Tell me about scalp flap surgery/ scalp reduction surgery/scalp tissue expander?

With the advent of micro follicular hair transplant technique, these techniques  nowadays are being considered as of  historical interest. In these techniques the bald area is removed surgically and adjacent hair bearing area is moved using skin laxity. In some cases the hair bearing skin is increased in size by putting tissue expanders (balloons) under it; and this is used to replace the bald areas.

These techniques though considered history, still are useful in select group like–

Localized bad/thin scar over head, where the transplanted hair will not grow due to lack of proper blood supply. In these cases the scar can be excised in one or multiple stages and can be replaced with adjacent hair bearing area giving instant natural results with practically insignificant scarring. This also involves skills of a cosmetic surgeon.

Is there any role of medicines in baldness?

The role of medicine in hair loss has been said temporary because the hairs which have destiny to fall will fall ultimately because of their genetic programming. Though the drugs have been said useful to decrease the hair fall and increase the density but once the use is stopped, the effect vanishes. But the role of medicines has been established by promoting growth of the transplanted hair after hair transplant. This is said to be helpful in two ways.

1. The transplanted hair are said to be permanent and once the medicine promote and expedite the growth of these hairs; the resultant growth is early and permanent.
2. The existing hair will increase in density with these medicines, thus supporting the density of transplanted hair and amply contributing to change, enhanced look after hair transplant.

There are 2 medicines whose role is established for this.

1. Minoxidil – used as a local(topical) application works primarily by increasing blow flow. Nowadays combinationof  Minoxidil and Aminexil is being claimed to decrease fibrosis and maintain the growth potential.
2. Finasteride- reduces hair loss, and is said to be more useful in younger population. Studies have shown that it requires at least 6 months to 1 year for some significant improvement to be seen from the use of finasteride.