Dr Lam's Hair Restoration Forum

Dr. Lam,
I'm actually an ENT resident in San Antonio who's about to do a grand rounds on hair restoration. Through my reading, I can find very little current literature on scalp reduction and Juri flaps. I was wondering if you can comment on scalp reduction in general from a current practioner.

1. I know follicular unit transplantation is the gold standard now days, so how much scalp reduction do you perform?
2. What kind of patients would you consider scalp reduction on?
3. What's your opinion on the different excision designs (ellipse, Y, crescent, horseshoe, etc.)?
4. Last questions is your opinion on Juri flap. Mainly when would you perform it?

Thanks for the help.

Sean

1. I know follicular unit transplantation is the gold standard now days, so how much scalp reduction do you perform?
None, I don't although I have trained to do it. The real problem today is that scalp reduction is not a great technique in the majority of hands out there. too much risk to expose incisions as alopecia progresses.

2. What kind of patients would you consider scalp reduction on? None.

3. What's your opinion on the different excision designs (ellipse, Y, crescent, horseshoe, etc.)?
The design does not matter so much as the triple flap created by Frechet on the final move that helps to restore the natural whorl pattern. without that, if you just do an ellipse, y, etc., you will still leave a pattern that is unnatural.
4. Last questions is your opinion on Juri flap. Mainly when would you perform it?
NEVER. this is the worst flap in the world. again, i trained to do this but there are so many problems with it that i can only begin to scratch the surface: too much frontal hairline density, hair angles in reverse pattern to natural hair angles, misapplication of density gradients where you are not gradually building density backwards, unnatural patterns that develop behind the hairline, etc.
hope that helps as a start.
best,
sml

Most scalp reductions are performed under general anesthesia. Sometimes doctors will opt for a local anesthesia instead (like that used by dentists) combined with a sedative to make you drowsy. You'll be awake but relaxed, and although you may feel some tugging and mild discomfort, you won't feel any pain.

thanks.