About Face

Procedures Menu

About Face

Chapter Ten Hair Transplants Types of Male Pattern Baldness Surgery Punch Grafting Flaps Scalp Reduction Scalp Expansion

Flaps

The patient who shows up for the first time in a surgeon’s office in an advanced, stage-three condition of male pattern baldness presents a challenge. This is the sort of patient who is quite often referred on to a facial cosmetic surgeon, for treatment with the more intensive techniques of short and long flap surgery, and scalp reduction. (I am not saying that stage-three patients are the only ones who benefit from these techniques - in fact, I prefer to treat all balding patients with a combination of the four basic methods.) Again, it is wise to remember that facial plastic surgery has its limitations; the classic “billiard ball” dome can be improved upon, but not entirely restored to its former, hirsute glory.

Short flap surgery is ideal for the older patient who is unlikely to progress beyond stage one of male pattern baldness; he is about fifty and has some “frontal temporal recession.” A flap is like a graft, but different from other grafts in that it remains attached to the scalp at one end even while it is rotated into a new position. The scalp is the skin and associated subcutaneous tissues that cover the upper part of the head. To create the short flaps, a section of bald skin in each of the temples is excised, or cut out, while the patient is under local anesthetic. Correspondingly sized sections of skin from behind the hairline - complete with hair follicles - are raised with one end still attached to the scalp, and rotated to settle into the excised area. The wounds left behind by the transferred flaps are pulled together and stitched closed; scars are hidden by the patient’s own hair.

The flaps must be cut on a slight diagonal angle at the point of incision. Similarly, the skin surrounding the transplanted flaps must be cut on an angle, so that the two meet at a beveled edge. This allows the hair follicles in the transplanted flaps to grow up and through the natural scar tissue that will form as a result of surgery.

The technical details a surgeon must consider with short flap surgery include the possibility that there might be a certain “fullness,” or bunching up of skin, where the flaps were rotated. (Try rotating sections of a heavier material like corduroy and you’ll see what I mean.) Sometimes, this bunching up or kinking, which we call a “dog ear,” settles down by itself within six weeks, but often it doesn’t and minor surgical revision is necessary to reduce the kinking, again under a local anesthetic.

[previous page] [next page]