: eshrs :

Treatments for Hair Loss
Summary : I - Medical treatment for Hair Loss ----A - FINASTERIDE ----B - MINOXIDIL II - Surgical treatment for Hair Loss -----A - Hair Transplantation ----B - Alopecia Removal and Hairlift --------1 / Scalp reduction --------2 / Scalp extension combined with slot correction --------3 / Scalp expansion
II - Surgical treatment for Hair Loss B - Alopecia Removal and Hairlift - Principle : Consists of removing the bald scalp which will be replaced by the hair bearing scalp. (in comparison hair transplantation consists of inserting "hairs" in bald areas). - When to use Alopecia Removal Procedures : In cases where hair transplantation alone cannot offer a good result. These cases are mainly extensive baldness and scarring alopecia. - In case of Extensive baldness Hair transplantation alone cannot cover cosmetically all the bald area. For a cosmetic hair coverage an average of 80 hairs/cm2 are necessary. In an extensive baldness the bald area can average 300 cm2, 24 000 hairs are needed for a full head of hair. Hair transplantation can cover the frontal area : usually 100 cm2 with an average of 8000 hairs. Modern Alopecia Removal Techniques can eliminate the two posterior thirds of the bald area or 200 cm2 which will be replaced by 16000 hairs lifted and stretched from the sides. 1 / Conventional scalp reduction : Consist of excising an ellipse of bald scalp, usually 3-4 cm wide. Follows the undermining of the parietal sides under the galea to free the adhesions. Then it becomes possible to bring the two edges of the ellipse together and close it. One scalp reduction can eliminate up to 50 cm_ of bald scalp which will be replaced by hair bearing scalp once stretched and lifted. - Side effects and complications : Stretch back of the bald area usually occurs in the following months which may reduce the efficiency of the procedure by 30-50 % in some cases. To eliminate 200 cm2 of bald scalp 6 to 7 procedures may be necessary over a period of one to two years time. The other main problems related to scalp reduction are possible widening of the scar, slot formation in most cases, and poor efficiency with tight scalp.
2 / Scalp extension combined with slot correction : ----a - Scalp extention technique or hairlift : the moderne alopecia removal Consists of assisted scalp reduction using an "Extender" also called scalp extension. Before closing the ellipse during the scalp reduction , an "extender" or bioelastic device is stretched and affixed to the galea at the level of the 2 lateral hair bearing areas. (Illustration n°2)


During the 4 to 6 following weeks, the extender applies permanently a flat traction on the hair bearing scalp which stretches progressively, while the bald area compresses and reduces in size. No deformity of the scalp is observed allowing the patient to live a normal social and professional life. Usually for a 15 cm wide baldness, two scalp extensions are performed one after the other to remove most of the posterior and top baldness. (Illustration n° 3a, 3b). When taking off the second extender a three hair bearing transposition flap is performed to avoid the slot (Illustration n° 4)



- Side effects and complications : Pain for a few days occurs requiring pain killers. Forehead swelling and exceptionally ecchymosis around the eyes may be seen. Infection may be seen in 1 % of cases due to the foreign body. Antibiotics are systematically prescribed and renewed if necessary. - In conclusion : With two scalp extensions and three procedures performed over a period of 2 to 3 months an average of 16 000 hairs have progressively replaced the bald area : A "Hair lift" has been accomplished. ----b - Slot correction with the three hair bearing transposition flap : When removing bald scalp whatever the technique or the pattern of the scalp reduction, a slot forms at the back of the head when the two lateral hair bearing areas come close to one another. The hairs on each side are directed in opposite direction and horizontally.(Normal hair direction at the back of the head is vertical and downward). The only technique which has been able to eliminate the slot and replace the hair in the right direction offering an aesthetic result which mimics nature is the triple flap which is performed when the extender is being removed. (Illustration n° 5a, 5b) (Illustration n° 6a, 6b)





- Side effects and complications : Telogen may be observed in about 10 % of cases, usually at the tip of the second or the third flap. Necrosis even though exceptional may be observed in less than 1 % of cases. The patient must be aware. CONCLUSION The result of the treatment of an extensive baldness in a patient who has now a full head of hair. (Illustration n° 7a, 7a2, 7b, 7b2, 7c, 7c2)






This result has been obtained after 2 scalp extensions, 1 three hair bearing transposition flap, and grafts for the frontal area. This represents the transfer of 25000 hairs. in other circumstances where Alopecia Removal Techniques may be used : Scars, burns, and other scarring alopecias each time they may be considered easier to eliminate rather than grafted.
3 / Scalp expansion : Expanders are balloons, introduced under the scalp and inflated progressively to strectch the hair baring scalp. As a consequence, a volumetric difformity occurs, which may restrain social activities. That is why this technique is mainly used for reconstructive surgery. Here is the case of an extensive burn.

Treatments for Hair Loss

B - Alopecia Removal and Hairlift

- In case of Extensive baldness

- In conclusion :

CONCLUSION

in other circumstances where Alopecia Removal Techniques may be used :