Scalp Scarring and Tissue Expansion

Case #1: This 17 year old female, Patty, wore a hair piece her entire childhood to conceal a 7 cm wide alopecic mid-sagittal scar that was the result of an attempt to close a congenital amniotic band scar as a 3 year old. She was prevented from such activities as swimming and sleepovers. In preparation for starting college, Patty and her family investigated different treatment options- two local hair transplant doctors recommended hair transplants, a third recommended several cycles of scalp extension to be followed by transplants. A local plastic surgeon suggested tissue expansion but felt unable to properly restore her hairline.

Patty decided to have tissue expansion, preferring to commit two months to the tissue expansion process, knowing that this would assure the best chance of complete removal of the scar. A day after graduating from high school, Patty flew to Miami for the first surgery. Performed under general anesthesia (although these procedures can be performed under intravenous sedation), two tissue expanders, each measuring 6 by 13 cms, were inserted in the subgaleal plane parallel and adjacent to each side of the defect, with the inflation ports tunneled under the midline defect. Simultaneously, 175 hair grafts containing 2 and 3 hairs were transplanted into the 3 cm frontal-most aspect of the scar, where, due to the curvature of the expander flaps, removal of this scar tissue would not be possible.

Two weeks after insertion, twice weekly filling of the expanders with 15 to 20 ccs of saline was initiated, so that by eight weeks each contained approximately 300 ccs. Cosmetically, thanks to her thick curly hair, it wasn't until the last three weeks that the expanders became obvious. Ten weeks after insertion, under general anesthesia, the expanders were removed and the two flaps of expanded scalp tissue were brought together, allowing for the complete removal of the scar tissue, with the exception of the frontal-most 3 cms of scar, which was anticipated and already transplanted with hair grafts. The very next day, Patty and her family were able to appreciatively see her now normal scalp.

Before.	After Tissue Expansion.

Case #2: This 52 year old female, Joyce, two years prior had two melanomas removed from her scalp, resulting in two large alopecic defects. While her scalp density was already somewhat low, she decided to undergo tissue expansion to allow for the removal of her scars and complete hair coverage. Similar to Case #1, two tissue expanders were inserted then inflated, then 12 weeks later the expanders removed and the expanded flaps rotated advanced into the defects. At just 4 weeks post op, the approximately 20% of shock hair loss was reversing with the possible expediting of minoxidil, and Joyce no longer needs to wear a hair piece or head scarf to go out. Read Joyce's story here.