What if my baldness is more extensive on top?
- Well-defined bald area on top (crown)
- Tall donor area
- Stable, or slowly progressive, hair loss pattern
- Loose scalp
- More mature patient
- Willingness to undergo two or more scalp lift procedures and 3-4 anterior (frontal) grafting procedures
Alternatively, SCALP EXTENSION may enable the surgeon to reduce the bald crown area. During an initial scalp reduction, immediately following removal of some of the bald scalp, the hair replacement surgeon inserts a flat, contractile device called an extender (developed by Patrick Frechet, a French hair surgeon). As this memory-possessing device gradually contracts over the next 30-45 days, it slowly elongates, and pulls together, the two hair-bearing sides of the scalp. When the extender is subsequently removed in a second operation, the surgeon can excise the remaining bald scalp while uniting the “stretched” sides of the scalp in the midline. For patients with extensive baldness, the use of one or two scalp extenders can be combined with extensive scalp lifting.
Drawbacks of scalp reduction and scalp lifting include: the generation of surgical scars, which must be subsequently covered with micrografts; the risk that the patient’s hair loss may progress beyond the excised areas in years to come, necessitating further hair restoration procedures, and the need for an average of 5-6 procedures instead of 3-4, since the front of the scalp must still be grafted. Patients with a fair amount of remaining hair may not yet be candidates, as they may not wish to remove thinning hair that may nonetheless remain for another few years on the crown of the scalp.