controversial -- both surgical and conservative managements are described. Minor lesions can be controlled with nonsurgical treatment, but large defects require early surgery. We report the case of a female newborn with acrania and scalp aplasia cutis congenita, which was treated with a bipedicle scalp flap based on the temporal vessels. Full- and partial-thickness skin grafts were used to cover the donor site on the temporo-occipital region. Postoperatively, the patient developed a liquorice cyst, which was treated with a shunt, and she has been followed up for evaluation of the bony defect closure and skull morphology. Her neuropsychomotor development is normal.

The outcome of aplasia cutis congenita of the scalp, nonmembranous type, in a series of 21 Caucasian patients is reported. In all the patients the congenital skin defect healed with irregular hypertrophic scar formation.

MRI appearance of Sturge-Weber Syndrome (SWS) in patients with Tuberous Sclerosis (TSC) has been rarely reported. We describe a new patient with confirmed diagnosis of TSC and MRI appearance of SWS and review the pertinent literature. We discuss these findings on the basis of the new classifications of brain malformations, which take into account the role of neural-crest. The coexistence of signs of both diseases in the same individuals could be explained by common altered pathways that could lead to an anomalous angiogenesis.

We present a female infant with a combination of finger duplication, amniotic band-like constrictions and extensive syndactyly affecting all four limbs with skin tags. No facial dysmorphic features nor associated malformations were present. Growth and development was normal and there was no family history of congenital abnormalities. The presence of constriction band-like regions on the hands and absent or hypoplastic digits suggests the amniotic deformity, adhesion and mutilation complex. Mutations in the human homologue of the mouse gene disorganization gene may also be the mechanism for the combination of constriction/duplication abnormalities with distant skin tags seen in this patient.

Background: The treatment of sAVF is difficult, and many therapeutic approaches have been proposed. General approaches for the treatment of sAVF include ligation of the feeding arteries, surgical removal, electrothrombosis, embolization, and a combination of these approaches., Case Description: A 35-year-old man presented with occipital subcutaneous pulsatile thrill. We discussed and illustrated a rare sAVF, which was a high-flow sAVF fed by the occipital branch of the right ACE draining intraosseously into the SS. The case was treated by surgical origin ligation., Conclusion: This case was unusual in the sense that it was apparently spontaneous, and the major venous drainage was through the bone into the SS. Arterial supply pattern of sAVF is very important in therapeutic decision-making. We suggest that surgical origin ligation for sAVF be considered if the case has 1 feeding artery.

Background: Arteriovenous malformations of the scalp consist of abnormally connecting arterial feeding vessels and draining veins, devoid of a normal capillary bed within the subcutaneous fatty layer of the scalp. We present a case of a left temporal scalp AVM treated for aesthetic and pain-related concerns. A multidisciplinary approach combining endovascular AVM embolization and AVM excision with local flap reconstruction was chosen., Case Description: The patient presented with a progressive painful pulsatile mass in the left temporal region. On examination, there was no evidence of any facial nerve compromise or any other neurologic deficits. Computed tomographic angiography revealed a 6-mm lesion located totally within the scalp and not associated with bone or periosteum. A recommendation was made to proceed with preoperative embolization to facilitate surgical resection. The AVM was occluded endovascularly using multiple detachable platinum coils, and the patient was neurologically intact. The following day, the patient was taken to the operating room. By that time, the mass was minimally pulsatile. The AVM was resected en bloc, and a 3-layered intermediate closure of the 5.5-cm defect was then performed. The procedure was well tolerated, and the patient had an uneventful postoperative course., Conclusions: Scalp AVMs are interesting lesions with heterogeneous anatomical features. Treatment can be optimized in a multidisciplinary environment, using a prescribed treatment algorithm to minimize the size of soft/hard tissue defect and enhance cosmesis. Careful selection of therapeutic modalities based on AVM anatomy and aesthetic concerns can lead to safe and durable results with high patient satisfaction rates.

Sinus pericranii is a rare vascular anomaly in which an abnormal communication exists between the extracranial venous system and the dural venous sinuses. The natural history is of increasing size and potential life-threatening complications, including thrombosis and haemorrhage. Thus surgical management is the mainstay of treatment. We present a unique case of spontaneous involution of two sinus pericranii in a 1-year-old patient, the second reported case of spontaneous involution in the literature, and the first in which regression occurred at such a young age. The clinical, diagnostic and management options are discussed.

A 1-day-old boy with the characteristics of Adams-Oliver syndrome was presented. Adams-Oliver syndrome has a wide spectrum of anomalies ranging from aplasia cutis congenita, cutis marmorata telangiectatica congenita and transverse limb defects to lethal anomalies. Our patient had aplasia cutis congenita with scalp, skull and dura defect. He had also a large dura defect with herniation of brain tissue. Besides these he had bilateral clubfoot, cortical fissure and nail hypoplasia in the hands, scrotal hyperpigmentation and generalized cutis marmorata telangiectatica congenita. He was operated on the 3rd day of life. The herniated brain tissue was resected and the dura was repaired with a synthetic dural graft.

A 17-year-old Saudi male patient presented with progressive asymptomatic skin changes on the scalp for 4 years. Upon examination, he was a well-built muscular male with coarse facial features with broadening of the nasal bridge and thick lips. Scalp examination revealed multiple gyriform oblong skin folds in the fronto-parietal region (Fig. 1). Extensive velvety dark brown plaques were seen on sides of the neck, axillae, and groin. Similar eruption was seen on the knuckles of both hands and around the eyes. Clinical diagnosis of cutis verticis gyrata of the scalp and acanthosis nigricans was made. Because of the extent and the rapid progression of the above changes, acromegaly was suspected. Endocrinology referral confirmed this by the findings of high random growth hormone level at the value of 37.3 mIU/L (normal 0.2-13.0). Arrangement of magnetic resonance imaging (MRI) of the brain was made, but unfortunately the patient was lost to follow-up.

Objective: To describe the magnetic resonance imaging (MRI) findings in cutis verticis gyrata (CVG) and familiarize the interpreters of neuroimaging studies with its characteristic appearance and intracranial and systemic associations., Methods: The MRI examinations of 12 patients (7 men and 5 women; age range, 16 to 66 years; mean, 40.3 years) with CVG were retrospectively evaluated for distribution, orientation, number of folds, and the associated intracranial or calvarial abnormalities., Results: Eleven patients had bilateral involvement. The number of folds was 3 to 8 (average, 6), and the direction was anterior-posterior (longitudinal) in 9 patients. Transverse and longitudinal folds coexisted in 3 patients. The subcutaneous tissues underneath CVG were thickened in all patients, whereas skin was thickened in 7. Intracranial abnormalities identified included meningioma, schwannoma, glioma, and prolactin-secreting pituitary microadenoma. There were no skull abnormalities., Conclusions: Cutis verticis gyrata CVG has a typical appearance on MRI characterized by scalp undulations due to thickening of the skin and subcutaneous tissues.

Cutis verticis gyrata describes a scalp condition where there are convoluted folds and deep furrows that resemble the surface of the cerebral cortex. We report three cases of cutis verticis gyrata that demonstrate the current classification structure. The first case is the most commonly described primary non-essential acquired form, appearing in the scalp of an 11-year-old girl with mental retardation. The second case is the primary non-essential congenital form, presenting at birth in a baby with Noonan's syndrome. An association between cutis verticis gyrata and Noonan's syndrome has been rarely described. The third case illustrates secondary cutis verticis gyrata, occurring in a 27-year-old man with discoid eczema.

Objective: To improve the recognition and treatment of Chinese cutis verticis gyrata., Methods: Based on the review of the etiopathology, clinical features, diagnosis, classification and treatment of the disease in the literatures, six patients with the cutis verticis gyrata were treated with the skin graft or the expanded scalp flap., Results: The operative effects were satisfactory during 6 months to 5 years of the follow-ups. No recurrence was found in all cases. Two patients treated with skin graft had lead to baldness, four patients treated with the expanded scalp flap had been good appearance., Conclusions: The method of the expanded scalp flap is good and effective treatment for the cutis verticis gyrate.

Aplasia cutis congenita is a rare congenital disorder of skin and most commonly involves the scalp. The skull and dura underlying the defective skin may also be affected, relative to severity of the disease. The typical lesion is present at birth and ranges in size from 0.5-3 cm. The main complications of larger defects include infection, bleeding and trombosis that may be deadly. Therefore, prompt diagnosis and appropriate treatment are critical for avoiding the adverse outcomes. Controversy exists in the literature regarding the treatment of aplasia cutis congenita; both surgical and conservative treatment modalities have their proponents and opponents. We present a case of full thickness aplasia cutis congenital lesion bigger than 3 cm in diameter that healed with the application of novel wound dressing materials without any complications. The physiopathology, classification and treatment options of the disease are discussed.

Background: Rhytidoplasty may cause permanent and unwanted stigmas, such as dislocation of the temporal and cervical hairline. Widened scars inside the hairline may cause considerable social embarrassment. Furthermore, pretrichial incisions, even if well placed, may widen or become hypochromic, thus revealing that an aesthetic procedure has been performed. Various procedures for the correction of these undesirable telltale signs of a face-lift have been published. This report aims to present the results of correction for postrhytidoplasty stigmas using follicular transplantation. Patient assessment is discussed, and relevant technical aspects are detailed and illustrated., Methods: A prospective study at the Ivo Pitanguy Clinic investigated patients who underwent hair transplantation to correct unaesthetic signs secondary to rhytidoplasty from January 2001 to December 2004. The aesthetic results and complications were evaluated, as well as the patients' satisfaction rate. The patients presented in this series either were referred from another service or had their rhytidoplasty originally performed in the authors' service., Results: A total of 33 female patients were included in this study. Two patients were lost to follow-up evaluation and not included. The complications were minor. In the late follow-up assessment, 24 patients classified the result as excellent, 4 as satisfactory, and 3 as unsatisfactory. Only the patients who classified the results as unsatisfactory requested a second procedure (i.e., another follicular transplantation)., Conclusions: When performed by an experienced surgical team, the follicular unit transplantation technique is a simple, safe, and efficient way to correct stigmas secondary to a rhytidoplasty, such as a visible scar or a displaced hairline, with satisfactory results and a very low complication rate.

Arteriovenous malformations (AVM) in the scalp are infrequent vascular lesions. Its clinical presentation varies from annoying and unaesthetic mass of the skin to devastating hemorrhages. Its origin can be congenital or traumatic. The diagnosis of AVM is based on physical examination and confirmed by internal and external carotid angiography. Nowadays the gold standard treatment is the surgical intervention although the endovascular approach is gaining field in order to reduce blood losses as presurgical or like lonely treatment. A 50 year old woman was admitted with a huge mass in scalp, with subcutaneous enlarged vessels and no other symptoms. A head traumatic antecedent had occurred 12 years before. The angiography evidenced a mottled AVM with blood supplies from the external and internal carotid arteries, with meningeal transosseous branches from both ophthalmic arteries. Endovascular treatment could not be performed due to high risk of uni or bilateral amaurosis. Thus, a conventional surgical treatment was done without complications. The treatment of AVM of scalp offers various possibilities but the individualization of each case becomes essential to decide the correct management in order to avoid complications.