Hair Restoration Surgery

Scalp Expansion Surgery

Although hair transplantation is by far the most commonly performed type of surgical hair restoration procedure some patients may be candidates for scalp reduction or scalp flaps. The scalp reduction of scalp flap procedures can be performed with or without scalp expansion.

Principle of Tissue Expansion

If you gradually expand skin over a period of time, the pressure exerted on the skin actually stimulates new tissue to grow. The most common example of this is pregnancy, when the abdominal skin grows to accommodate the enlarging baby. This same concept can be applied to treat bald areas of the scalp. Scalp expansion surgery employs the concept of tension induced tissue growth to increase the area of hair bearing skin, and then use that new hair-bearing scalp to cover the balding area.

You are a good candidate for tissue expansion:
If you are bald and have enough hair at the sides and back of the head.
If you do not have rapidly progressive male-pattern hair loss.
If you have a bald patch due to burns scar, postoperative scar, scar after excision of tumour.

An implantable balloon-type scalp skin expander was first used for medical purposes about 25 years ago to facilitate surgical removal of a tattoo. By the early 1980s the technique of tissue expansion and bald scalp excision was being pioneered at Hershey (Pennsylvania) Medical Centre for treatment of massive scalp defects in children. By the mid-1980s the technique was being used by physician hair restoration specialists to treat selected patients with male-pattern hair loss.


Volumetric scalp expansion begins with the insertion of a Silastic (non tissue reactive) envelope beneath the scalp. About two weeks after insertion of the device(s), a small amount of saline fluid is injected into the envelope to begin inflation of the devices and to begin the process of scalp expansion. Injections of saline are repeated at intervals over succeeding weeks and the scalp responds by expanding.

When scalp expansion is judged to be satisfactory the devices are removed. The available hair bearing skin is used to cover the Bald patch, after excising the bald area.

The most obvious drawback of scalp expansion surgery is the period of weeks or months in which the balloons are inflated and your head takes on an oddly-shaped appearance. For this reason, scalp expansion surgery is very uncommon.

Results and Recovery

After scalp expansion surgery, you will probably have a gauze dressing on overnight to maintain pressure, minimize swelling, and absorb any drainage. The dressing usually is removed after 1 or 2 days, and sutures come out after 7 to 10 days.

You will be able to wash your hair after a few days and return to work. If desired, follicular unit grafts (grafts of 1 to 4 hairs) can be placed along the flap edge for a more natural appearance or to camouflage scars 6 weeks after your surgery Once the new hair-bearing scalps is in place, it will continue to remain just as if it were in its original site.


Scalp expansion surgery can result in infection, scarring, or rarely, insufficient blood supply during the expansion phase that leads to loss of part of the flap.

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