SURGICAL METHODS

Dr. McAndrews has written many chapters in textbooks and has been interviewed many times by television, news programs and national newspapers about the latest advances in hair loss, hair transplants, and hair restorations.

Dr. McAndrews believes that an informed patient is the best patient. There are many different surgical techniques to correct androgenetic alopecia and it is important that our patients understand the risks and benefits of each and make an informed decision.

1. HAIR TRANSPLANTS

Hair transplants have evolved dramatically since Dr. Ayers and Dr. Corbett started performing hair transplants in 1961 (In 1996 Dr. McAndrews was honored when asked to take over their practices). Dermatologists have made huge strides over the past several years, creating hair transplant techniques that are undetectable and look completely natural. There are pros and cons to the various techniques used to create the hair transplant. Dr. McAndrews believes it is very important to get 2nd opinions and get a few consults from doctors that have been formally and properly trained. More About Hair Transplants

2. SCALP REDUCTIONS

Scalp reduction is a technique where a portion of the bald scalp is surgically removed and the hair-bearing scalp is stretched over that area. In theory it sounds logical, however in reality it is highly illogical. The downside to scalp reduction surgery is many:

1. It has a higher complication rate than hair transplants.
2. It leaves a scar in the balding area, which usually necessitates 2-3 hair transplants to hid. (It would be more logical to do 2-3 hair transplants in the first place instead and avoid the complications of scalp reductions.
3. Many times the scalp stretches back, which leaves the patient with the same amount of bald scalp and a visible scar that can be difficult to mitigate.
4. When a patient has a limited “hair bank,” it is far more important to use that “hair bank” to create a frontal forelock to frame the patients face. Unfortunately, scalp reductions only reduce the bald scalp in the vertex and on the sides of the patient’s scalp. Scalp reduction often does a patient a disservice by using most of the “hair bank.” Eventually, the patient will need this “hair bank” (that will no longer be available) to frame the face.

Dr. McAndrews no longer performs scalp reductions because he believes that there is no discernable benefit when compared to current hair transplant techniques.

3. SCALP FLAPS

There are several different techniques used to create scalp flaps. Scalp flaps were developed to shift hair from the sides and back of the scalp to the balding front of the scalp. These methods address the issue of using the limited “hair bank” to frame the face, unfortunately they are fraught with complications and produce an unnatural look:

1. It is a very complex procedure that is performed in stages over several weeks.
2. The complication rate is much higher than that of a hair transplant and potentially devastating (i.e.- necrosis or tissue death, of the whole scalp flap).
3. It usually looks quite unnatural because…
   1. It crosses over the frontal-temporal triangle (an area that is naturally bald in most men) creating a very unnatural look (the face is not framed correctly in relation to the hairline).
   2. The hairs along the hairline are directed in the wrong direction, creating an unnatural look (usually hairs on the hairline naturally point forward, in the flap all the hair along the hairline is usually directed sideways or backwards.
   3. The flap creates an unnaturally dense look right on the hairline.
   4. The flap creates a scar in front of the hairline, which now needs to be hidden with hair transplants.
   5. It is an inefficient use of the “hair bank.” Dermatologic studies have shown that the naked eye cannot distinguish the difference between a scalp that has 50% hair density versus 100% hair density. The flap method shifts a large portion of the “hair bank” to the frontal hairline at 100% density. A Hair Transplant could have used this same donor area and spread it over twice the area as the flap at a 50% hair density, with the appearance of the same density to the naked eye.

For all the above reasons, Dr. McAndrews will not perform scalp flaps.

Become Educated: FUE Hair Transplant Clinics are springing up as quickly as 24-hour mini-marts and fast food restaurants. Most of these FUE clinics have physicians with no formal training in hair transplants and have minimal knowledge of the androgenetic alopecia. Be very wary of plastic surgeons/facial plastic surgeons offering FUE hair transplants with an automated device (i.e.- neograft, smartgraft, artas robot or other FUE device). Many of these doctors are allowing the unlicensed technician to perform the surgery. This is illegal in the state of California (and almost all states and countries) and the doctor and the technician are involved in a criminal act and could go to jail. Furthermore, the doctor’s malpractice carrier would not cover a lawsuit when the doctor allowed the unlicensed practice of medicine to occur in their office. These doctors seem to be okay with breaking the law in order to bring in some extra revenue to their office. Unfortunately, the patient is left to determine if a particular procedure is the right match or if a doctor has adequate training to perform that procedure.