What Does Scalp Expansion Surgery Involve? (photo)

      The scalp tissue expansion would involve placing 1 or 2 tissue expanders within the scalp in one operation.  Hospital stay is not necessary.  Then, these would be filled and expanded in multiple office visits over the next several months.  Then operation 2 would involve removing the expanders and rotating a scalp flap to cover the defect of the skin graft, which will be excised.  No hospital stay necessary here either.  The main drawback to the surgery is that the scalp expanders are unsightly, and you will want to hide them with a custom hat or bonnet or something. 

Scalp expansion is very effective. The scalp does not stretch as much as one would expect. Therefore, for a large scalp defect that local tissue flaps won't cover a scalp expander is placed under the scalp in a short surgical procedure. This is then sequentially expanded with saline over a period of several months until adequate expansion has been achieved. During the second and final procedure, the expander would be deflated and removed and the skin graft would also be cut out and replaced with the expanded scalp tissue. I hope this information is helpful.Stephen Weber MD, FACS

Your problem is more common than you might think.  Expanding the scalp to take the place of a bald skin grafted area can be done several ways. A small area can be covered by hair bearing scalp by removing small amounts of the skin graft at a time and advancing the hair bearing scalp in increments. This can be done under local or general and has little down time. Usually shaving of hair does not need to be done.  Larger areas can be closed with "scalp flaps".  This can be done in one sitting under general anesthesia.  Again shaving does not need to be done and sutures stay in a week to 10 days.  Areas larger still can be helped by inserting tissue expander(s). This requires  a balloon(expander) under the hair bearing scalp being placed at surgery and adding fluid to it on a regular basis (weekly).  Then when the scalp is stretched adequately the graft is replaced by the expanded scalp at another operation. All of these procedures can be done as an outpatient.

Large defects in the scalp are difficult to close, in those cases a tissue expander is inserted near the defect, some times one needs two expanders. The incision used is in the bold or scarred area. Once the wound heals then expansion starts by injecting salt water into the expander which then baloons gradualy and stretches the skin, very simmilar to oregnancy.

A second surgery is needed to remove the expander, may be score the galea and advance the stretched skin to cover the defect.

Hair is never going to grow in a scalp skin graft. Therefore, excision of the skin graft to bring the hair-bearing portions of the scalp is the only way to get 'hair growing' in the area again. Depending on the size of the scalp defect, there are two approaches to use. Cut out the skin graft in one or two stages and pull the scalp together. Or place tissue expanders to stretch out the scalp first and cut out the skin graft all at one time. What is clear from these scenarios is that a one-stage procedure can only be done if the skin graft area is small. It would be help to see some pictures of your scalp skin graft to let you know which approach may be best for you. Regardless of how it is done, however, no shaving of the head is required.