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If you gradually expand skin over a period
of time, the pressure exerted on the skin actually stimultaes
new tissue to grow. The most common example of this
is pregnancy, when the abdominal skin grows to accomodate
the enlarging baby.
This same concept can be applied to treat
bald areas of the scalp. Scalp expansion surgery employs
the concept of tension induced tissue growth to increase
the area of hair bearing skin, and then use that new
hair-bearing scalp to cover the balding area.
A tissue expander is a balloon that is
placed beneath the scalp. Over a period of weeks or
months, saline (salt water) is gradually added to the
balloon to slowly inflate it. As the balloon is inflated,
it puts tension on the skin. Within a few days, the
scalp seems to relax as new skin grows in response to
the tension. Once the scalp is lax again, more fluid
is added and the process is repeated until enough hair-bearing
scalp is present to cover the desired area.
After the expander (or expanders) are
placed in the first operation, you will begin the expansion
phase. During this stage, your head will begin to look
more and more distorted as the expanders are inflated.
It will likely be necessary to wear a hat to conceal
your oddly-shaped head.
The actual expansion procedure involves
simply inserting a needle into a valve in the expander
and adding fluid. It is not painful, although you may
feel some uncomfortable tightness or aching for a few
hours or a day after your expansion. Common over the
counter pain relievers such as Tylenol should be all
you need to control any discomfort.
After the expanders have been inflated
several times, and your hair expansion surgeon has determined
that you have enough new hair-containg scalp to cover
the bald area, your second surgery will take place.
In the second surgery, the expanders will
be removed, the bald scalp will be cut out, and the
new hair-bearing scalp with hair will cover where the
baldness used to be.
The most obvious drawback of scalp expansion
surgery is the period of weeks or months in which the
balloons are inflated and your head takes on an oddly-shaped
appearance. For this reason, scalp expansion surgery
is very uncommon.
recovery - After scalp expanison
surgery, you will have prescriptions for antibiotics
to prevent infection and pain pills to control discomfort.
Many patients do fine with acetaminophen (Tylenol) after
surgery and do not require stronger medication.
You will probably have a gauze dressing
on overnight to maintain pressure, minimize swelling,
and absorb any drainage. It is normal to see a few drops
of blood on the gauze. If you notice more than a few
drops, or if the area of blood is increasing, call your
doctor right away. The dressing usually is removed after
1 or 2 days, and sutures come out after 7 to 10 days.
Your hair expansion surgery may allow
you to wash your hair after a few days. At this point,
most peole return to work, if they haven't already.
If desired, follicular unit grafts (grafts of 1 to 4
hairs) can be placed along the flap edge for a more
natural appearance or to camouflage scars 6 weeks after
your surgery.
risks - Scalp expansion surgery
can result in infection, scarring, or rarely, insufficient
blood supply during the expansion phase that leads to
loss of part of the flap.
cost - Scalp expansion surgery
can cost $5,000 to $10,000 or more.
results - Once the new hair-bearing
scalps is in place, it will continue to remain just
as if it were in its original site. Scalp expansion
surgery does not stop hair loss, and you will continue
to lose hair just as you would have if you had not had
the scalp expansion surgery, but usually the effects
will last 10 to 20 years or more.
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