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Let us then suppose the patient decides he wants to have a hair
transplant to help with the hair loss in the front of the scalp
or to place in the scalp reduction scar to help hide it. The problem
is that he has “robbed Peter to pay Paul”. With every
scalp reduction, the scalp becomes tighter. Remember that to perform
a transplant, the patient must have a donor strip excised and closed.
That can become very difficult with a tight scalp. Instead of being
able to receive large sessions of follicular units, he will possibly
have to settle for small sessions, which will likely have so few
follicular units that they will fail to cover adequate areas. If
he can get grafts for a transplant and he wants to use them to plant
into the scar on top of his scalp to help hide it, then he must
accept the possibility of poor growth from the grafts because they
are being implanted into scar tissue.
The final problem is the shape of the bald spot in the vertex left
behind after starting scalp reductions or after balding around previous
scalp reductions. If the standard
single excision down the middle of the scalp is used, the bald spot
will turn from a circle to an ellipse. This football-shape is not
normal and people notice. As the scalp reductions progress the patient
may also notice a hump of extra skin developing in the very back
of the scalp. This is due to excess tissue being pushed together
at the ends of the excision. The surgeon may then want to repair
these problems with a Frechet Flap. This is a complicated, step-like
surgical flap that entails its own separate risk of complications.
Figure 11-3. Scalp reductions distort the bald
area in the back of the scalp and lead to a protrusion of excessive
tissue in the donor area. The scar is present on top of the
scalp making it difficult to hide.
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Hopefully, potential patients will begin to get the picture. Why
should he set himself up for so many possible problems when follicular
unit transplantation is now available? The only time I would consider
a scalp reduction as a legitimate option would be in the case of
a middle-aged man or older who has developed a small bald spot in
the vertex, and who is still a Norwood type II or III in the front,
and who has used Propecia or Rogaine for a year or more, and is
confident that it has stabilized his baldness, and who has been
thoroughly educated about follicular unit transplantation as an
alternative. That is a lot of “ands”. Fortunately, scalp
reductions appear to be undergoing a slow death.
Figure 11-4. Scalp flaps are created by excising
a long
strip of hair from the side of the scalp. The end of the
strip nearest the face is left attached. The strip is then sutured
into the hairline. Frequently two scalp flaps are created to
complete the hairline.
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Is there something I dislike more than scalp reductions? Absolutely—scalp
flaps. Scalp flaps involve the excision of a strip of hair from
the donor area, but instead of removing it entirely from the scalp,
one tip is left attached. This strip is then turned on its base
and the strip is sewn into the hairline. As with the scalp reductions,
there are numerous variations, but the theme is the same. The only
positive thing I can think of to say about these is that the patient
gets an instant, full-thickness hairline. If he has lost his hairline
and will do anything to get it back, no matter how goofy it looks,
and he is incredibly impatient, this may be a good alternative.
Otherwise, he should steer clear.
Next Topics:
Hair Transplant Repair
Follicular Unit
Extraction
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