Patient RGL
Before
AfterPatient RGL was an early Norwood Class 6 with dark brown hair and average scalp laxity. His donor density was above average. In 1970 he had an old type of hair restoration procedure called a flap, where a strip of hair is removed from the donor area and sewn intact into the hairline. This is called a Vallis flap or free flap, because it is completely removed from the donor area rather than rotated from it. Following the Vallis flap he has two subsequent hair transplant procedures where large grafts were placed on the top of the scalp and at the hair line giving an unnatural pluggy look to the already geometric appearance of the flap.
To decrease the pluggy appearance and harshness of the flap, we removed 44 large grafts and re-implanted them as 142 individual follicular units and added an additional 3,686 grafts over three follicular unit hair transplant sessions.
View the photos as a slideshow
Detail of Hairline
These photos show the stages of the repair beginning with the removal of some of the larger grafts behind the flap and their re-distribution on the right side of the patient’s scalp. Most of the cosmetic improvement is achieved through the three subsequent follicular unit hair transplants where the additional hair was obtained from the donor area.
Vallis Flap and Large Grafts 
Grafts Redistributed as Follicular Units 
After 1st Follicular Unit Transplant Session 
After 2nd Follicular Unit Transplant Session 
After 3rd Follicular Unit Transplant Session Top View
Top view with the hair from the flap moved away showing the plugginess of the front part of the scalp and the progression to a more natural look.
Flap Lifted to Uncover Grafts 
Flap and Grafts Combed Back 
Position of Hairline, Hair Combed Back 
After 2nd Session 
After 3rd Session Left View
Left view showing the pluggy, unnatural left hairline corrected through a series of graft excisions and hair transplants.
Before with Flap 
Plugs Around Flap Exposed 
After Repair and Hair Restoration Right View
Right view before and after the repair and subsequent hair restoration.
Before Hair Restoration 
After Repair and Hair Restoration 
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