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Localized
scar induced alopecia
Surgery of any kind may induce a temporary diffuse hair loss called
telogen effluvium (see
post surgery effluvium), but some surgical procedures can cause
a permanent alopecia. Any surgical incision into the skin can result
in permanent damage to the hair follicles at the incision site.
As any wound heals a certain amount of scarring occurs. If the scar
tissue is formed within and around a hair follicle the hair follicle
is usually destroyed.
Surgeons are generally aware of the problem and should take extra
care when making incisions into haired skin. They make an incision
such that they avoid cutting through the hair follicles. Rather,
the scalpel cuts at an angle appropriate to the angle of the hair
follicles.
Forehead
and brow lift alopecia
Plastic surgery that involves forehead and brow lifts (coronal
lifts) can cause quite extensive alopecia. Some techniques are safer
than others but all the methods employed involve extensive manipulation
of the scalp skin and an element of risk. Open forehead lifts pose
a significantly greater risk to alopecia development than endoscopic
lifts. In coronal lifts alopecia can develop due to skin stretching
that may "strangle" the hair follicles. In addition, the
scar at the incision site itself may stretch and in doing so can
give the impression of localized alopecia. These risks are best
minimized by having the procedure conducted by a surgeon experienced
in coronal lifts.
Bilateral
scalp reduction and necrosis associated alopecia
Bilateral scalp reduction is a surgical technique sometimes
used to treat pattern baldness and other forms of scalp alopecia.
However,
the technique can involve significant problems if it is not conducted
correctly. Skin necrosis can develop and as the skin dies so
hair
follicles in the skin will also die. This technique is not widely
practiced because of the significant side effect risks. However,
some plastic surgeons do still conduct this and similar techniques.
The procedure should only be carried out by very experienced
surgeons
and comprehensive post operative care is required.
Surgery
induced permanent alopecia references
- Burm JS,
Oh SJ. Prevention and treatment of wide scar and alopecia in the
scalp: wedge excision and double relaxation suture. Plast Reconstr
Surg. 1999 Apr;103(4):1143-9.
- Ramirez
OM. The anchor subperiosteal forehead lift. Plast Reconstr Surg.
1995 May;95(6):993-1003; discussion 1004-6.
- Dardour JC. Treatment of male pattern baldness
and postoperative temporal baldness in men. Clin Plast Surg. 1991
Oct;18(4):775-90.
- Unger MG. Postoperative necrosis following
bilateral lateral scalp reduction. J Dermatol Surg Oncol. 1988
May;14(5):541-3.
- Nordstrom R. Tissue expansion and flaps
for surgical correction of male pattern baldness. Br J Plast Surg.
1988 Mar;41(2):154-9.
- Norwood OT. Scalp reduction in the treatment
of androgenic alopecia. Dermatol Clin. 1987 Jul;5(3):531-44.
- Frechet P. How to avoid the principal complication
of scalp reduction in the management of extensive alopecia. J
Dermatol Surg Oncol. 1985 Jun;11(6):637-40.
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