If the scalp is tight or more than 2 cm of advancement is needed or the widow peaks are very wide, the following two-stage procedure can be considered. This technique has been developed by Dr. Kabaker and used for over 20 years. It has proved to be almost immediately effective and is well tolerated by patients.
Tissue expansion is a procedure commonly used in reconstructive surgery to repair burn wounds and injuries with significant skin loss. Its use in hair replacement surgery has generated dramatic results because it gives significant coverage in a relatively short amount of time.
Skin expansion is a common surgical procedure to grow extra skin through controlled mechanical overstretch.It creates skin that matches the color, texture, and thickness of the surrounding tissue, while minimizing scars and risk of rejection.
In this technique, a balloon-like device called a tissue expander is inserted beneath hair-bearing scalp that is next to a bald area. The device is gradually inflated with salt-water over a period of weeks, causing the skin to expand and grow new skin cells. This causes a bulge beneath the hair-bearing scalp, especially after several weeks.
When the skin beneath the hair has stretched enough, usually about two months after the first operation, another procedure is performed to bring the expanded skin over to cover the adjacent bald area.
During the first operation the croissant-shaped expander is inserted under the hair bearing skin and filled up to 120ml.
The balloon is expanded over a 7-week period, to stretch the scalp sufficiently to allow for 4-8 cm of advancement. Hair-bearing tissue can be expanded to approximately twice its size without a noticeable deficit in hair density.
This is well tolerated by patients aside from the cosmetic inconvenience during the last three weeks of the expansion.
During the second and final surgery, the device gets removed and the expanded hair-bearing scalp is moved forward, replacing the top section of the high forehead or wide widow peaks. With this approach we are able to move hairlines as far as 8 cm and close wide widow peaks. The procedure of this hairline lowering surgery is the same as the one of the simple one stage hairline lowering surgery.
Before you can start stain your hair again after a forehead recontouring the incision should have healed 100%. If the incision was made a few cm inside the hair (no hairline lowering) this will take about 6 weeks. In case you had a hairline lowering this might take longer (up to 4 months).
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