Scalp reconstruction and repair.

Reconstruction and repair of scalp deformities poses several challenges. The repair and/or removal of the existing defect is often difficult; however, the appearance of the repair is often the most difficult challenge. Thus, an understanding of normal hair morphology, anatomy, and physiology is important to achieve long-lasting, satisfying results. We must anticipate future hair loss, communicate that to the patient, and consider it in surgical planning. In addition, residual effects such as radiation therapy after cancer resection may pose additional challenges. Today, many extraordinary techniques are available that allow creation of natural and almost undetectable hairlines, but these techniques are often unsuitable for repairing large scarred areas of hair loss. By using more traditional techniques of scalp reduction and tissue expansion, however, excision of many large scarring defects can be accomplished. Combining older methods with modern hair restoration surgery permits the satisfactory treatment of many previously untreatable conditions.