Scalp Scarring and Tissue Expansion

Treating Scalp Scars

For many patients with scalp scars, it can be confusing as to the different options for treating them. Whether due to prior surgery - plastic surgery, hair transplantation, or cancer surgery - or trauma, including burns, these scars can be difficult to treat. The most common recommendation given to treat these scars is for hair transplantation - the placement of hundreds to even thousands of individual grafts each containing from one to four hairs. And when performed properly for the right indication, hair transplantation can be effective - in fact, Dr. Epstein has treated hundreds of patients with this technique (click here to see examples of transplanted scars).

However, for certain types of scars, hair transplantation is not the best treatment, and sometimes will not work at all. In these special cases, tissue expansion, or scalp expansion, is the treatment of choice. With tissue expansion, the scalp can be stretched by the placement of surgical balloons, allowing for the partial or usually the complete removal of areas of scarring. Sometimes hair transplantation can be combined with scalp expansion to create the most aesthetic result. While many plastic surgeons can perform tissue expansion, one such surgeon, Dr. Jeffrey Epstein, specializes in this procedure. Unique in the hair transplant field as he is a board certified facial plastic surgeon, and unique in the plastic surgery field as he specializes exclusively in hair transplantation, Dr. Epstein is able to provide his patients with the most aesthetic and natural scalp reconstructions, using if necessary a combination of different techniques.

Patients from throughout the US as well as the world travel to be treated by Dr. Epstein. After going through this website, you can see what is possible. On patients from as young as 4 years old, Dr. Epstein provides state of the art compassionate care, creating unique treatment solutions for each of his patients. You can be evaluated by the doctor by sending some photos, and clicking on the patient questionnaire.

What is Tissue Expansion?

Tissue expansion is what occurs with the abdomen skin of pregnant women. Over the course of time (in pregnancy, 9 or so months), the skin gets gradually stretched out, resulting in the growth of NEW SKIN. When used to treat scarring of the scalp, the expansion process is created by the placement of a surgical balloon, called an expander, under the scalp skin that over time, usually 8 to 10 weeks, is gradually inflated with saline until enough excess new skin is generated to cover over the areas of scarring. These balloons are inserted in a surgical procedure that typically takes 90 minutes, usually performed with the patient under general or intravenous anesthesia. With a second surgical procedure, the balloon(s) is/are removed, and the excess stretched scalp skin is used to cover over that part of the scalp that contains scar tissue which is to be excised. This new tissue then continues to grow hair for a lifetime.

While new skin grows when expanded, no new hairs grow rather the hairs are spread further apart. This rarely if ever becomes a problem, such is the dramatic improvement that can be achieved by this technique.

There is a definite role for tissue expansion in select cases, but unfortunately quite a few hair restoration surgeons do not know how to identify these cases. The two main indications for choosing tissue expansion over hair transplanting are when the scars are located along the top of the scalp, are quite large, or where these scars have a poor blood supply and/or are too thin to support the growth of transplanted hairs. This is especially true in patients who have their scalps reconstructed with skin grafts- a poor substitute for normal scalp skin- which needs to be excised and replaced with normal surrounding skin.

Tissue expansion must be performed properly, otherwise there can be problems with hair growth direction, residual scarring, and others. Theoretically there is no limit to the amount of tissue that can be created with tissue expansion, provided that the process is conducted gradually. If desired, the expansion process can be repeated, allowing for the removal of additional tissue.

You can see examples of Dr. Epstein's work in the photo gallery.

If you have any questions about Dr. Epstein's artistic and natural hair restoration procedures, or about hair transplants, follicular unit grafts, or anything else, please don't hesitate to contact our office.

Procedures

Page topic: Artistic, natural hair restoration for hair replacement

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