For baldness of the frontal 1/3rd of the scalp – frontal hairline and temples- the redistribution of own hair, by micro grafting, is an efficient solution. For the crown area, a scalp extension gives a better and more natural looking result.

REDISTRIBUTION BY MICRO GRAFTING: Each hair is individually transplanted. The hairs flow naturally into the hairline, giving it a more natural appearance.

MICRO GRAFTING WITH LASER:

The hole, in which the hair follicle is transplanted, can be made in 2 different ways:

1. a small incision with a surgical needle ( = puncture method ), or
2. with the laser, which burns a little hole in the scalp.

The laser can burn some tissue loss around the small hole. This makes the method unsuitable for densification of areas of thinning hair.

Therefore, in the Yoskarn Clinic, we normally prefer the puncture method.

WHO IS A GOOD CANDIDATE? The donor hair on the back of the scalp –“the eternal crown”- should be of good quality. Darker more curly hair gives better visual density. Generally, men are the primary candidates but woman who experience regional baldness can also benefit from this procedure.

WHO IS NOT A GOOD CANDIDATE? If hair loss is caused by disease or lack of vitamins and minerals, then treatment is recommended prior to transplantation.
If good, healthy, donor hair is not available micro grafting becomes impossible. Hair restorative surgery should be carefully thought through, also with the long term progress of balding in mind. The surgery is irreversible and invariably does give rise to permanent scarring, which may in later life become a problem.

IS HAIR TRANSPLANTATION PERMANENT? Yes. The plastic surgeon transplants good healthy donor hair to the bald area. The lifespan and quality is the same as that for the hair of the donor region.

IS 1 TRANSPLANTATION SURGERY ENOUGH? Generally, approximately 90% of the transplanted hair will grow successfully. Micro grafting allows only 1500 grafts to be transplanted in one session. According to the degree of baldness the density can be still insufficient. A second session, from six weeks after the first onwards, can be essential to achieve thicker hair growth.

All worlds leading hair restoration surgeons agree that it is virtually impossible to transplant more than 1500 grafts in one surgical session.

Micro grafting is an efficient solution for restoration of the frontal 1/3th of the scalp. Scalp extension gives the best result for the balding crown. Until recently, redistribution of own hair was limited to implantation methods. However they carry their limitations, particularly with a long term view.

It is impossible to achieve the necessary thickness for extensive baldness with only the maximal 2.000 hairs. After only a micro graft procedure is done on substantial baldness, the scalp will still be shiningly visible. Several transplant procedures should be necessary to achieve a natural result.

The scalp extension method gives a better, natural result and fuller hair for the crown and on the rear of the head.

• SCALP EXTENSION: THE PROCEDURE

With the use of an internal elastic stretching system the plastic surgeon gradually stretches the hairline. The device is not noticeable.
Between 8 and 12 cm of bald scalp can thus be removed over a period of two months without significant social or professional interference.

	In a first surgical phase, an elastic stretching system (extender), is placed unnoticeably under the skin. If possible, some excess scalp will already be removed at this first stage.
	After 1 month you will come back for a second phase. The plastic surgeon removes some more of the bald scalp. The stretched hairy scalp will then fill the defect.
	If necessary the surgeon places a new extender during this second phase, for further treatment.
	1 month after the second phase you will have to come back to the Yoskarn Clinic. The hairy skin is lifted into the bald position. A natural hair growth direction is achieved by an interlocking scar on top of the head. For very extensive baldness and in patients with a tough scalp, a central defect may remain albeit only a small fraction of the original bald surface. This small area will be amenable to further redistribution procedures.
	Transplantation of micro-grafts, for filling up the front hair line and temples, can happen during the same procedure of the scalp extension.

This means that full surgical recovery can normally take place in 3 sessions during a two month period.

SCALP EXTENSION: THE SEDATION

Scalp extension takes place under intravenous sedation. Contrary to traditional narcosis, you are not connected to a respirator. You will be asleep and breathe yourself, without feeling any pain at all. When waking up several hours after the surgery, you feel fine, without suffering from any of the side effects of general anaesthesia.

The extender is temporary implanted under the skin. The implant is not visible. The skin is sutured in a fine line and can result in crust formation in the first 14 days.

Most people go back to work the second day after the surgery. Social and professional interference are minimal.