Burn causes permanent damage to skin and skin appendages. Once lost, the hair cannot regrow on a burnt skin therefore we have two solutions for post burn scalp baldness.

1. Tissue Expanders - Tissue expansion requires minimum two surgeries. In this, a silicon balloon like implant is placed under the normal skin just adjacent to the bald patch in scalp. This implant is expanded at regular intervals until desired area of skin is obtained. In next surgery the expander is removed followed by removal of bald patch and its replacement by expanded normal hair bearing skin.

   This technique is superior to hair transplant because skin from the adjacent area is used to cover the defect therefore there is excellent match of skin color, texture and thickness with minimal risk of rejection and only single suture line along the scar margins.

   It is a two staged procedure. The first stage where expander is inserted adjacent to the bald area and the second stage where expander is removed and the flap advancement is done.

   Patient is discharged usually a day or two after the first surgery of expander placement and then stitches are removed at 12th day approximately. After 2 weeks, expander is begun to inflate. Inflating is done by normal saline fluid at weekly intervals and once the desired expansion is obtained in usually 8-12 weeks, the patient is again admitted for second stage surgery to remove the expander and use the expanded skin the desired way. Post operatively, the patient stays in hospital for 2- 3 days and the course of treatment is same as before except that regular monitoring of expanded skin flap is done.

2. Hair Transplantation - Hair transplantation is also an option for burn scars in hair bearing areas of scalp and eyebrows. It is really challenging for the surgeon because the scar tissue behaves differently from the normal skin. The burn scar may be due chemicals, hot fluids, electrical appliances accidentally coming in contact with the body. It is important to discuss realistic options with the patients. There are many challenges faced by the surgeon in cases of burn as compared to a normal hair transplant because of reduced blood supply and elasticity of skin and underlying tissues in and around the hair get destroyed or scarred and replaced by fibrous tissue. Hair transplantation is still the best choice for restoring hair over eyebrow region.

   Grafts can be taken from scalp/ beard for hair transplant. The goal of treatment is to cover the bald areas using hair systems or hair wigs. Hair transplantation is a surgical technique that removes hair follicles from one part of the body, called the 'donor site', to a bald patch of scalp or balding part of the body known as the 'recipient site'. Hair transplantation can be performed to cover bald patches only if there is sufficient undamaged donor hair elsewhere on the scalp which can be taken out for transplantation without any significant noticeable hair density reduction.

   For several days prior to surgery the patient refrains from using any medicines which might result in intraoperative bleeding and resultant poor grafting. Alcohol and smoking can contribute to poor graft survival. Post operative antibiotics are commonly prescribed to prevent wound or graft infections.

   The vulnerable recipient area must be shielded from the sun, and shampooing is started 5 days after the surgery. Shampooing is important to prevent scabs from forming around the hair shaft. During the first ten days, some of the transplanted hair may fall out due to "shock loss". After two to three months new hair will begin to grow from the moved follicles. The patient's hair will grow normally and continue to thicken through the next six to nine months.