Beyond Hair Plugs: Modern Surgical Options For Hair Loss in Men
When medical treatments for hair loss fail to bring satisfactory results, some men turn to surgical treatments like hair transplantation ...

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It's almost comedic and if I wasn't there it might be tragic.

DAVID R. MARKS, MD: What about healing? Are there bumps when you run your hand over the scalp?

ROBERT V. CATTANI, MD: There can be what is known as cobblestoning, when these small grafts raise above. Mostly with the passage of time, they'll level out. Beyond that, David, let me make a few comments. Most of my patients, not most of my patients, all of my patients have one request. Can you do it all at one time, doc? The answer is usually no. At least in my hands. There's only a certain amount of grafting you can do per session. Secondly, I try to impart to them that a hairline is anything but a line if you think about that. It is nota line. It's a gradual transition zone from the baldness of the frontal skin to the fullness of the more posterior scalp and that's so important. So we like to get it irregular. As irregularly irregular as possible and that's naturalness. Lastly, and probably the most important thing, if my patients, who are in the 25, 30, 35 year old range, considering the fact that what we do lasts forever, we try to give them hairlines -- a 25 year old -- we'll give him the hairline of a 50 year old. So it will look natural throughout his life. That's a very hard message to impart to a young man, but a very necessary one.

DAVID R. MARKS, MD: Let's move on to scalp reduction. What is it? What exactly are you doing in scalp reduction?

ROBERT V. CATTANI, MD: I think I've been performing scalp reductions since 1978. In 1977, almost out of desperation -- but you think about it, if you have a man who is slick bald, let us say grade six, Jackie Leonard baldness if people knew who he was -- the more hair you have lost the less you have to put back. So we have to even out that ratio and one of the ways we've done this is by eliminating the bald skin by literally cutting it out. When I first started telling this to patients I almost made sure that my consultation room door was locked because there's kind of a tendency to run out when they heard this. But what is involved is the following. Let us pretend that this is the area of baldness. If we don't have enough donor area of hair to cover the entire area and the patient wants us to cover as much as possible, then somehow we have to reduce the paucity of the donor area and the expanse of the bald skin. So what we do it literally cut out the bald skin. This was done in several patterns. One, this pattern here. Lower down here is a midline incision where we cut out the bald skin and bring it together. Now we can remove approximately two inches of skin from the balding area in one session. Another pattern is a more elliptical pattern along the hair line. The third is in the crown or vertex area where we literally cut out the skin. However, this leaves scars and you have to transplant too. So what we do now is what is known as a buzz triangle scalp reduction. I will try to demonstrate. We'll make an incision along her like this, across the scalp. We'll extend it this way, as such like this, and this way as such like that. If you can visualize this you're now two tons of tissue. We will lift this up, lift that up, and literally pull the scalp together as such, and this will bring this to here, this to here. So from an area that is this bald, we will go to an area that is that bald and now we only have to micrograft in here. The principle of scalp reduction.

DAVID R. MARKS, MD: So you would follow that up with a transplant.

ROBERT V. CATTANI, MD: Always. Always. I think that is a modality that some surgeons still use to great effect. Others choose not to perform scalp reduction. I will say this.

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