Bare and bones of hair transplant surgery procedures

Scalp reduction, also referred to as advancement flap surgery, is generally used for individuals requiring coverage of bald areas at the top and back of the head, and may not be beneficial to those requiring coverage of the frontal hairline. For this procedure, the scalp is injected with a local anesthetic, then a segment of the bald scalp is removed. The segment removed typically resembles an inverted Y-shape, particularly if a large amount of coverage is required, but it may also resemble a U, a pointed oval, or some other shape. The skin surrounding the removed segment is loosened and pulled, then sections of hair-bearing scalp are pulled forward, brought together, and closed with stitches.

Tissue expansion is a procedure which has been commonly used in reconstructive surgery for burn wounds and other injuries involving significant skin loss. The use of tissue expansion for hair reconstruction tends to result in significant coverage in a relatively short period of time. For this procedure, a tissue expander, or a balloon-like device, is inserted beneath an area of hair-bearing scalp which lies next to a bald or thinning area of the head. Over a period of weeks, this device is gradually inflated with salt water, forcing the skin to expand and ultimately produce new skin cells. This will cause a bulge to form beneath the hair-bearing scalp, usually several weeks after insertion. Typically within two months following the first surgery to insert the tissue expander, the skin will be sufficiently stretched and ready for a second procedure to move the expanded skin over to the adjacent bald or thinning area.

Flap surgery is a procedure which has been performed for over 20 years and is generally thought to be able to cover large areas of a balding scalp fairly quickly. One flap is capable of achieving the results acquired by 350 or more punch grafts. The surgery is customized for each patient, thus the size and placement of the flap will depend upon each patient’s goals and needs. For flap surgery, a section of bald scalp is cut out and replaced by a flap of hair-bearing scalp. The hair-bearing flap is lifted off its surface, moved to its new position and sewn into place, all the while still attached at one end to its original blood supply. The resulting scar is typically hidden by the relocated hair. Flap surgery is often combined with other hair restoration procedures: for better coverage of the crown of the head, it may be combined with scalp reduction; for better frontal coverage and a more natural hairline, it may be combined with tissue expansion.

Hair transplantation is the procedure designed to fill in balding areas of a patient’s scalp using that patient’s own hair. It is important to note that no ‘new’ hair is added but rather existing hair is simply transplanted, thus the actual volume of hair will not increase. Hair transplantation is the most widely available hair restoration technique and the most likely approach that a hair restoration clinic will offer to you. There are several different variations on the general theme of transplanting hair from the back of the sclpa to blad areas. When hair transplantation was first developed, quite large "plugs" of skin with around 20 hair follicles in each plug would be extracted from the back of the scalp and implanted. The problem was that the result looked very artificial and produced a "doll hair" corrow look. However, over the last 20 years many improvements have been made in hair transplantation and today a good hair transplant surgeon can produce a very natural looking result. The most advanced form of hair transplantation currently available involves the transplantation of follciular units - small pieces of skin containing no more than five hair follicles and on average only three hair follicles each, and even single hair follicles. These implants are arranged to mimic the natural pattern of hair growth and can give a very effective and pleasing result.