Scalp expansion for male pattern baldness.

male pattern baldness may be effectively eliminated in most patients through the use of soft-tissue expansion. Expansion affords larger temporo-parieto-occipital flaps with a more easily closed donor defect. Differential expanders are used to eliminate hippocratic male pattern baldness through a massive scalp reduction and simultaneous reconstruction of an anterior hairline.

Surgical procedures for the treatment of baldness.

New surgical methods are now available for the correction of male pattern baldness. Standard techniques have been significantly refined during the past decade. These methods include punch autografts, strip grafting, scalp reduction, use of hair-bearing flaps, microsurgery, and various combinations of these techniques. A more recent refinement of hair transplantation is the use of minigrafts and micrografts. We present an overview of the advantages and indications for each procedure.

Increased androgen binding capacity in sebaceous glands in scalp of male-pattern baldness.

Sebaceous glands were isolated by manual dissection under a microscope from surgical specimens of scalp skin with male pattern baldness and skin specimens of hairy and bald scalp obtained at autopsy. The 800 X g pellet (nuclear fraction) and the 164,000 X g supernatant fraction (cytosol) of homogenates of the sebaceous glands were used for measurements of androgen binding characteristics, using dextran-coated charcoal and sucrose gradient methods. Scatchard plots showed high affinity binding for [3H]dihydrotestosterone (DHT) and [3H]methyltrienolone (R1881). Nuclei prepared from bald scalp contained greater total androgen binding capacity than nuclei of hairy scalp, although Kd values of type I binding were similar (0.68 vs 0.56 nM, respectively). On sucrose gradient, the binding protein from cytosol was found in the 7 to 8S density range. Androgen binding by cytosol of sebaceous glands of hairy scalp had Kd of 1.89 +/- .79 and 2.05 +/- .56 nM for DHT and R1881, respectively, and Bmax of 18.7 +/- 4.4 and 20.0 +/- 4.6 fmol/mg protein for DHT and R1881, respectively. Cytosol from sebaceous glands of bald scalp had Kd values approximately half those of hairy scalp, and Bmax values 50%-100% higher. The bound 3H labeled DHT and R1881 could be partially displaced by testosterone (40-50%), moxestrol (28-32%), promegestone (19-26%), and delta 4-androstenedione (6-12%), but not by dehydroepiandrosterone. These data demonstrate the presence of specific androgen binding protein in sebaceous glands, and that sebaceous glands of bald scalp have greater binding affinity and capacity for androgens than those in hairy scalp. This difference may explain the greater androgenic response in androgenic alopecia.

Micrografts and minigrafts: a new approach for baldness surgery.

The main problem in conventional operations for baldness has certainly been the resultant scar. The scar stigmatizes the patient's forehead and frequently gives an unaesthetic and unnatural appearance. Any observer would say the patient is wearing a "hairpiece" or some other artificial element. To minimize this problem, we introduced and improved a new procedure for the treatment of pattern baldness by using microsurgical hair grafts taken from the occipital region. These are inserted, one by one, into the bald area through a small microsurgical knife and with the help of a jeweler's forceps. This technique is based on works of Marrit and Nordstrom, who made use of these micrografts for the first time to hide the anterior line of the forehead after surgery.