Hair Replacement
Scalp reduction is done to cover bald spots at the top and back of the head. This involves removal of the bald scalp as portions of the hair bearing scalp are pulled together to fill in the area. This procedure can be used alone or in conjunction with grafting techniques, which can be used more efficiently toward the hairline areas.
When the scalp is too tight or the area of baldness is too large for scalp reduction surgery alone, tissue expansion may be necessary. This requires at least two operations. In the first operation, a silicone lined device is placed beneath the scalp. The device is then expanded over several weeks with saline solution injections until the hair bearing scalp has been stretched sufficiently. In the second operation the device is removed, the bald scalp is removed, and the extra hair bearing scalp is pulled together to fill in the area.
Flap surgery can be used for covering large bald areas. A portion of bald scalp is removed, and a "flap" of hair bearing scalp, with its circulation attached at its base, is brought over to fill in the area. The equivalent of hundreds of punch grafts can be repositioned with such surgery.
Most hair replacement surgery can be done with local anesthetics and sedation in an outpatient setting. Some patients, including those undergoing tissue expander and flap surgery, may require additional anesthesia and monitoring in a hospital setting.
Following surgery, head elevation helps reduce swelling and bleeding. Bandages may be used for the first few days, after which time the hair can be gently washed. Some bruising and swelling are normal during the first few weeks. Strenuous activities are usually avoided for the first few weeks. Following graft surgery, the transplanted hair normally falls out in the first month or two, and will usually take a few months to regrow. Additional procedures are sometimes done as this change is occurring.
As with any surgical procedure, hair replacement surgery has risks. Infection and major bleeding problems are uncommon. Widened scars can sometimes form from the tightness of the scalp following scalp reduction surgery. Some grafts may not "take." Sometimes patients will notice small bumps at the plug sites. These can usually be camouflaged by additional grafts. Additional hair loss following surgery can result in a patchy appearance that can also usually be improved with additional surgery.
Patients with reasonable expectations are generally very satisfied with the results of
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