By utilizing scalp flaps, especially expanded flaps, large areas of scarred scalp can be excised and replaced with hair-bearing tissue from the flap. Scalp flaps have been used for treatment of androgenic or male pattern baldness only over the past 20 years. While baldness is a cosmetic problem, it can be of significant concern, enough so that the individual is willing to undergo surgery to repair the perceived problem. The condition is more common in whites than in African Americans. African Americans have the lowest incidence among all ethnic groups.
Scalp scarring as a result of burns, other types of injuries, or infections occurs infrequently.
DHT is created from testosterone by the action of the enzyme 5-alpha reductase. The genetic predisposition for male pattern hair loss is thought to be multigenomic. The initial action of 5-alpha reductase on the hair follicle causes miniaturization of the follicle and hair. Eventually, the miniaturized hair follicle involutes permanently, and the hair falls out. Typically, early hairline recession occurs initially, developing into deeper frontotemporal recessions and progression of crown hair loss.