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