The lateral scalp flap for anterior hairline reconstruction.

The lateral scalp flap is a valuable addition to the armamentarium of the trained surgeon who manages the problem of male pattern baldness. With careful patient selection and frank counselling, the quality of reconstruction of the anterior hairline can be enhanced for some patients. The transfer of a large number of hair follicles in their normal pattern of density is an obvious advantage over free graft techniques. The disadvantages of a posterior direction of hair growth in the transposed flap, although readily overcome by careful grooming in most patients, may provide a stimulation for microvascular free flap acceptance in the future. At the present time, the magnitude of the latter procedure and the associated expense preclude consideration of this approach for the usual patient, and it is beyond the capability of many surgeons. Only with accurate reporting of complications and long-term results can one ultimately determine the rightful place of this technique. It is our continuing responsibility to inform patients of the changing options and guide them to a proper treatment based on their individual desire and need. The future generation of physicians and surgeons will undoubtedly dwarf our best effort with their accomplishments. I hope and trust that some day patients with male pattern baldness will no longer require surgery for relief. The ideal hope of the future is discovery of a safe method for prevention or medical treatment.