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The first problem with scalp flaps is that the angle of the hair
at the hairline is reversed. Instead of angling forward like normal
hair, it will angle backwards like a cowlick.
Only this cowlick will cover the entire hairline. Try as the patient
might, even combing his hair straight back, it will look funny.
In addition to the wrong angle, he will now have an abrupt wall
of hair as his hairline. Instead of the hair gradually becoming
more dense in his hairline the further back it goes, his hairline
will go from no hair to a wall of hair in one-sixteenth of an inch.
Usually micrografts are sprinkled out in front of this wall of hair
to decrease the abruptness. This is largely ineffective because
of the sheer number of micrografts that would have to be transplanted.
Why would a surgeon not use follicular units instead of micrografts?
The answer is that because if the surgeon were able to perform follicular
unit transplantation, he probably would not still be doing flaps
in the first place.
Figure 11-5. A) The hair in the front of the
scalp with a scalp flap is angled backwards like a cowlick.
B) The hair in the front of the scalp is angled forward with
a
transplant just as it is found in nature.
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Now the patient must not forget that since the flap is sutured into
the hairline, a scar will be present. Guess where the scar is? Right
in front of the new hairline. Of course,
that scar is nothing compared to the scar left in the hairline if
the flap dies. Since the surgeon is taking a long flap of skin with
a thin base and rotating it on its base, the circulation of the
base had better be great, or the flap will fail. Unfortunately,
flap failure is not all that uncommon.
I have harped repeatedly on the progression of male pattern baldness.
Imagine what a flap looks like with no hair around it after the
original hair disappears over time. It is not good. It makes scalp
reduction scars seem appealing. Am I going to have surgeons who
still perform scalp reductions and scalp flaps angry with me? Absolutely.
Do I believe what I have just written is critical information that
often is not explained to potential patients? Absolutely. Individuals
considering surgical hair restoration must do their homework.
Next Topics:
Hair Transplant Repair
Follicular Unit
Extraction
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