Scalp reconstruction

The extent of the affected area, the quality of the healthy scalp, previous surgery, your health and your preferences determine the available options. In selected cases, we use tissue expansion and advancement of hair-bearing scalp.

Whenever possible, scars are positioned beneath the hair, although they may not always be fully concealed.

More than one cycle of tissue expansion or additional procedures may be needed, even when healing progresses well. A waiting period may be necessary between stages.

It is not always possible to reconstruct the entire affected area. Partial improvement can still make a meaningful difference to appearance, discomfort or the ability to conceal remaining areas. We assess when the benefits of further surgery no longer outweigh its burdens and risks.

Hair density may temporarily decrease after tissue expansion and reconstruction. Before recommending a hair transplant, we assess how the area develops over time: initially reduced coverage may improve and does not necessarily require another procedure.

If an area of hair loss persists, we coordinate assessment with specialists in hair restoration surgery. They may recommend observation, medical treatment where appropriate, or hair transplantation. Not all scarred areas are suitable for transplantation.

We usually use general anaesthesia, depending on the size and depth of the procedure and your clinical circumstances. Inserting the expander may take less time than removing it and advancing the tissue.

One stage may be performed as a day case, while another may require a hospital stay. Each stage is planned individually.

Filling begins once the wound has healed. The schedule is tailored to the tissues, your tolerance and individual circumstances; there is no single interval suitable for everyone.

Once the planned expansion has been achieved, we allow a variable period for tissue adaptation and coordinate the next operation with your health and any other treatments.

If the filling port is beneath the skin, you may feel a needle prick during filling, followed by pressure or tightness. Pain should not automatically be considered a normal part of the process.

Contact the team if you develop severe or increasing pain, pale or darkened skin, redness, warmth, fever, discharge, wound opening or a sudden loss of volume.

During expansion, washing your hair and gentle activity are usually possible if there are no open wounds and the team has confirmed that it is safe. Avoid sustained pressure, rubbing or pulling over the expander.

Hats and scarves should fit loosely. We assess any method used to conceal the expander to ensure it does not damage the skin. Hair colouring and harsh hair treatments should be postponed during expansion and around the operations.

We prefer assessments and filling sessions to take place at our centre. You may not need to stay nearby throughout expansion, but visits and proximity to the team after major operations must be planned.

In selected cases, we coordinate parts of follow-up with local teams. Travel arrangements should not dictate an accelerated expansion schedule.

Skin irritation, infection, recent wounds or poor tissue quality may make it advisable to postpone treatment. We assess blood supply with investigations when needed and recommend stopping smoking according to your clinical plan.

Keep the wounds dry initially. Dressings and any supportive garments are tailored to the reconstructed tissue; do not apply pressure yourself. We recommend gentle products for washing.

Many patients can return to office work or studies within one or two weeks, although the timing of exercise and strenuous activity is personalised.

The first review usually takes place a few days after discharge to assess the wounds and dressings. Further nursing and medical appointments are tailored to your progress throughout scar maturation, which may take 12 to 18 months.

Temporary or permanent changes in sensation may occur at any stage. If these cause discomfort, we assess them during follow-up.

Sun protection, moisturising and scar massage are introduced once the team confirms that the wound has healed sufficiently. Silicone sheets or gel may be recommended depending on the area, the surgical technique and how healing progresses.

Care continues until the scars have matured clinically. Scars do not all mature at the same rate, even in the same person. If a scar becomes raised, firm, itchy or develops unfavourably, the Institut Ruiz Castilla (IRC) team will assess whether specific treatment is needed.

Contact us if you notice increasing pain, persistent bleeding, a rapid change in swelling, spreading redness or increasing warmth, fever, discharge, wound opening or any other change that concerns you. You do not need to decide whether it is a complication: the team will assess it.

Institut Ruiz Castilla (IRC) provides on-call medical support 24 hours a day, seven days a week. Medical and administrative contact numbers are included in your care instructions.

If you experience difficulty breathing, chest pain, fainting or another clear emergency, seek urgent medical attention rather than waiting for a scheduled appointment.