It is impossible to predict the eventual degree of baldness in an individual. Therefore, the flap is best reserved for individuals in the third decade and older, with hair loss limited to the frontal-most hairline and whose risk of significant progression of hair loss is unlikely. Hairpiece or hair system wearers who are accustomed to a dense hairline often will choose scalp flap surgery because a dense hairline rapidly is produced. Curly haired individuals, including African Americans, can be good candidates for scalp flaps because minimal transection of curled hair follicles occurs during this surgery. In contrast, many hair follicles can be destroyed by graft preparation during hair grafting.
Motivation is one of the most important elements in determining patient suitability.
A scalp flap requires willingness of the patient to undergo a surgical procedure with a definite increased risk over other hair transplant procedures. A scalp flap is not the appropriate treatment for an individual with extensive baldness or who is at high risk for developing such a condition. The scalp flap has a width of no more than 45 mm and provides a very dense hairline. Further hair loss behind the flap can be filled in only with a second flap, leaving patches of bald scalp in between. In addition, when progressive baldness causes a significant lowering of the superior fringe of the temporal scalp, this baldness may extend into the area of scalp from where the flap was harvested.