Scalp expansion in the treatment of male pattern baldness.

Tissue expansion has been extremely valuable in the treatment of traumatic scalp defects. We have recently used expansion techniques in the treatment of male pattern baldness. Expansion has been used in conjunction with scalp-reduction procedures and pedicled hair-bearing flaps. Flaps have been designed as Juri flaps, and in one patient, a new posteriorly based flap was used. This design gives the advantage of a more natural-appearing hairline and forward-growing hair. The major advantage of tissue expansion in the treatment of male pattern baldness is that it generates new hair-bearing scalp. The increase in vascularity which occurs during expansion allows for large, safe, and predictable flaps. Donor sites are also relatively easily closed. The disadvantages of expansion include the need for two or more surgical procedures and multiple office visits. There is also some discomfort following expansion and a cosmetic defect as the expanders become larger. Complications include infection, exposure or extrusion, deflation, and hair loss. Tissue expansion combined with scalp reduction and pedicled hair-bearing flaps have proved to be a valuable technique in the treatment of male pattern baldness with a high degree of patient satisfaction.