Thursday, February 28, 2008

Incision Decisions: Dealing with Displaced Hairlines After a Lift

Today, more and more people over 50 look at least a decade younger than they really are. While some people are the beneficiaries of good genes, others may be just reaping the rewards of a healthy non-smoking lifestyle that consists of a good diet, an exercise regimen and lots of sunscreen. And some of these "youthful-looking" men and women may have taken advantage of the expertise of a plastic surgeon. But what not everyone realizes is that the surgery may not end there.

Facial cosmetic surgery is popular among people seeking to smooth wrinkles, tighten sagging facial skin or jowls, or get rid of that double chin. And some may seek it out because of facial disfigurement. While new cosmetic surgery techniques have minimized the risk of scarring, not everyone knows that hair loss can be a side effect of these procedures. In some cases, the loss may be significant enough to merit a hair transplant.

Who is at Risk for Hair Loss after Plastic Surgery?
The cosmetic surgeries that are most likely to cause hair loss are facelifts and forehead lifts. "Anytime there's an incision in the scalp that creates hair loss or a hairline is displaced because of cosmetic surgery, there is a need for hair restoration surgery in those areas," explains James E. Vogel, MD, an assistant professor of plastic surgery at the Johns Hopkins School of Medicine in Baltimore, Maryland.

During a facelift, incisions are usually made near the hairline at the temple and run down to the front of the ear and behind the earlobe to the lower scalp. After removing fat and tightening muscle, the surgeon pulls the skin back, trims the excess and stitches the tissue together. The hairline is therefore pulled back further on the head, and hair loss may occur due to scarring.

In men, the sideburns are often lost, and women can lose hair affecting their bangs as well as hair on and around the scar. The hair loss may be especially problematic for women who like to wear their hair off their face in a ponytail.

Likewise, a forehead lift, also known as an eyebrow lift, can lead to hair loss because incisions are usually made at or near the hairline and the skin is then pulled back. Endoscopic browlifts involve newer techniques in which multiple, tiny incisions are made in the hair-bearing scalp rather than at the hairline. Even though this surgery is often favored because the small scars heal quickly, the hairline can shift back noticeably.

So for someone with thinning hair, Dr. Vogel says, placing the incision at the hairline instead of farther back on the head might be the preferred approach. "The incision choice is tempered by the landscape," he explains. "Sometimes people who have thin hair or high hairlines don't want to take a chance on making things worse, so we'll use an incision that doesn't affect the placement of the hairline."

Fixing the Problem with Hair Transplantation
Women who have facial cosmetic surgery make up the bulk of corrective hair transplantation, according to Edwin S. Epstein, MD, a hair transplant surgeon in private practice in Richmond, Virginia and Virginia Beach.

As when performing the standard hair restoration surgery, most hair transplant surgeons will use the follicular unit transplantation technique. With this approach, hair is taken from a donor area, usually at the back or sides of the head, and moved to the area where there is hair loss. A decade ago, donor hair was harvested and transplanted in large bunches of 10 to 20 hairs, creating a "pluggy look." Today, surgeons transplant tiny bundles of one to four hairs that grow together in what are called follicular units for a more natural appearance.

When transplanting in a scarred area, surgeons have to be extra cautious about how close together they place the tiny grafts of hair they are transplanting to ensure that the hair is properly nourished. Hair growth in or near scarring may also be slower than it is healthy tissue, but Dr. Epstein says, "transplanted grafts often attract a blood supply, and that makes subsequent transplants work better."

Although people are usually happy with the results of their hair transplant, if you're considering facial cosmetic surgery, be sure to also discuss hair loss risk with your plastic surgeon so you don't end up with more surgeries—or less hair—than you bargained for.