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Scalp Flap Surgery
1) Patient Selection
2) Evolution of
Scalp Flap Surgery
for Hair Restoration
3) Recovery
4) Results
5) Facts About Scalp
Flaps
If you have typical
male pattern
baldness and have a
good fringe of hair
that measures at
least 3½" in height,
you may be a
candidate for a hair
restoration by scalp
flaps surgery.
A scalp flap is one
way to quickly and
effectively move a
large group of
healthy, densely
packed hair to an
area of thinning or
baldness. Up to
10,000 hairs or more
can be moved in one
flap. In this
procedure, a strip
of hair-bearing
scalp adjacent to a
bald area is
separated. A small
area of about 2
inches at one end is
left attached to the
scalp to allow
continued blood flow
in to that piece of
skin and hair.
The scalp flaps
surgery gives you:
1)The most
hair transfer
possible,
2) The
potential for
removal of all
presently bald
scalp,
3) completion
of the major work in
as little as 90
days,
4) The
potential for no
lag-phase in hair
growth, therefore
having a result that
can be styled and
worn within days
after the completion
of surger,
5) Natural
direction of hair
growth,
6) Naturally
contoured
hairlines,and
7) cost
savings over other
procedures giving
comparable results.
Skin flap surgery is
a method of moving a
"flap" of skin and
underlying tissue
from one area of the
body to another.
This two- or
three-stage
procedure can
totally resurface
the balding part of
your scalp with your
own growing hair in
as little as 90
days. Any other
method of hair
restoration surgery
would take a minimum
of one year of work
and six to twelve
surgeries to
transfer an
equivalent amount of
hair.
This surgery is
performed to :1)
repair a
non-traumatic
cosmetic defect such
as male pattern hair
loss, 2) repair a
site of traumatic
injury to restore
its functionality
and cosmetic
appearance, or 3)
repair a skin defect
caused by a
congenital
malformation.
The flaps used in
both cosmetic and
reconstructive
surgery are either
"pedicle" flaps or
"free" flaps:
Pedicle flaps
are flaps that are
surgically removed
from a donor site
and transferred to a
recipient site with
an attached pedicle
of tissue that
contains the flap's
artery-vein blood
supply along with
the flap tissue.
Transfer of
artery-vein blood
supply along with
the flap improves
the survival and
health of the
transferred tissue.
Pedicle flaps are
the type most often
used for cosmetic
hair restoration.
The free flap
is called "free"
because it is
transferred from
donor site to
recipient site
without any attached
pedicle. However, it
must contain
arteries and veins
that are reattached
to blood vessels at
the recipient site
by microvascular
surgery. Free flaps
are often used in
reconstructive
surgery when local
skin is not
sufficient to raise
a pedicle flap to
cover a defect-for
example, to cover a
substantial area of
scarred scalp
tissue. In recent
years, free flaps
have been used for
cosmetic hair
restoration by
skilled and highly
trained physician
hair restoration
specialists.
Scalp flap surgery
has an important but
limited role in hair
restoration. The
surgeon who performs
the procedure must
be a skilled
physician hair
restoration
specialist with
specific training
and experience in
use of skin flaps
for hair
restoration. In the
hands of an
appropriately
trained and
experienced surgeon,
scalp flap surgery
can be a highly
successful approach
to hair restoration
in carefully
selected patients.
1) Patient Selection
Patients with
frontal baldness
exclusively are good
candidates for scalp
flap hair
restoration, but
many physician hair
restoration
specialists do not
regard scalp flap
surgery as
first-choice
treatment for
frontal baldness.
The choice of scalp
flap surgery, hair
transplantation,
scalp extension or
scalp expansion as
first-choice
treatment for
frontal baldness
should be weighed
carefully in
discussions between
patient and
physician hair
restoration
specialist.
Frontal baldness may
be in any degree
from "frontal only"
to "frontal to
mid-scalp". When
scalp flap surgery
is the treatment
selected, the
rotation of one flap
or multiple flaps
from the
hair-bearing donor
area of the scalp to
the bald area
provides
instantaneous full
hair coverage;
narrow gaps between
transferred flaps
may require some
subsequent
"touch-up" by hair
transplantation or
alopecia reduction
procedures.
More extensively
bald men with vertex
(crown of the head)
balding may benefit
substantially from
scalp flap hair
restoration with
proper preoperative
planning, and when
the procedure is
performed by a
skilled, experienced
physician hair
restoration
specialist.
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2) Evolution of
Scalp Flap Surgery
for Hair Restoration
Scalp flap surgery
for hair restoration
was performed as
early as the 1930s
but did not become
an established
technique at that
time. In 1969,
plastic surgeon Dr.
José Juri, Buenos
Aires, Argentina,
reported development
of the scalp flap
techniques that are
the basis for
practically all
scalp flap
techniques for hair
restoration in use
today. A master of
flap surgery, Dr.
Juri uses both
pedicle and free
flaps as a method of
choice for treating
baldness of various
types and degrees as
well as baldness due
to various causes.
However, since the
1980s, the majority
of physician hair
restoration
specialists prefer
hair transplantation
and alopecia
reduction as
first-line
treatments for
cosmetic hair
restoration because
of the success of
these methods. Scalp
flaps now tend to be
reserved to correct
traumatic and
congenital defects
in reconstructive
hair restoration.
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3) Recovery
After scalp flap
surgery, you will
have prescriptions
for antibiotics to
prevent infection
and pain pills to
control discomfort.
Many patients do
fine with
acetaminophen
(Tylenol) after
surgery and do not
require stronger
medication.
After the first two
preliminary
procedures, you will
wear a bandage
overnight. After the
flap is moved in the
third stage, you wil
have a gauze
compression dressing
on for a few days to
protect the flap,
minimize swelling,
and absorb drainage.
It is normal to see
a few drops of blood
on the gauze. If you
notice more than a
few drops, or if the
area of blood is
increasing, call
your doctor right
away. The dressing
usually is removed
after 2 to 3 days,
and sutures come out
after 7 to 10 days.
After about a week,
you will be allowed
to gently wash your
hair. At this point,
most people return
to work, if they
haven't already. If
desired, follicular
unit grafts (grafts
of 1 to 4 hairs) can
be placed along the
flap edge for a more
natural appearance 6
weeks after your
surgery.
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4) Results
Once the flap is
rotated and healed,
it will continue to
remain just as if it
were in its original
site. Scalp flap
surgery does not
stop hair loss, and
you will continue to
lose hair just as
you would have if
the flap of hair was
not rotated, but
usually the effects
of scalp flap
surgery will last 10
to 20 years or more.
Although you will
instantly have hair,
this will likely be
very noticeable to
those that know you
because of the
dramatic, quick
change from thinning
or no hair to dense,
full hair (unless
you normally wear a
hairpiece). The scar
may be visible along
the edge of the
flap, and the sharp
demarcation between
the flap and the
hairless area may
also contribute to
obvious hair
replacement.
Follicular unit hair
transplant
(hair grafts) can
then be used to
camouflage the flap
and scar by placing
grafts of one or two
hairs along the edge
of the flap.
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5) Facts About Scalp
Flaps
1)Pedicle
Flaps
The transfer of
tissue from one site
to another on the
scalp is usually
done in a series of
procedures a week or
more apart. These
procedures include
planning and marking
the flap(s) and
recipient site(s),
incising the flap,
raising and
transferring the
flap with its
attached pedicle of
blood vessels, and
closing the wound at
the donor site. The
same series of
procedures are
carried out for any
subsequent flap
procedures.
Planning for flap
transfer to a bald
area must include a
consideration of
hair direction in
the transferred
flap. Hair does not
grow in a uniform
direction on all
areas of the
scalp-it grows in
several different
directions on
various scalp areas.
Planning of flap
transfer from donor
to recipient area
should aim to avoid
the potential
problem of distorted
hair pattern that
can be a
complication of
scalp flap surgery.
Although scalp flap
surgery produces
immediate heavy
growth of hair over
bald areas, there
may be narrow gaps
of thin or no hair
between multiple
flaps. Subsequent
hair transplantation
or alopecia
reduction may be
necessary to close
these gaps.
Adjustments in hair
styling may be all
that is needed to
disguise small
differences in hair
growth direction and
narrow bands of thin
hair growth between
flaps.
Some potentially
serious
complications of
scalp flap surgery
are:
A)
Failure of blood
supply to the flap
due to "kinking" or
pressure on the
flap's blood supply,
resulting in partial
or total loss of the
flap;
B)
Transection of
nerves during
surgery with
resulting loss of
feeling over all or
part of the scalp;
C)
Scarring at donor or
recipient sites;
and, Permanent loss
of hair at donor
sites that could be
necessary for future
hair
transplantation.
2)
Microsurgical Free
Flaps
The "free" flap is
surgically removed
from the donor site
and transferred to
the recipient site
without any attached
blood supply. The
free flap must,
however, have a well
defined arterio-venous
system that can be
reattached to the
recipient site's
circulation by
microsurgery.
Surgeon innovators
of microsurgical
free flaps for
cosmetic hair
restoration have
presented results
showing that use of
microsurgical flaps
can eliminate the
complications of
distorted hair
pattern and
inconsistent hair
density. They
recommend
microsurgical free
flaps as a treatment
of choice of various
types and degrees of
baldness. It is
important to note
that microsurgery is
an advanced
technique in
cosmetic and
reconstructive
surgery that
requires great
skill, training and
experience. Most
physician hair
restoration
specialists have not
sought such training
and would not
recommend use of
microsurgical flaps
for cosmetic hair
restoration.
The tissue expander
is inserted under
the hair-bearing
portions of the
scalp. After a
healing period, the
expander is
gradually inflated,
so that the scalp is
gradually
stretched. After
the scalp has been
stretched, large
flaps of
hair-bearing scalp
are designed.
The expander is
removed and the
flaps are
turned.Most, if not
all, of the bald
scalp is removed.
If total removal of
baldness is not
possible at the
second surgery, a
minor additional
surgery is done to
achieve full
coverage.
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