Beware of the Crooks in the Hair Transplant Industry

To return to SCALP LIFTS PART 1 please click here.

Note that this section contains graphic images. I hope this section of my website will help consumers make an educated decision about these procedures. I have tried very hard to make this website 100% medically accurate, however I am not a doctor, so I apologize if there are any errors.

There are two basic approaches to Scalp Lifts: Bilateral and Bitemporal. The following surgical images are taken from Dr. James Swinehart's medical textbook "Color Atlas of Hair Restoration Surgery". Dr. Swinehart suggests that a good approach is to start with a Bilateral Scalp Lift, and then follow up with a Bitemporal Scalp Lift a few months later.

We saw an overview of the Bilateral Scalp Lift in Section 1, lets look at the Bitemporal Scalp Lift next.

BITEMPORAL SCALP LIFT

Results of a patient who had a Bilateral Scalp Lift (phase 1). This is a different patient, than the one pictured undergoing the Bilateral Scalp Lift in PART 1. Note the difference in frontal hair (1st patient has no frontal hair). It doesn't matter that it's a different patient. This is how Dr. Swinehart presents it in his textbook. The U shaped scar from the first Lift is visible. That scar line will be used during the next scalp lift.

Patient is marked with pattern for Bitemporal Scalp Lift. The next area to be removed is inside the solid lines. This surgery takes place in a hospital setting, with the patient under general anaesthesia (knocked out).

The incisions go into the sideburn area.The caption recommends cutting just behind the frontal hairline there... only 1 to 1.5 centimeters (about a half inch to 3/4s of an inch). Since hair loss is PROGRESSIVE there is a serious risk that these scars will be visible in the future, as a patient continues to lose hair. I know Scalp Lift patients who complain that these scars are too visible now. They are are very close to the facial area.

Undermining begins. Undermining is the term for separating the connective tissue that anchors the scalp. Then the area of balding scalp is removed by the doctor, leaving a gap. Undermining allows the maximum stretch, when closing up the gap in the scalp. By undermining (disconnecting) the scalp, the doctor can pull from down to the nape of the neck upwards. Extensive amounts of Scalp Lifting typically pulls the patient's hair way out of position, causing an unnatural appearance.

Undermining continues. The patient is lying on his stomach. It might be easier to undermine the scalp during a second surgery, since the first surgery severed the connective tissue so completely. That may explain why the surgeon is able to use his hand, instead of a scalpel or surgical scissors. It probably takes some time for the body to regenerate the connective tissue that re-anchors the scalp down.

View from the patient's top. Patient is lying on his stomach. His shoulder is at the bottom left corner of the photo. We can see his ear, as he lies face down.

Patient is facing the botttom of the photo. Look at how very little hair is in front of the incision line (going into the area above the sideburns.) This means that the scar might be very hard to hide, later.

More undermining. The patient is face down.

"Top" view of the patient. The caption says undermining during surgery #2 will go slightly deeper than surgery #1.

Undermining continues. A combination of blunt and sharp tools are used to detach the scalp, down to the nape of the neck.

Undermining complete. Scalp is shown completely free. Now it is time to cut away the center island of balding scalp. I find these photos very hard to look at.But I have no doubt that many of the doctors doing "hair restoration surgery" get a kick out of photos like this. In my opinion, many of the doctors have a callous attitude towards patients, which they try to keep amongst themselves. I say this based on my privately observing the way that some of these doctors talk to each other, with an attitude of contempt for patients who have been screwed up by hair surgery.

Scalp is still detached, but back in general position. The surgery team pulls hard, to measure how much overlap is available. This tells them how much of the center island can be removed. The "free" edge of flap is used to mark the position of the next incisions.

Marking the next incision line. This marks the border of the area to be removed.

Island of scalp is cut away. The next step is to close the gap, that results from removing this piece of scalp.

Scalp flap has been cut away. Flap sits in original position, for photo. Notice that some perfectly healthy hair is about to be thrown into the garbage. Wasting useful hair during a "Hair Restoration Surgery" is unforgivably stupid.

Suturing the gap begins. Because of the deep undermining, the large gap in the scalp can be closed. However this will cause other problems, as we will see. There is no such thing as a "free lunch", as the old saying goes.

Gap is closed with physical force from surgical team, while doctor sews the edges together. Notice how the incision goes well into the patient's crown area. We'll see some examples of serious scarring there due to Scalp Lifts, in just a bit.

Suturing continues.

Suturing almost complete.

Surgery complete. Now the weeks of healing begin. Misleading booklets from the Cleveland Hair Clinic (shown elsewhere on this site) call Scalp Lifts "instant gratification". These deliberately misleading booklets were handed and mailed out, under the guise of "educating" patients. Does this look like "instant gratification" to you? Notice how the hair on top is angled towards the side. This will be unnatural looking, as the correct angle should be forward. This is sometimes called "The Parting of the Red Sea" effect. We'll look at poor results and the serious problems that Scalp Lifts cause, next.

However I think it is AWFUL that some hair transplant clinics mass-market this kind of surgery to the public for "Cosmetic Hair Restoration", because the final results are very often terrible, according to my research.

(Dr. Swinehart's textbook has hundreds of photos, but VERY few final results are shown in the book. Most of these photos conceal the patient's critical nape (neck) area, cropping many of the "results" photos off at the bottom. Eight "case study" photos don't reveal final results on the top of the head, do not show final "grown out" results, cut off the nape (neck) area out of photos, etc.)

A sensible approach to cosmetic surgery doesn't try to solve one problem (baldness) by causing terrible NEW problems, at the same time.

An example of the "mushroom cap" effect, a common result of aggressive Scalp Lifting.

First photo shows patient before two scalp lifts. Second photo is after two Scalp Lifts (Bilateral and Bitemporal).

This patient's nape (neck) hair is now on the same level as his ears. Overall, the hair looks like the cap of a mushroom, or an upside down bowl "riding on top" of the head.

Patients also have problems with enlarged hairless gaps around their ears... the scalp that used to be near the ears has been permanently stretched up, towards the top of their heads (sometimes referred to as the "Whitewalls" effect.

Patients with this problem often look like children from the rear. This patient has the 'rear hairline' of a little boy, not a mature adult.

Another "Mushroom Cap" example of a patient whose hair has been pulled out of position by aggressive Scalp Lifts. The entire scalp looks like it was slid forward, to cover up a bald spot. Most of the "stretch" in a Scalp Lift happens in the nape area, around the ears, etc, often causing an unnatural result.

Donor scar stretching, as a result of Scalp Lifting. See the section on Strip Excision Procedure, for additional information. Lets follow the logic, to see why this terrible scarring in is almost predictable: Scalp Lifts are always performed first, prior to regular hair grafting, to reduce bald area. Hair grafting after Scalp Lift is necessary, to try to cover Scalp Lift scars. Scalp Lifts increase the tightness of the scalp. Tight scalps will very often lead to enlarged donor scars, when doing hair grafting. Scalp tension is a major cause of enlarged scar formation. This patient was caught in a predictable Catch-22, and the result is the "stretched" donor scars that we see here.

Enlarged scarring after Bilateral Scalp Lift. This patient looks like he underwent brain surgery. Scalp reduction scars are dense, with poor blood flow. These scars can often resist regular grafting, which makes them hard or even impossible to hide. Dr. Swinehart later cuts the scar out, but he doesn't show final results.

The "Hit in the Head with an Axe" look. Again, dense scars very often resist grafting, especially the DEEP scarring that Scalp Lifts cause. Again Dr. Swinehart doesn't show this patient's final results, he just says that "grafting can now procede" or words to that effect. MANY case studies are shown in his textbook, with very FEW final results shown. Coincidence? I don't think so; In my opinion it's because the aesthetic results from these surgeries are generally disappointing, or even poor. Notice that this fellow also has a mild Mushroom Cap effect (nape area pulled up out of position), which he hides by letting his hair grow long.

Same patient as above. The "Parting of the Red Sea" effect. Arrows show the direction his hair is now incorrectly angled, after surgery (especially towards the "crown" or rear scalp). In order to look totally normal, a person's hair should be angled normally. Hair on the top of the head is supposed to be angled foreward, not towards the ears. This patient may have difficulty styling his hair in a way that looks totally normal. Scars like this can be hard to hide, they are deep and dense. Dense scars can often resist or reject attempts at hair grafting. Blood circulation in dense scars is usually poor, so hair grafts placed there may not survive after transplantation. When that happens, the patient still has a visible scar, and has also wasted some of his precious limited donor supply. (There are no additional "results" photos of this patient after this one in Dr. Swinehart's textbook, that prove that scars like this can be easily hidden. That is typical of the book.)

Spread scar from Bilateral Scalp Lift. The incision in the temple area is plain to see. This scar could be visible because of doctor error. Or it could be a normal result, based on typical patient hair loss that continues after hair surgery. It's impossible to know why this stretched scar is so "out in the open." Usually this incision is supposed to be hidden behind a little hair. Since hair loss is progressive, scars that were hidden early on, can be visible as the patient gets older. Hair surgeries can speed up hair loss, by interrupting blood flow, for example, or possibly other reasons. (It's not completely understood, why some patients lose hair more quickly after surgery).

This next patient has multiple problems from Scalp Lifting. Look at the large gap around his ear, from the doctor pulling his scalp out of position. This is a common problem for patients with extensive Scalp Lifts. Some doctors refer to this effect as "White Walls" (as in White Wall tires). He also has a Mushroom Cap effect, as the nape also appears to be too high. The hair on top has an unnatural angle (it points towards his ear, instead of forward). He has wide scar formation, which is often a result of excessive scalp tension from over-aggressive Scalp Lifting.

In his own words: "I was doing some stunt acting and modelling. I was asked to do some hair shows but my hair was just starting to thin so I went to Dr. Dominic A. Brandy for a hair transplant. He said he has done top models and he would not do a transplant on a model. He said a bi lateral hair lift is state of the art and the only thing he would do on a model or actor. He said he has had 100% sucess rate with this opperation. This photo is the result of his work. He has distroyed my life and reason to live."

Dr. Brandy is considered to be an "expert" by other doctors, in the practice of Scalp Lifts, and even has a technique that he named after himself: "The Brandy Lift". BUYER BEWARE