Gone Today... Hair Tomorrow

Posted Wednesday, September 5, 2007 to PROCEDURES > Hair

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

More than two-thirds of the male population suffer from baldness. Holly O'Neill explains a procedure that restores hair thickness and growth to areas of loss.

Appearances do count. Not just in the competitive world of business, but also in the social world. For many men, hair loss not only causes them to feel older and less attractive, but it can also feel like a partial loss of identity. Most men suffering from baldness have male pattern baldness - a hereditary disorder thought to be caused by hormones that stop genetically susceptible follicles producing hair.

One surgical solution that has shown good results is the revolutionary Fleming/Mayer Flap technique. Dr Richard Fleming and Dr Toby Mayer resliarched an idea from a South American surgeon and perfected it. The procedure is performed using the patient's own hair as a donor source. The basic idea is this: hair from the sides and back of the head is genetically programmed to grow throughout a person's life - and will continue to grow even after it has been moved to another part of the scalp. The Fleming/Mayer Flap works exactly on this premise, by rotating a flap of skin from the side of the head to the bald area. The hair continues to grow naturally.

The surgery involves three stages: Flap Delays, Flap Rotation and Dog-Ear Removal.

Flap Delays

First, the desired hairline is designed. The surgeon draws the outline of the flap onto the donor area of the scalp. The flap is positioned so its base is above the ear. This area contains the superficial temporal artery which provides the flap with blood. Under local anaesthetic, incisions are made along edges of the flap. The incisions are immediately closed and a dressing applied. The dressing is removed the next morning. This is called a Delay.Two of these are done before the flap is rotated to its final place. The Delays concentrate blood flow along the flap so it has a healthy supply of nourishment after it is rotated.

The second Delay is done a week later. Incisions are made around the tail end of the flap and immediately sewn up. A dressing is worn overnight. No hair has been removed and no-one - apart from doctor and patient - would be aware surgery has been performed.

Flap Rotation

Two weeks after the first Delay,the flap is rotated to create the new hairline. Under general anesthetic, the bald area is removed. The flap from the donor area is lifted and rotated to replace the previously bald area. The donor area is closed by stretching the edges together and stitching them up. A dressing is worn for 3-4 days. The stitches in the hairline are removed six days after the procedure, and after a further four days the stitches in the donor area and behind the flap are removed.

To create a natural-looking hairline, the incision at the new hairline is beveled to bury the hair follicles under the skin so the hair continues to grow through the stitched area and camouflages the scar.Additional micrografts of one or two hairs along the hairline can be done after surgery to refine the hairline and make it look softer.

Discomfort after the entire procedure is minimal. After each Delay,it is possible to return to work the following day.After the Rotation, the patient can return to work in six days - after the stitches in the hairline are removed. Light exercise can be resumed after about 3 weeks, but heavy exercise should be postponed for 6 weeks.

Dog-Ear Removal

A small lump of skin appears at the front edge of the flap - at the point it is rotated. The hair covers this area after surgery, but after six weeks this dog-ear is removed. It is a minor procedure and it's possible to return to work the next day. Once the procedure is done, there are very few limitations in styling the 'new' hair. Until the redness disappears, the hair will need to be styled over the new hairline.

Normal uniform density is immediately achieved. The equivalent of 10,000 micrografts is rooted within the flap.

Frequently Asked Questions about the Fleming/Mayer Flap

Will it leave scars and will they be visible?

All surgery will leave scars but the scar lines are very fine and will be concealed within your hair. As with any surgery, the surgeon's experience with the procedure can affect the quality of the result.

Will any numbness be experienced?

Some numbness behind the new hairline and above the donor area is expected. This goes away, usually within a year. Some sensitivity is experienced as sensation returns. Occasionally, a patient experiences permanent sensation loss in a small area.

Can the flap die?

In 25 years of doing thousands of flaps, we have rarely had any loss of a flap. It can occur in the last 1 inch of the flap. But this is very rare and it usually occurs in reconstructive cases and smokers.

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