corrective hair restoration for temperoparietal flap problems
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Corrective hair restoration for temperoparietal flap problems

During the course of improvement of hair transplant techniques, the mid and late 1970s saw the introduction of two new techniques known as the temperoparieto-occipital flaps or Juri flap technique as proposed by Juri and a variation of the same as suggested by Elliott known as the temperoparietal flaps. Both these techniques involved the use of a band of hair strip to cover the front of the head. The Juri technique involved the harvest of a long strip of donor hair starting from the side of the head along the ears and down to the back of the head. This single long flap was then used to cover the entire front of the head where hair loss had taken place. It more or less looked like a hair band. The other version suggested by Elliott involved two strips of hair from both the sides of the head; that is from the side and along the ear which were then brought to the front of the head to cover the baldness. Imagine the long ears of a bunny criss-crossing across his head. It was very similar to that. These techniques were practiced by many of the hair surgeons until the 1990s.

Both the techniques described above had many disadvantages given that they were better than the punch grafting method as they had immediate cosmetic benefits. The techniques gave the patient a very unnatural look after the transplant. This was because the covered areas had denser hair, an abrupt ending and only a part of the baldness was covered leaving a gaping area of scalp without hair. Many who underwent these procedures were not satisfied with the results although a few exceptions do remain.

The late 1990s saw the technique of follicular unit transplant as a very viable alternate to all the procedures that preceded it.

Dr. Brandy has evaluated the difficulties and procedures that could be followed regarding the correction of already performed hair transplant procedure to restore as much normalcy as possible. According to him the following points are to be considered for evaluating such patients:-

1. the type of flap technique employed
2. density of hair growth
3. direction of hair growth
4. abrupt ending of the hair line
5. angle of the natural hairline that is responsible for the face value

Since the hair was most often found to be denser in the transplanted area, it was necessary to remove some of them to make the overall hair pattern appear normal. Hence the thinning down of the hair was performed by punching out 2 or 3 mm of the scalp. The hairs from these punches were used to reconstruct the abrupt hairline ends. This depended on the amount of thinning to be done and the color of the hair. Usually men with darker hair were subjected to 2mm punches. The number of punches to be removed depends on the natural density of the patient’s hair. Denser the hair results in more number of punches. Ideally 50-100 punches are removed per session. These are then used to reconstruct the front hair line and fill in all the gaps as required for that patient.

The abrupt ending of the hairline had another problem. The hairline had to have a natural blend with the scalp. To achieve this, the forehead skin had to be sculpted below the surface so that the scalp is uniform in flow and not appear undulating. The author feels that in most cases such procedures for correcting the abrupt ends need to be done twice with a gap of 4 months between each procedure to get the desired result. When the bluntness of the hairline has not been so obvious, a single procedure was enough to restore the hairline.


Corrective hair restoration for temperoparietal flap problems references

  • Brandy DA. Corrective hair restoration techniques for the aesthetic problems of temperoparietal flaps. Dermatol Surg. 2003 Mar;29(3):230-4; discussion 234. PMID: 12614414
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