Tissue expansion and flaps for surgical correction of male pattern baldness.

Abstract

Summary-The author describes how to use a long, non-delayed temporo-parieto-occipital (TPO) flap across the total frontal hairline, and tissue expansion for coverage of the bald area behind the flap. This concept can be used successfully in extensively bald patients where two TPO flaps would not be sufficient to cover the total bald area. An even growth of hair is achieved. When the hair “reserve” is good, quite dense hair can be reconstructed. The flap described is performed under local anaesthesia without delays and does not have the risk of postauricular necrosis sometimes seen with certain designs of TPO flaps. The combination of tissue expanders and flaps in the treatment of male pattern baldness has, in certain patients, allowed us to achieve a far more natural result than previously obtained with punch grafts, alopecia reductions and flaps. In moderate alopecia limited to the frontal area it is possible to achieve excellent results with flaps alone, but in patients with more advanced baldness extending over the total crown area it is not usually possible to cover this completely with flaps alone. The sagittal measurement of such baldness is about 16 20 cm (Fig. 1) and tempororo-parieto-occipital flaps, even when maximally stretched, are no more than 5 cm wide, covering a maximum of 10 cm