Scalp reduction- also called alopecia reduction- is a surgical hair restoration procedure that involves the removal of a portion of bald scalp and the subsequent stretching of the surrounding hair-bearing scalp upward to replace the portion that has been removed. This technique can be performed as a stand-alone procedure, but is usually performed in combination with a hair transplantation procedure as well to achieve optimal cosmetic results. This procedure may also be carried out in selected patients using a scalp expander. This then allows for the removal of an even larger area of bald scalp following the expansion of the surrounding hair bearing scalp over a period of weeks preceding the reduction procedure. Although hair transplantation is by far the most commonly performed surgical hair restoration procedure, scalp reduction with or without the use of expanders can be an extremely effective surgical option, especially where there are large areas of hair loss from injury, burns or tumor excisions.
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Scalp- also called tissue- expanders are balloon like devices that are implanted under the hair-bearing scalp. They are then gradually filled over a one to three month period with saline solution, increasing their size under the scalp. Skin has an enormous capacity to expand in response to under-the-skin pressure. This results in an increased area of "loose" hair bearing tissue that can subsequently be placed over an adjacent area where a large portion of bald scalp has been removed. Scalp expanders can be used as an integral part of scalp reductions, hairline advancements, and forehead reduction procedures.
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Revision of scars of the hair-bearing scalp can be accomplished as a stand-alone procedure, or in conjunction with a hair restoration procedure. At La Jolla Hair Restoration Medical Center, Dr. Carman utilizes the most advanced donor closure technique, known as the tricophytic closure method. This method of closure results in minimal scarring over traditional closure techniques.
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The surgical technique known as the browlift has as it's goal the elimination or reduction of the lateral lines present across the forehead which develop with age. It also can be used in conjunction with the appropriate application of BOTOX® as well as the use of augmentation techniques utilizing tissue fillers such as Restylane®.
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Forehead reduction is a more advanced hair restoration surgical procedure that can involve the use of tissue expanders. This procedure is generally performed in female patients who are born with unusually long or "high" foreheads which feature of very receded complete hairline. For further information regarding this procedure, contact our office to discuss your individual needs.
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Some surgical procedures involving facial rejuvenation or "lifting" rely on incisions that are made in the area of hair bearing scalp. This is done with the intention of making them virtually undetectable. On occasion, these scars may become more visible over time. Hair transplantation into these areas provides an excellent result with high rates of patient satisfaction.
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Beard and moustache transplantation is a refined form of hair transplantation wherein single hair follicles are dissected from the donor strip and are placed in small (.7 mm) incisions to create fuller growth within a preexisting facial hair pattern. It is also common to create entirely new facial hair patterns in those cases where very little facial hair is present due to hereditary or others factors.
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Eyebrow transplantation may be indicated as a result of a variety of conditions including, but not limited to trauma, burns, infection, chronic plucking, alopecia areata, as well as a congenital absence of eyebrow hair or a genetic predisposition for the eyebrow hairs to thin prematurely with age.
Recreation of a naturally appearing eyebrow requires the reconstruction of the ever changing direction of hair growth throughout the length of the eyebrow from it's medial to lateral aspect. Hair along the top of the brow grows laterally and inferiorly (points out and down). Hair along the bottom of the brow grows laterally and superiorly (points out and up). The body of the eyebrow, therefore, is comprised of these intermingling crisscrossed hairs along the middle of the eyebrow line.
In creating recipient sites, very fine incisions are made at a very low angle to the skin, to insure that the hairs lie as flat as possible. Single hair micrografts are then placed at the correct angle and direction to recreate the subtle variances that combine to produce the final appearance of a natural, full eyebrow shape.
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An important consideration to discuss with your hair restoration surgeon is the role that medical intervention may contribute to your hair restoration plan. The success of the use of the 5-alpha-reductase blocking medication Propecia®, generically known as finasteride, is well documented in the majority of those men taking the medication to stop or slow the progression of their hair-loss. 90% of men see visible results (either in terms of regrowth of hair or no further hair loss), while 66% of men taking propecia will regrow new hair.
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Rogaine® (generically known as minoxidil) is a topical agent that works by a different mechanism than Propecia® (finasteride). It can be used alone or in conjunction with finasteride, and has been shown to be effective in 85% of those using the preparation as directed.
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The use of BOTOX® and/or Restylane® as a compliment to the hair restoration procedure or as a stand-alone procedure in and of itself is available, and both can be performed concurrently with the hair restoration process.
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Today, there are a large number of herbal and/or topical agents available which claim to have an effect on the growth of hair through any number of different mechanisms. These alternatives can range from minimally effective to helpful to sometimes harmful. It is best to consult with a hair restoration expert prior to initiating any treatment for which there is little or no clinical evidence of efficacy (proof that a given product actually does what it says it does).
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