During the 3 stages of the flap, the first 2 stages involve training the flap to rely completely upon blood flow from the posterior branch of the superficial temporal artery. TPO flaps are preferable for most individuals choosing to undergo scalp flap surgery. The single TPO flap is long enough to span the entire frontal hairline, leaving the potential flap from the opposite side of the scalp for use in treating further hair loss behind the flap if desired. Two TP flaps are required to span the entire hairline, because they are shorter than TPO flaps. These individuals, assuming they choose to have a flap, can be treated with 2 TP flaps.
Medical candidacy is an important criterion.
Patients must be healthy enough to tolerate the surgical procedure, which can run as long as 3-4 hours. Patients must not take any anticoagulation medications or herbal products for 10 days prior to surgery. Two medications with FDA approval currently are available for treatment of male pattern baldness. Both minoxidil and finasteride work primarily in the back half of the scalp, having little to no effect anteriorly. Both medications must be taken daily.