Tissue Expansion in Cicatricial Alopecia

In 1987, Roenigk and Wheeland explored tissue expansion as a treatment for cicatricial alopecia, noting its advantages over traditional methods like scalp reduction and hair transplantation, especially in cases with tight scalp or large areas of hair loss. The technique involves implanting silicone expanders under the skin and gradually filling them with saline to stretch the skin and create excess for covering bald areas. They detailed the procedure, including preoperative, implantation, and postoperative care, and presented a successful case study of a 35-year-old woman. Histological changes from the expansion were also discussed, showing minimal epidermal change but dermal thinning and increased collagen synthesis. Despite the need for multiple stages and potential complications, tissue expansion can yield excellent cosmetic results with immediate coverage by hair-bearing skin. The document also recommends medical therapy before surgery for inflammatory cicatricial alopecia and confirms the technique's effectiveness for both cicatricial and male-patterned alopecia.