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Surgery

Nlike wigs, surgery is only suitable for some types of baldness such as male pattern baldness and for hair loss due to scarring (for example, after burns).

Surgery is feasible because the hair follicles retain their characteristics regardless of where they are transplanted to. This is why grafts taken from the back of the scalp and transplanted to a bald area affected by male pattern baldness do not also succumb to male pattern baldness.

Surgery is performed by plastic surgeons and some dermatologists. However, it is an expensive and protracted procedure and not every patient is suitable for surgery. The surgeon will assess each patient individually and decide whether surgery is the answer.

Surgery will improve the appearance, but whether the improvement is acceptable to the patient is another matter. Your expectations of improvement must coincide with the improvement that surgery can bring about.

If your expectations are too high, then you are likely to be disappointed with the results of surgery. You cannot also expect surgery to change other aspects of your life, such as career advancement, wealth and friends; these depend on other factors, not appearance alone.

Below are some of the surgical treatments available:

Punch grafting

This involves taking cylindrical grafts of the hair-bearing skin (usually from the back of the scalp) and transplanting them onto the bald areas where similar or slightly smaller_ sized holes have been punched out (Fig. 16).

Several sessions are required and at each session 80 to 100 grafts may be done. The procedure can be performed under local anaesthesia. Grafts are obtained with a biopsy punch (which works like a cookie cutter). The hair on the graft will fall off but new hair will begin to grow after three to four months. Punch grafting is probably the best form of surgery for male pattern baldness.

Strip grafting

This is similar to the above except a strip of hair-bearing scalp is removed and transplanted to the bald area. The wound left behind is then closed with sutures.

Scalp reduction

This involves removing a strip of bald scalp and then stitching the edges together. Scalp reduction (Fig. 17) reduces the size of the bald patch. The width of the strip that can be removed depends on the laxity of the scalp; a lax scalp will allow a larger strip to be removed.

Scalp reduction is commonly performed prior to transplantation to reduce the amount of graft required. It is particularly useful for people who do not have much hair left for grafting. Scalp reduction can be done under local anaesthesia. Another benefit of scalp reduction is that it gives the face a mild face lift.

Transposition flaps

Transposition flaps were originally used for the treatment of baldness resulting from bums and other scarring diseases. The same procedure has also been used for treating male pattern baldness. It involves raising a pedicle flap of hair-bearing skin (a flap of scalp with a stalk or pedicle still attached to it) and removing a strip of skin from the bald area. The flap is then rotated around its stalk and stitched into place on the bald area (Fig. 18).

Transposition flaps are useful because they can reposition large areas of hair bearing scalp onto the bald areas. However, the procedure needs great technical skill in order to produce good results. A more complicated type of transposition flap is the Juri Flap, named after its inventor. This allows even larger areas of hair-bearing skin to be transposed, but even greater skill is required.

Hair implants

This consists of inserting natural or synthetic hairs into the scalp. The ends of the hairs are barbed or knotted. Unfortunately, they still fall out and infection and inflammation commonly occurs. A void this treatment!

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