Flaps
This technique is not performed by NHI.
A "Flap" is a medical term that refers to a strip of tissue that is rotated on a narrow base (pedicle) into an adjacent area. In hair restoration, a hair-bearing strip of scalp usually taken from the sides of the head is rotated into the balding area in the top or front.
A flap is freed of its attachments to the surrounding tissue on three sides but it remains attached on the fourth side, through which it receives its blood supply. Unlike free skin grafts, flaps must carry their blood supply with them.
In performing a flap, the recipient site is first prepared in the intended area by making an incision and freeing the overlying skin. The free end of the flap is then transferred from its original location to the new one. The remaining opening in the donor area is closed by sewing the skin edges together. Some flap procedures use two flaps, one from each side of the head. Other procedures use a single, long flap from one side and the back of the head.
Flap procedures are major surgery that must be performed in a hospital-level operating room. Some doctors do the operation in two, or even three stages. First, they delay the flap by making the incisions for it, but leaving the flap in place to stimulate the development of an independent blood supply. This creates a barrier of scar surrounding the flap on three sides. Once the area becomes wholly dependent upon its base artery for its entire blood supply, the flap can be rotated into its new position.
The main advantage of flaps is that they offer the quickest method of putting long, dense hair into a frontal bald area. However, they have so many disadvantages that most hair restoration surgeons no longer perform them.
The main problem is that this hair is too dense. So much hair is placed in a relatively thin band across the front of the scalp that it doesn't look natural. In addition, so much hair is used up that other parts of the scalp can't be covered if the patient continues to bald.
The abrupt transition from a bald forehead to a band of dense, coarse hair, which is growing in the wrong direction, gives a distinctly abnormal appearance and is literally impossible to correct. In an effort to improve the appearance of a flap, some doctors remove part of the hair from the leading edge of the flap. Some doctors place small grafts of fine hair directly in front of the flaps. These techniques attempt to create a zone of finer hair oriented in the proper direction in order to hide the straight line of scar that is often visible in front of the flap. Unfortunately, they are rarely completely successful.
Another problem is that the scalp remains bald behind the flap. This area may not be too visible in patients with dense hair and limited balding, but patients whose hair is sparse, or who have highly contrasting hair and skin color, have difficulty hiding the expanse of bare scalp. Patients whose temple hair thins as they age also have problems with visibility of the bald part of the scalp. These patients typically become extremely self-conscious about their appearance. Transplanting hair into this area can improve its general appearance, but the effects of the flap procedure markedly decrease the number of available grafts, making complete correction impossible.
As mentioned above, the rotation of the flap changes the direction of hair so that the hair actually grows in the reverse of its natural direction. Because of the rotation, the corner of the flap is often distorted so that a natural looking hairline is never achieved.
A "Beetle Brow" occurs when the loose skin over the eyebrows is pushed down and forward when the flap is transposed to the forehead so that the patient develops jutting, overhanging eyebrows that give a weird, Neanderthal appearance to the face. This can be corrected by a brow lift operation in which the loose skin in front of the flap is excised. However, it is best if this problem were avoided altogether.
In addition to these problems, there are a host of complications associated with flaps. The worst of is flap necrosis (a medical term for tissue death). In one study done by an experienced plastic surgeon, more than one-third of the flaps sustained some degree of necrosis. The surgeon said that because of the frequency of this problem he would not do flap surgery any longer. When a flap dies, it often leaves a wide, ugly scar in the frontal hairline area of the scalp. Necrosis of the flap causes permanent loss of the hair in the part of the flap that dies, and this very difficult to conceal, even with further surgery.
In sum, flaps move "too much hair," in the wrong direction, and to the wrong place. Unfortunately, this wrong place happens to be the cosmetically critical frontal hairline, where it's the most important for the scalp to look natural.
© 2008 New Hair Institute. www.newhair.com |
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