Scalp Surgery: Anatomic and Biomechanical Considerations

Background: The purpose of surgery is to effect functional and/or cosmetic benefit while causing as few adverse consequences as possible. At its core lies incision/excision, tissue mobilization, and reconstruction. Each body region presents its own particular surgical challenge. Scalp is made up of collagen, elastin, blood vessels, nerve fibers, and lymphatics with mucopolysaccharide ground substance and tissue fluid, together with hair follicles, sweat, and sebaceous glands. All these elements are anatomically and biologically affected by each modality of surgery.

Objective: To establish technical guidelines for scalp surgery compatible with maximal functional/cosmetic benefit and complication-free results.

Methods: More than 3000 scalp operations done personally were reviewed. These included the entire spectrum of plastic and reconstructive surgery and hair restoration procedures.

Results: Some guidelines compatible with improved scalp surgery results were derived.

Conclusion: Complication-free scalp surgery is most likely to occur when incisions spare neurovascular structures; do not transect collagen or elastin; undermining is modest and discriminate; deep plane fixation is used; and hair directional orientation (drape) is preserved.