Posts Tagged ‘hairline design’
In this ongoing series of posts from an article written by Hair Foundation’s former president E. Antonio Mangubat, MD, he gives an overview of HRS cosmetic and reconstructive options and applications for their use in implementing treatments for massive hair loss from devastating illness or injury.
Specifically, Mangubat focuses on the challenges of major scalp defect reconstruction in achieving a cosmetically superior result.
In today’s post, we’ll take a look at Hairline Design.
Besides hair transplantation, scalp flap procedures are the mainstay of scalp reconstruction. While creating an undetectable and natural hairline often represents a great challenge to HRS surgeons, scalp flap techniques are able to cover large defects swiftly and effectively.
Alopecia reduction (AR) allows the surgeon to eliminate unwanted bald tissue. Originally innovated for cosmetic HRS in the 1970s, it is a procedure that became very popular because of its simplicity and effectiveness in reducing the amount of bald scalp requiring hair transplantation. Its popularity waned as hair transplantation techniques improved and our understanding of the natural history of hair loss became more refined. But the techniques remain valuable tools for reconstructive purposes.
The first AR procedures were simple excision of bald scalp from the central area of hair loss. The scalp was undermined to the nuchal line that is a prominent ridge on the parietal and occipital scalp where several muscle attach to the skull. Undermining in the subgaleal plane was easy, bloodless, and fast, allowing the surgeon to remove a significant area of bald scalp rapidly.
Limitations and disadvantages of AR were soon discovered including widening the bald area also known as stretch-back, slot deformity, and visible scarring. Many technique variations were developed to further improve the method to enhance bald scalp removal and minimize hair deformities.
The extensive scalp lift (ESL) is one of the more interesting and effective AR techniques in that the dissection was carried out beyond the limits of the galea aponeurotica marked by the nuchal line, extending it down to the nape of the hair line. Furthermore, no expander devices were required. Brandy determined that the majority of the tissue stretch occurred in the tissue beyond the thick and less elastic galeal layer; thus, ESL permitted a much greater reduction of bald scalp.
This greater efficiency was not without greater complications, however, in that an incidence occipital hair-bearing scalp necrosis was noted. Mangubat developed the procedure to preserve the occipital artery of the posterior scalp and eliminated the incidence of necrosis.
In our next post, we’ll discuss hair-bearing flaps and tissue expanders.