The Brandy Lift was developed as a means of lifting hair from the back and sides of the scalp onto the top of the scalp. The procedure resulted in a slot of bald surface area that required rotational flaps to conceal. The procedure also lifted the donor area on the nape of the neck and above the ears superiorly toward the top of the scalp. This resulted in a spacious area of hair loss above the ears and a lack of natural hair on the nape of the neck.
The procedure often covered the scalp well on the top and the back of the scalp, but none on the frontal area. The frontal scalp required grafting from the donor area.
Traditional donor area: The traditional safe donor area was lifted superiorly toward the top of the scalp. This meant that one could harvest higher on the back and sides of the scalp. It also meant that harvesting from the lower regions following a Brandy lift might result in future hair loss as the hair on the nape of the neck is not always permanent especially in those who will experience significant degrees of hair loss.
Scars: In addition to the slot scars from lifting, the Brandy lift resulted in numerous other scars. The rotational flap on the top, which was meant to conceal the slot scar, resulted in scars, as well. The lift procedure resulted in scars in the sideburn areas. Coverage in the frontal area left strip harvest scars in the donor area. The lift eliminated much of the skin elasticity in the donor area, so the donor area was very tight. This often made strip scars appear worse.
The CIT method of FUE hair transplant eliminates the requirement to perform strip procedures and is ideally suited for the very tight Brandy donor area. In this example over 1600 grafts were obtained from the donor area and place on the frontal hairline. The original grafts were pluggy in appearance and the hairline was built too low at 7cm. This hairline was elevated and the larger grafts placed below the new hairline were harvested and moved back to the top.
The patient may require additional thickening over time to the front and softening of some of the larger grafts. Often times grafting into and around the larger grafts initially helps to conceal them such that future softening requires the removal of only some of the larger grafts. I call these the bad actors or the ones that really stand out.
I removed the lower grafts that were placed on the hairline today and elevated it from a 7cm hairline on the sides and a 6 cm hairline in the mid-frontal area. A higher hairline is more acceptable and age-appropriate. The patient will need to decide if he wants to add more hair to the multiple scars that are present.
Fortunately, he did not have obvious scars with his hair long and his temple area scarring was faint. He did not request grafting of the scars at this time.