Hair restoration treatments explained: Treating baldness with Pedicle Flaps, Microsurgical Free Flaps, Scalp Expansion

Debraj Shome, Facial Plastic Surgeon elaborates.

While baldness comes down to your genes and hair loss is not always in your control, there s a good chance that you would have tried a host of methods to retain your hair volume. But while there are so many overwhelming options to choose from, one cannot deny that at times it can be really hard to pinpoint which method is actually worth your trust. But with the advent of revolution in biology, new and powerful tools have been able to understand the complex chemical languages of the body, especially when it comes to managing and treating baldness.

Debraj Shome, Facial Plastic Surgeon - Apollo Spectra Hospitals, helps us in understanding how these three most crucial procedures: pedicle flaps, microsurgical free flaps, scalp expansion, can help in fighting alopecia and baldness. Let us understand more.

Pedicle Flaps: Flap surgery is a hair restoration treatment for baldness. It involves moving a "flap" of skin from one area of the body to another. Scalp flap surgery moves hair-bearing scalp to the bald area providing instantaneous hair coverage. Narrow gaps between transferred flaps may require some "touch-up" by hair transplantation or scalp reduction later.

Microsurgical free flaps: Microvascular free tissue transfer or free flap is usually used to repair the areas where there are no hair follicles. A free flap takes a block of tissue from one part of your body (called the donor site) and moves it to the site that needs reconstruction (called the recipient site).

Scalp Extension: Excision of the bald scalp after either tissue expansion or scalp extension surgery can play a very useful and important role in hair restoration as well. Scalp tissue has the ability to elongate or stretch after tension or pull has been placed on it for a period of time, similar to the elongation of fish-net nylon stockings when pulled from two sides. In humans, this phenomenon is called mechanical creep . When tissue is pulled or stretched for longer periods of time, two other changes occur - new tissue is formed and also adjacent tissue moves into the area (called recruitment of surrounding tissue). This combination of new tissue growth and recruitment is known as biological creep , and pregnancy with stretching of the abdominal skin is an everyday example of this.

In order to excise more bald skin, and make the area of baldness become smaller or be eliminated, certain surgical procedures will utilize either mechanical creep or biological creep or possibly both, to achieve this goal. In the technique, also called volumetic expansion, using saline expanders, one or more balloon-like structures, called tissue expanders, are surgically placed below the hair-bearing scalp skin to cause biological creep.

Usually two weeks after the tissue expanders have been put in place, some salt water or saline is added to each expander, using a needle through the skin, to expand it. Saline is then added once or twice a week for 8-12 weeks until the hair-bearing scalp has been expanded the desired amount. Then, at a second operation, the saline is removed from the expander(s), the expander(s) removed, and then the desired bald scalp excised and replaced by the expanded hair-bearing scalp.

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