Question:
I am considering having the Fleming Mayer flap performed. I like the idea of having a very dense hair line. My concerns are that it seems very invasive and I will have to have scalp expanders in my head for a few weeks which seems a bit scary. What do you think about this hair restoration procedure?

Answer:
I would recommend that you do lots of research before you commit to having a Fleming Mayer flap procedure. The main positive feature associated with a flap is the high level of density which can be transferred during a single procedure. Unfortunately, the trade-off for this density is a very artificial look. I have never seen a patient with a flap who looked natural from every viewing angle.

During the Fleming Mayer flap procedure, a strip of tissue from the side of the head is dissected and then twisted around and relocated where the hairline is to be created. Your concerns about invasiveness with this surgery are well founded. Since this surgery takes a section of scalp from the side of the head, it is possible that the resulting scar will be noticeable after the surgery. Furthermore, if the blood flow to the section of flap is compromised, the flap could lose its hair or become necrotic. Even if the procedure goes as planned, the flap creates a wall of very dense hair which does not mesh well with the rest of the scalp hair. There is a very good reason why so few U.S. physicians perform flap procedures today. The explanation has nothing to do with technical difficulty or requisite expertise in the field. Rather, flap procedures simply do not look natural. The general feeling is why offer such an
inferior procedure when today’s hair transplant technology, in the hands of a competent physician, can yield a much more natural appearance?

Brandon Ross, MD
http://www.rmhri.com
IAHRS Recommended Hair Transplant Surgeon