Tissue Expanders for Hair Restoration in the Scalp: Overexpansion Does Matter

Background: Tissue expansion to treat of alopecia of the scalp is the corner stone to restore a hairy scalp, although the process of expansion takes time to achieve a satisfactory result. Overexpansion could help in managing limited areas of donor sites or inadequate supply of tissue expanders. Meticulous patient selection and follow-up is the key to avoid complications and to obtain good results. Methods: Tissue expanders were used to restore the hairy scalp after burns or direct trauma. More than one tissue expander could be used simultaneously or after the first stage; the expander could be reused for the same patient for further expansion in another part of the hairy scalp to complete hair restoration and removal of all scar tissue. Results: Twenty-five patients with alopecia underwent hair restoration with 28 expanders, all of which were overexpanded. Three pairs of expanders were used simultaneously in three patients. Three expanders were reused in the other three patients after removal to complete the second stage. All patients showed complete restoration of their hairy scalp with minimal complications and a high rate of satisfaction. Conclusions: Tissue expansion is a cornerstone in the treatment of scalp alopecia. Meticulous patient selection and follow-up provided the most satisfactory results, with fewer postoperative complications. Overexpansion can be safely used.