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Scalp Flaps/Scalp Lift
 
For most men, some balding is an inevitable reality. Hair loss can begin as early as the teens. Many men (and women) become increasingly self-conscious as their hair begins to become progressively thinner. Most often, such hair loss is not caused by an illness but is simply a genetic trait.

New surgical techniques make it possible to re-create a thick, full head of hair by moving areas of existing hair to the bald areas. For patients looking for alternatives to hair transplants, many doctors now offer scalp flaps and scalp reductions to produce a new, natural-looking head of hair. Of all hair restoration procedures, scalp flaps move the greatest amount of hair in the shortest amount of time.

As with hair transplants, scalp flap surgery involves removing hair from a section of the scalp where hair follicles are abundant and transferring some of those to the balding area. However, instead of cutting the section of hair into smaller grafts and then inserting them into thinning areas, scalp flap surgery is performed by moving the entire strip to a completely bald section of the head. The hair then continues to grow, in its new location, at the same rate of growth as the previous location. It will not thin or die unless hair in the area it came from also thins or dies.

Scalp flaps are sometimes performed in combination with hair transplants for a more natural look, or with scalp reduction, to more effectively cover a large bald area.

If you are considering a scalp flap, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you consult a plastic surgeon who is board certified or has completed a residency program that includes instruction in this procedure.
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What are some of the most common benefits of this surgery?
Like all hair restoration procedures, scalp flaps are designed to produce a healthy, youthful appearance. While regular hair transplants may require several treatments, and the results may take months to become apparent, flap surgery produces immediate results. Doctors most often use flap procedures for balding near the front of the head.
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What will happen at the initial consultation?
During the consultation, your doctor will talk to you about the changes that you would like to make in your appearance. He/she will explain the different options available to you, the procedure itself, and its risks and limitations. He/she will also explain the kind of anesthesia used, surgical facility where it is performed, and costs involved.

Your doctor will begin by recording your complete medical history, and then examine your scalp and hairline. He/she may also take “before” photos, and give you specific instructions preparing for surgery, including guidelines for eating and drinking, smoking and taking or avoiding vitamins, supplements and medications.

Be sure to tell your doctor if you have had previous hair restoration surgery, if you smoke, or if you take any drugs or medications (including aspirin). Also tell your doctor if you have a tendency to form large scars or keloids

Take this opportunity to ask all the questions you have about the surgery, and ask to see photos of the doctor’s recent patients, before and after surgery. Also ask for, and follow up on, patient references. Learning everything you can about your options, risks and benefits is the key to making an informed decision. See Questions to ask your doctor below.
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How are scalp flap surgeries performed?
During a scalp flap surgery, your doctor will take an entire strip of hair from one section of the head and move it to the bald area. This is typically done in three stages, each scheduled about a week apart. Most scalp flaps are performed under general anesthesia. Sometimes doctors will opt for a local anesthesia (like that used by dentists) combined with a sedative to make you drowsy. In this case you'll be awake but relaxed, and although you may feel some tugging and mild discomfort, you won’t feel any pain.

First Stage (Week 1):

Two parallel incisions are made on the side of the scalp. (Usually this is done on just one side, but both sides can be done at once.) The incisions are then closed and sutured.

Second Stage (Week 2):

A smaller incision is made near the back of the head to connect the first two parallel incisions. That incision is then closed and sutured. The purpose of these first two procedures is to redirect the blood supply to this area of the scalp.

Third Stage (Week 3):

An incision is made near the front of the head, near the hairline. The scalp flap is then lifted and rotated about 90 degrees and placed into this new incision area (the previously bald area). The flap is sutured into place. The original area of the flap is then closed and sutured as well.
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How long does the procedure take?
Scalp flaps require about 2-3 hours for each of the three procedures.
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Where will the procedure be performed?
A scalp flap surgery can be performed in the hospital or in an office surgical suite, depending on your preferences as well as your doctor’s. The longer the procedure is expected to take, the more likely that general anesthesia will be recommended. You may be allowed to return home within a few hours of the surgery, and spend the night in the comfort of your own home, or it may be necessary to spend the night in the hospital so your recovery process can be monitored.
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How much pain is there?
The amount of pain experienced varies from person to person and depends on the extent of the procedure. There may be some discomfort following the procedure that can be alleviated with oral medication. You should discuss your goals, budget, and pain tolerance with your surgeon in order to help him/her determine the procedure, or combination of procedures, that will produce the best results for you.
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What can I expect after the procedure?
During the first several days following the procedure, you will experience some discomfort in both incision areas. Mild headache, swelling and bruising around the eyes are all common. Scabbing is also common. Most people will be able to return to work within 3-5 days following the procedure.
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What is the recovery period like?
You should be able to slowly resume normal daily activities over the next several days. Shampooing and combing should be avoided for at least 5-7 days. Strenuous activity should be kept to a minimum for about two weeks.
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What is the long-term outcome like for most people?
Most patients who decide to undergo scalp flap surgery are pleased with the results. All procedures are designed to last a lifetime. The scalp flap procedure produces the densest area of hair out of all the hair replacement surgeries. While there may be some scarring around the incision, it is normally covered by hair. Occasionally, a hair transplant procedure is used to help cover the scars.
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Ideal Candidate:
In general, the best candidates for scalp flap surgery are:

  • Physically healthy
  • Psychologically stable
  • Completely bald toward the front of the scalp
  • Informed about the procedure
  • Older, with relatively stabilized pattern of hair loss
  • Informed about the balding process
  • Possessing healthy hair growth on the sides and back of the head
  • Realistic about the procedure outcome

The above is only a partial list of the criteria that your surgeon will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your surgeon if he / she considers you an ideal candidate for this surgery.
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Alternatives:
Other hair replacement treatments include hair transplants, wigs and drugs therapy such as Propecia. Scalp flaps and reductions can be done in combination with hair grafts in order to fill in the remaining thinning or balding areas. Although much depends on the individual case, these combinations can produce very natural-looking results.
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Risks and limitations:
Scalp flaps are usually performed on patients who experience complete balding in the front area of the scalp. Men whose hair is just beginning to thin, or whose hair patterns are still changing, may want to choose a different type of treatment.

Scalp flaps will produce scars where the incisions were made. The scars are usually faint, however, and concealed by hair.
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Choosing a doctor:
It is very important that you select a physician adequately trained and experienced in this procedure. We strongly recommend that you consider choosing a surgeon who is board certified by the American Board of Medical Specialties. See our Physician Locator feature to find a surgeon in your area, including detailed profile information for many of the listed doctors. Also read How to Select a Plastic Surgeon for a more detailed discussion on choosing the right doctor.
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Questions to ask your doctor:
  1. Are the desired results I described realistic?
  2. Where is the surgery performed? How long will the procedure take?
  3. Would another treatment give better results for me?
  4. Are there other procedures that I should consider to enhance the effects of this procedure?
  5. What kind of anesthesia is used?
  6. What is the recovery period like? How soon can I return to work following the procedure?
  7. Are there certain types of shampoo that I should use or avoid using following my hair replacement procedure?
  8. How much does it cost?
  9. What is your experience in performing this procedure? (How long has he/she performed this procedure, and how many he/she has performed in the past year?)
  10. What percentage of patients have had significant complications? (The physician should disclose this information to you.)
  11. Will you repeat or correct procedures if it does not meet agreed upon goals? And if the procedure must be repeated / corrected, will I be charged again? (The physician should provide you with his/her policy on this issue.)
  12. May I see "before and after" photos of recent patients? The physician should provide many photos of recent patients.
  13. May I have the names and contact information for several recent scalp flap patients? (Follow up to get first-hand information on the procedure and the surgeon.)
  14. Could I observe the exact procedure I am considering before I decide to have the surgery? (Either on videotape or ask to view one in real life.)
  15. What should I expect post-operatively in terms of soreness, what to watch for, medication, bathing, and level of activity?
  16. Who will be assisting during the surgery? What are their qualifications? (Does the plastic surgeon perform the entire surgery?)
  17. Have you ever had your malpractice insurance coverage denied, revoked, suspended?
  18. Do you offer patient financing?
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Be sure to:
  • Tell your doctor about any allergies you have (to foods, drugs, environmental elements).
  • Tell your doctor about all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription), including such natural remedies as Echinacea and St. John’s Wort.
  • Be sure to tell your doctor if you smoke. Smoking can lead to complications and poor healing.
  • Carefully follow any instructions your surgeon gives you regarding eating and drinking.
  • Avoid aspirin and aspirin-containing medicines for two weeks prior to surgery.
  • Arrange for someone to drive you home after surgery.

The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.
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How do I finance this procedure?
Did you know that 29% of all Americans have considered having an elective procedure? Of those, 60% would schedule a procedure immediately if financing was available. With iEnchances patient financing options, money no longer has to be the barrier between you and your new image. By filling out our on-line application you can qualify for a loan in as little as 30 seconds.
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Related Articles
Please review the following articles for more information on this procedure.
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Facts:

*Top 5 Surgical Cosmetic Procedures in 2008:

1. Breast Augmentation: 356,000
2. Liposuction: 341,000
3. Blepharoplasty: 195,000
4. Rhinoplasty: 152,000
5. Abdominoplasty: 147,000

*Top 5 Non-Surgical Cosmetic Procedures in 2008:

1. Botox: 2,464,000
2. Laser Hair Removal: 1,281,000
3. Juvederm/Restylane: 1,263,000
4. Chemical Peel: 592,000
5. Laser Skin Resurfacing: 571,000

* Data collected from the American Society of Plastic Surgeons (ASPS)
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