Aesthetic results of treatment of large alopecia with total scalp expansion

In the last 7 years, 18 patients with large alopecia (approximately one-thi rd of hair-bearing scalp) were treated with 31 tissue expansion procedures. In the previous 34 patients, with various degrees of alopecia treated with conventional tissue expansion technique, the major complication rates were as high as reported in the relevant literature. The clinical experience ga ined with these cases led us to make some modifications in the surgical tec hnique. We applied some simple surgical maneuvers and Z-plasties to the las t 18 cases with large alopecia. The major complication rate of 3.2% observe d in this study is comparable to the lower complication rates of 6-12% repo rted in the literature for different degrees of alopecia. We believe that t hese simple modifications and meticulous approach improve the results of co nventional treatment of alopecia with tissue expansion and flap. In this pa per, details of the insertion technique and reconstructive procedures and t heir relevance to the success rate of the aesthetic treatment of the large alopecia are discussed.