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Dr
Vogel on Corn Row correction >
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Correcting The ‘Temporal Alley’ Caused
by Progressive Hair Loss
Alopecia by definition
is progressive. Hair loss may not be visually noticeable throughout
one’s life but thinning of hair density is a natural aging
feature of hair bearing scalp. A principle of hair restoration
surgery to perform a procedure today that will stand the test
of time is based on the premise that hair loss is progressive.
(5)
When progressive alopecia affects the appearance of previous
transplant procedures the complaints are usually due to one
or a combination of three problems. 1. Increased visualization
of previously camouflaged plugs, 2. Increased appearance of
alopecia because only the grafts remain, or 3. The development
of alleys of alopecia in the temporal area. The approach to
the first two problems would generally involve P R & R
and additional hair grafting from occipital donor sites. When
alopecia alleys need to be filled in, the forelock hair needs
to be linked to the temporal fringe.
Case 5: (fig 8) 42-year-old male
who had previously undergone plug transplants in his mid 20’s.
Progressive alopecia has resulted in the increased prominence
of his anterior hairline plug grafts and the development of
bitemporal alopecia alleys. Although the appearance of an
isolated forelock is a naturally occurring pattern of hair
loss, the patient was not satisfied with the appearance of
bald scalp in these areas. One option for correcting these
alleys was to perform limited scalp reductions to raise the
temporal fringe. After discussion with the patient it was
felt that P R & R and additional grafting from the occipital
donor site was the best choice for him. The patient underwent
three sessions of plug reductions and grafting to correct
his anterior hairline and link the forelock hair to the temporal
fringe. A total of 35 plugs were reduced at the hairline and
1200 grafts containing 1-3 hairs per graft were placed at
the anterior hairline and temporal alleys. Numerous 4-mm plugs
in the crown vertex area were removed with 4.0-4.5 mm punch
excisions and closed primarily without surrounding grafting.
Results are seen 10 months following his 3-rd procedure.
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Fig. 8. 42 year old male whose progressive
hair loss resulted in the development of temporal
alleys of alopecia. In addition, anterior and posterior
plugs were unsightly. (a, b, d) results after 3 sessions
( c ) intra operative plan for linking the forelock
to the temporal fringe, PR &R anteriorly and elimination
of crown plugs.
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Case 6: (fig 9) 47-year-old male
whose previous plug hair transplant was performed 20 years
earlier. Progressive alopecia has unveiled previously camouflaged
plugs and resulted in the emergence of a temporal alley of
alopecia on the right. The left temporal recession was inappropriately
designed and grafted and the result is an unnatural blunted
angle of recession. A total of three sessions of anterior
plug reduction, recycling and grafting from occipital region
were performed to link the frontal hair with the right temporal
hair, soften the hairline and fill in the frontal forelock
density. Plug excisions were also performed in the left temporal
recession. A total of 1800 transplants with 1-3 hairs per
graft were used in addition to approximately 50 plug reductions.
Results are seen 1.2 years following the last procedure. The
patient is currently having additional corrections performed
to the crown vertex plugs
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Fig 9. 47 year old male with corn row plugs,
a right temporal alopecia alley, and a blunted left
temporal recession. Results are seen following three
sessions of PR &R, plug excisions in left temporal
recession, linking of the forelock to the right temporal
fringe and extensive grafting.
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more...
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Hair Loss information
on this site has been contributed by hair loss specialists
and surgeons who have years of experience in the field of hair
loss.
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