Fleming/Meyer Flap by Dr. Richard Fleming

Pioneers in the field of hair restoration, Drs. Fleming and Mayer have developed and/or perfected several surgical hair replacement techniques. They are especially proud to offer patients with thinning hair and/or baldness the revolutionary Fleming/Mayer flap in Beverly Hills. This remarkable procedure delivers immediate, natural-looking results, allowing patients to enjoy full, natural-looking hair for years to come. In the paragraphs below, Drs. Mayer and Fleming provide comprehensive information for potential Beverly Hills Fleming/Mayer flap patients.

The term “Flap” is generic. There are many different types of Flaps, including differences in size and shape, as well as numerous surgical techniques for developing and moving this hair-bearing tissue. When we talk about Flaps, we must be careful to delineate which procedure they are talking about. The following is a discussion of the Fleming/Mayer Flap.

The surgeons at The Beverly Hills Institute researched an idea conceived by a South American surgeon, and have spent more than 25 years enhancing and perfecting his procedure to make it the most natural form of hair replacement surgery in the world. They have made so many major innovations on the technique that it is now known as The Fleming/Mayer Flap. The doctors authored a textbook for plastic surgeons describing this and other hair replacement techniques.

The Fleming/Mayer Flap is a procedure requiring great skill and expertise to achieve the best results. The surgery is performed in three stages at The Beverly Hills Institute’s out-patient surgery center. The first two procedures are performed one week apart and are done under local anesthesia. These preliminary steps separate the Flap from the surrounding skin except at the forward end of the Flap, which will be the entire source of nourishment when the Flap is moved to the bald area.

In the first procedure, you and your Beverly Hills Fleming/Mayer flap doctor design your new hairline. The doctor then marks the outline of the Flap on the side of your head. Then incisions are made along both edges of the Flap, three-quarters of its length (see left-hand figure below). No incisions are made around the tail-end at this time. The incisions are immediately closed, and a dressing is applied. When that dressing is removed the morning after surgery, you can return to non-strenuous work. One week later, you return for the second procedure. This time incisions are made around the tail of the Flap, and the edges of the incisions are sewn together (see left-hand figure below). Again, you wear a dressing overnight, and can return to work the next day. Up to this time, no hair has been moved and nobody other than the patient is aware that surgery has been done.

Fleming Meyer Flap scalp reductions

The Flap is transferred one week later (two weeks after the first procedure). Using light, general anesthesia, the bald scalp is removed and replaced with the Flap, which has hair of normal length, texture and density. With only frontal baldness, one Flap may totally eliminate the baldness. For Beverly Hills Fleming/Mayer flap patients who have or will develop more hair loss, a second Flap can be moved from the opposite side of the head in about three months, and placed behind the first Flap (see middle figure above). Scalp Reductions are then done between the Flaps, and behind the second Flap (see right-hand figure above).
patient's hair bearing scalp after procedure
The area from which the Flaps are taken is closed by stretching the surrounding normal hair-bearing scalp, leaving a line which is undetectable within the hair (see left).

The discomfort of this operation is minimal. A dressing is worn for three to four days; no hair is cut during any of these procedures so the hair may be shampooed and styled immediately after dressings are removed. The stitches at the hairline are removed after six days; after ten to fourteen days, the stitches behind the Flap and on the side of the head are removed.

Because the Flap is never totally separated from its blood supply, there is normally no temporary hair loss as occurs in hair transplant surgery, and therefore, coverage is immediate. This means that a patient with frontal baldness can return to work one week after a Fleming/Mayer Flap in Beverly Hills with a full head of hair. Some bloggers from hair transplant centers criticize the fact that Flap patients “suddenly have hair.” Our patients feel that this is an advantage, not a disadvantage. With hair transplants, the hair usually falls out and doesn’t begin to grow for three months. They do not want to waste several months after a transplant session with a strange looking scalp secondary to irregularity of the surface, redness, and stubble of hair which does not look natural. Therefore, it takes several months for the patient to style this hair after growth has progressed. Since the Flap involves a basic rearranging of hair which is already in a normal growth cycle, the hair itself remains unchanged. There is no change in hair texture or curl, as occurs with transplants. Large amounts of hair, the equivalent of approximately 10,000 transplants, but with much greater density, are immediately transferred. No other procedure moves more hair in a shorter period of time, or looks as natural as the Fleming/Mayer Flap.
natural hairline after flap operation
Among our significant refinements of the Fleming/Mayer Flap is the “sculpted hairline,” a procedure designed to create an extremely natural hairline. Originally, some 30 years ago, the hairline was made straight but we created this technique so that now it has a natural irregularity. The new hairline is created so the hair will grow through and in front of the incision (see photos above). On some patients we recommend a few micrografts at the hairline to “soften” the hairline (see photo below). Post-operatively, you can engage in any type of activity without worrying about maintaining a specific hair style to camouflage an undesirable result.

uniform hair density on patient 's calpResults are natural and dramatic, as you can see in the before and after photographs in our Photo Gallery. The thick hair without any change in texture, the immediate results, and the ability to return to work within one week after the Flap transfer, makes this procedure state-of-the-art in hair replacement surgery. Patients now have the ability to maintain an active life with freedom from an unnatural appearance.

Some patients with tight scalps will require tissue expansion in conjunction with the Fleming/Mayer Flap . This procedure is described in another section of this discussion.

The hair density provided by these procedures permits easy and varied hair styling because it is uniform, and as thick as the hair on the side of the head. Hair transplants require careful styling to give the illusion of coverage of the bald area. This illusion quickly disappears when the patient goes swimming, plays tennis, or engages in other physical activity. Flap patients do not worry about this. They can comb their hair straight back, part it anywhere along the hairline, and engage in any type of activity without worrying about their appearance.

Some have questioned the direction of hair growth after Flap surgery. For those not initiated to this discussion the direction of hair growth within the Flap may be different from your original hairline. Instead of growing forward or toward the front of your head as usually happens in most men, the Flap hair grows toward the back and side of your head. This difference in the growth is not viewed as a problem by most patients because of the uniform density that occurs within the Flap hair. Therefore, hair direction is a moot discussion because of the natural density and uniformity (see Photo Gallery for varied hair styles).

Drs. Fleming and Mayer have performed their Fleming/Mayer flap in Beverly Hills on many men who were dissatisfied with their results of previous hair transplantations. They are frequently able to salvage these unsatisfactory results. However, if grafting has left too much scarring in the donor area, the patient may not be a candidate for the Fleming/Mayer Flap.

Drs. Fleming and Mayer have performed hair transplants as well as Flaps for 30 years. Therefore, you get the procedure that is specific to your particular needs. Unfortunately, doctors who do only transplants can be intimidated by the results achieved with the Flaps. The comparison below illustrates the advantages inherent in the Flap technique when compared to grafting.


  • Hair is uniform and can be combed in any direction, even straight back, with a natural appearance.
  • Surgery is undetectable, even when hair is blown or wet.
  • No change in hair texture.
  • Hair density is perfectly thick and natural.
  • Never need additional work within the Flap area.
  • Results are immediate. Hair does not fall out. Patient returns to work 4-6 days after Flap with hair in place.
  • Cost is comparable to, or less than, the equivalent number of plugs, with much better and immediate results.
  • Equivalent to 10,000 transplants.


  • Hair must be styled to conceal low density and change in texture, which gives the appearance of graft transplants.
  • Visible when hair is parted through the transplanted area, or when hair is disturbed.
  • Hair may be kinky and wiry.
  • Even with many grafting sessions, at best only 50% density is achieved.
  • Continued hair loss in grafted area, and requires future procedures.
  • Usually takes months to years to complete. Transplanted hair falls out, and will take several months to begin to grow.
  • Cost per graft can be spread over the several years it takes to complete the process.
  • Even at “bargain basement” prices, grafts actually cost more than the Flap.