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This is a 34-year old patient with a history of undergoing a frontal hairline flap using tissue expansion of the left donor region.  He presented to my office with complaints of an abrupt hairline, a frontal hairline scar, an unsightly left-side donor scar, and thinning in the midscalp and crown regions.  His primary goals were: 1) create a more natural hairline; 2) camouflage scars along the hairline and in the donor area; and 3) enhance hair density in the midscalp and crown.

His physical examination revealed:

1.       An overly-thick frontal hairline flap with backward-oriented hair. 

2.       A disfiguring, hypopigmented scar that traversed the entire length of the hairline. 

3.       A prominent 1 cm scar in the left and back donor areas that traversed the path of the previously transposed hairline flap. 

4.       Significant density reduction in the temple region surrounding the transposition point of the flap. 

5.       Advanced miniaturization in the midscalp and crown.

6.       A clinically apparent scar along the back edge of the flap.

7.       Disproportionate thinning in the lower left crown which had resulted from this edge being displaced downward during closure of the flap’s donor defect.   

Surgical Plan: The entire left donor area and left occipital region were eliminated from consideration for donor harvesting because of severely limited elasticity and density reduction that resulted from removal of the flap and because of the preexisting wide scar.  In anticipation of a large graft requirement to accomplish the many goals at hand, a multi-stage approach was developed that would begin with strip harvesting and later convert to future FUE harvesting once the donor region elasticity threshold had been fully utilized to preclude any additional strip harvesting.  The right temple and occipital donor regions demonstrated sufficient density and elasticity to allow strip harvesting for the initial stages of this restoration.

Result: Presented here is the result of two graft sessions that were staged seven months apart and utilized a total of 3,685 grafts procured via strip harvesting.  Session 1 consisted of 2292 grafts, distributed into the frontal hairline scar region, the occipital scar, and the midscalp region.  Session 2 consisted of 1393 grafts that were distributed into the crown, a gap located between the right end of the flap and the adjacent temporal hair, the right hairline scar, and a thinning left-side donor area surrounding the flap’s transposition point.  Postoperative photos demonstrate results nine-months following the second session.  Additional density gains are expected. 




Preop - Front



Preop - Left



Preop - Right



Preop - Top



Preop - Back View



Planned Graft Zone - Front



Planned Graft Zone - Midscalp



Planned Graft Zone Session 2 - Crown



Postop - View 1



Postop - View 2



Postop - View 3



Postop - View 4



Postop - View 5



Postop - View 6



Postop - View 7



Postop - Top View



Postop - Back View 1



Postop - Back View 2



Flap Donor Scar - Anterior



Flap Donor Scar Graft Placement - Anterior



Flap Donor Scar Result - Anterior



Flap Donor Scar - Posterior



Flap Donor Scar Graft Placement - Posterior



Flap Donor Scar Result - Posterior



Graft Placement - Front Hairline



Graft Placement - Crown

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How on earth is a 34 year old receiving a fleming meyer flap procedure? This is absolutely insane. He is lucky to have found you @Dr. Raymond Konior it truly baffles me how some surgeons are still performing outdated procedures, especially for patients who would benefit from the gold standard follicular unit transplantation. 

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I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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On 1/26/2020 at 6:51 PM, Melvin-Moderator said:

How on earth is a 34 year old receiving a fleming meyer flap procedure? This is absolutely insane. He is lucky to have found you @Dr. Raymond Konior it truly baffles me how some surgeons are still performing outdated procedures, especially for patients who would benefit from the gold standard follicular unit transplantation. 

+10000 Totally agree with you Melvin. It´s insane and it should be banned somehow to use other options over FUE when it´s possible. A total pity some clinics are taking advantage of uninformed and desperate patients : (

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What an interesting case. Shocking that he's had a flap procedure in this day and age. He looks so much better now. Completely natural. Great repair job.

I am an online representative for Farjo Hair Institute


Dr. Bessam Farjo is an esteemed member of the Coalition of Independent Hair Restoration Physicians


I am not a medical professional and my words should not be taken as medical advice. All opinions shared are my own.

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2 hours ago, stephcurry30 said:

What a result. Can someone aware me what a flap is? they cut out a section of hair from the back side (similar to FUT) except they place the entire piece as a hairline?


That's basically it. It was done mostly in the 1980's and early 90's to fix a receding hairline. This was in the days when hair transplants were done with 4mm plug grafts, so the only way to get somewhat of a natural looking hairline was to do a flap. Once hair transplant grafts got small enough to look natural in a hairline flaps became outdated.


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