Alopecia [hair loss]

Alopecia arises from acceleration of hair loss. Among the different types can be distinguished: hereditary androgenic alopecia (the male pattern baldness), manifested by a decrease in the volume of hair or baldness, and affecting 70% of men; alopecia totalis may occur following a chemotherapy or a high stress; alopecia aerata may result from skin problems such as tumors, burns or radiation.

Scalp flaps

Scalp flap surgery involves moving entire parts of the scalp which are still growing hair into a bald area. This treatment is most effective in patients who have a receding hairline only, rather than a horseshoe shaped bald area on the top of their heads.

Scalp reduction

Scalp reduction surgery involves cutting open the scalp and, thanks to the flexibility of the scalp, stretching the areas of skin that can still produce hair over the bald area.

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Male pattern baldness
  • Androgenetic alopecia or “male pattern baldness” is the most common form of alopecia.
  • It usually starts with a receding hairline from the lateral sides of the forehead, which progressively advances to thin the crown of the head or vertex. Sometimes hair loss first occurs in the occipital region (tonsure area), and then extends forward into the the frontoparietal and frontal areas.
  • The onset of hair loss may be early and sudden or otherwise settle gradually over several years.
  • The plastic surgeon will consider different factors (topography, course of the condition, psychological profile of the patient) to suggest one or more techniques that are effective in correcting androgenetic alopecia.
  • Indeed, several therapeutic techniques are available to treat androgenetic alopecia, the most frequently used of which, which also yields the most natural outcome, involves “follicular units” transplantation or “hair by hair” transplantation.
  • If scalp reduction proves to be a satisfactorily adjunctive procedure, scalp flaps and scalp expansion techniques are rarely used nowadays. It is possible to correct androgenetic alopecia, even at an advanced stage, in one surgical session performed under local anesthesia.
  • The more natural aspect of the results obtained explains why these techniques are more and more used.
Hair transplants & replacement
  • Hair grafting is performed under local anesthesia.
  • Circular or fusiform mini-grafts are taken from the hair-bearing occipital region, and transplanted to the balding area. This sampling is performed using a circular scalpel (punch) and the number of grafts depends on the stage of alopecia.
  • After the intervention, a bandage is put in place for 24 hours to maintain and protect the grafts. Showers and shampoos are quickly possible.
  • Regrowth of grafted hair is a slow process that may take 2-3 months on average. It is often necessary to perform many sessions to get a good result, especially in case of advanced alopecia.
  • These sessions are repeated at approximately 1 month intervals. Progress achieved in graft techniques allow to perform mini-grafts, and even micro-grafts of a single hair. The smaller the graft the more natural the result.
Scalp reduction
  • This technique aims to reduce the bald surface, thereby reducing the number of grafts required to obtain satisfactory coverage.
  • Most often performed under local anesthesia, tonsure reduction is very useful in the treatment of extensive male baldness, but also in the correction of cicatricial or post-traumatic alopecias.
  • It is possible to perform two or three scalp reductions about two months apart. The excision shape depends on the topography of alopecia.
  • The procedure involves removing strips of non-hair-bearing skin about three inches wide and five to six inches long, thus reducing the number of grafts required in a further overall correction of male baldness.
Scalp flaps
  • The principle of this procedure is to cut out a flap from a hair-bearing area of the scalp and displace it to the balding region.
  • This technique has the advantage of providing a tissue structure with dense hair immediately visible as there is no discontinuity in hair cycle, and of restoring a natural appearance of the hair implantation.
  • The shape of the flap excised depends on the topography of alopecia and size of area to cover.
  • According to cases, the procedure can be performed in one, two or three sessions. One or two flaps may be necessary.
  • Most often a local anesthesia is used.
Scalp extension
  • The principle of a scalp extension procedure is to first stretch a hair-bearing area, thereby increasing its surface, to allow for a later coverage of a neighbouring balding area.
  • The procedure involves two operations, most often performed under general anesthesia. During the first intervention, a gradually expanding device is placed underneath a hair-bearing area.
  • Sessions at the clinic are planned every 10 days on average to fill the expander with a saline through a remote injection port.
  • When the obtained expansion is judged adequate (four to six weeks later), a scalp reduction is performed using the increased area of hair-bearing scalp available for coverage.
  • Scalp expansion is mainly used to correct cicatricial alopecia. Its main pitfall is the cosmetic deformation imparted by the device during the process, which requires the patient to be highly motivated.
  • This technique is also used in certain cases of male baldness and can facilitate the classical technique of rotation flaps.
Last editing on 04/01/2010
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Alopecia [hair loss]

Alopecia arises from acceleration of hair loss. Among the different types can be distinguished: hereditary androgenic alopecia (the male pattern baldness), manifested by a decrease in the volume of hair or baldness, and affecting 70% of men; alopecia totalis may occur following a chemotherapy or a high stress; alopecia aerata may result from skin problems such as tumors, burns or radiation.

Scalp flaps

Scalp flap surgery involves moving entire parts of the scalp which are still growing hair into a bald area. This treatment is most effective in patients who have a receding hairline only, rather than a horseshoe shaped bald area on the top of their heads.

Scalp reduction

Scalp reduction surgery involves cutting open the scalp and, thanks to the flexibility of the scalp, stretching the areas of skin that can still produce hair over the bald area.

Dr Sébastiano MONTONERI

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