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About Face

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

Long, “Juri” flap surgery, so-named for the first surgeon to perfect the technique, is ideal for patients who are headed toward stage two or three of male pattern baldness. (The Juri flap has since been modified by two surgeons: now, some doctors refer to the Fleming-Mayer flap, which is slightly different in length and width.) Like short flap surgery, it involves lifting a flap of skin with hair follicles from the skull and rotating to the new hairline. However, the flap is much longer in this case, extending from the side to the very back of the head. (If two such flaps are necessary to complete the procedure, the flaps would be correspondingly sized on either side and meet at the mid-line of the back of the head.) The long flap is then draped over the crown of the head to restore hair to the balding vertex. If two flaps are used, they are placed one in front of the other, to cover a wider area. Each flap is about four centimeters wide.

Because the Juri flap is so long - up to twenty-eight centimeters - the entire procedure must be completed in steps over a period of time, what the medical profession calls delayed surgery. By extending the surgery over two weeks, we are training the blood supply of oxygen while the blood redirects its flow (blood is the bearer of oxygen throughout the body). This will help the flap to survive the healing process once it has been transplanted. Without the precaution of delayed surgery, the end of the flap would likely die.

The first step is to mark out the flap and cut seventy-five percent of its perimeter while the patient is under local anesthetic. Dressings applied to the wound can be removed the following day. One week later, again while the patient is under local anesthetic, the “end” of the flap, that part closest to the back of the head, is lifted up and down to disrupt any healing, then restored to its position under a dressing that can be removed the next day. Another week passes before the patient returns to have the flap lifted and rotated into its new position, completing the surgery. As with the short flap, the “dog ears” will have to be corrected six weeks after the operation if they don’t settle down of their own accord.

The wound left where the Juri flap was harvested is pulled together and closed up with sutures. However, because the longer flap is so much wider, this part of the procedure really amounts to a neck-lift. The scalp and loose neck tissue are pulled up and closed just at they would be for the more extensive operation of a face-lift. The chapter on face-lifts (Chapter Six) provides more details.

After flap surgery, it is wise to avoid washing the scalp or combing the hair for a couple of days, and then only gently. A patient in the habit of having his head massaged should not resume the practice for a couple of weeks. I advise against a too-vigorous massage even after the flap surgery is completely healed.

Both short flap and long flap surgery for male pattern baldness provide the instant result of a new hairline. Some men are delighted by this, others with incomplete male pattern baldness prefer the less dramatic change of punch grafting. However, as I mentioned earlier, I often use a combination of techniques to create the most natural looking hairline. In addition to flaps and punch grafting, I also perform scalp reduction surgery, if it is warranted.

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