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Scalp Reduction
Surgery
1)Indications and
Patient Selection
2)Recovery
3)Alopecia Reduction
and Hair
Transplantation
4)Alopecia Reduction
Techniques
5)Potential
Complications and
Side Effects
6)Results
Scalp reduction
surgery can be used
to remove balding
areas of skin and
reduce the total
area of the scalp
that needs hair
replacement. This
procedure can only
be done on those
with loose scalps.
If this skin is
already tight, then
it won't be possible
to stretch it over
the bald areas
without the use of a
tissue expander,
such as in scalp
expansion.
Unlike scalp
expansion which
requires two
surgeries, or scalp
flap surgery which
requires three
surgeries, scalp
reduction surgery
occurs in one step.
Up to 2 inches of
balding skin is
removed, and an
adjacent area of
hair-bearing scalp
is stretched over it
and sutured into
place.
Scalp reductions do
not, by themselves,
produce the cosmetic
result of grafts or
flaps, but aid in
coverage and styling
situations. When
used with hair
grafts, scalp
reductions decrease
the area for hair
grafting. This
stretching of the
scalp can be
repeated as soon as
the scalp loosens up
enough to allow such
reduction, usually
after three months.
A process called
scalp extension can
accelerate the
reduction.
A significant
reduction can be
performed if the
scalp is loose
enough. Usually, a
portion of the scalp
two to five
centimeters (3/4" to
2") wide can be
removed in one
session. Because
the scalp is being
stretched, this
procedure diffusely
separates the hair
in fringe areas,
creating a good
cosmetic effect.
This surgery is only
effective in
covering small areas
of balding scalp
since the scalp
cannot typically
stretch very much.
For this reason,
scalp reduction
surgery is often
used in conjunction
with another method
of hair restoration
such as hair
transplant surgery,
but it will reduce
the number of hair
grafts that are
ultimately required
since there will be
less skin that needs
hair.
Scalp reduction is a
surgical hair
restoration
procedure that :
1)
surgically removes
bald scalp, and
2)
stretches
hair-bearing scalp
upward to replace
bald scalp that has
been removed.
In selected patients
alopecia reduction
is a very effective
method of hair
restoration when
performed by a
skilled and
experienced
physician hair
restoration
specialist.
Depending on
individual patient
characteristics,
alopecia reduction
may be performed (1)
as the only hair
restoration
procedure desired by
the patient, (2) in
combination with
hair transplantation
to achieve a desired
aesthetic effect, or
(3) occasionally in
combination with the
aesthetic surgical
procedure called
brow lifting to
remove frown lines
from the forehead
and crow's feet from
around the eyes.
Good candidates for
alopecia reduction
are patients with
excellent donor hair
on the sides and
back of the scalp
that can be
stretched upward to
cover areas of
excised bald scalp.
A good supply of
donor hair is also
needed to provide
donor grafts for any
supplementary hair
transplantation.
Alopecia reduction
may, in selected
patients, be carried
out by using a scalp
extension
or scalp
expansion device - a
technique that
stretches
hair-bearing scalp
skin to provide
greater coverage in
bald areas.
1)Indications and
Patient Selection
Is Alopecia
Reduction Right for
You?Any
non-emergency
surgical procedure
must be justified by
its applicability
and ultimate value
to the patient. This
is especially true
for elective
cosmetic procedures
such as hair
restoration. Full
and frank discussion
between patient and
physician hair
restoration
specialist is
essential to
determining whether
an elective
procedure is right
for you, the
patient.
Alopecia reduction
can be a very
successful approach
to hair restoration.
Is it right for you?
A number of factors
can bear upon that
decision:
1)
Physical
condition-the
patient should be in
good general health
and have no medical
conditions that
would rule out a
surgical procedure.
2)
Degree and pattern
of hair loss-the
patient and the
physician hair
restoration
specialist should
together make the
final decision as to
whether alopecia
reduction is a good
choice for hair
restoration. In
general, alopecia
reduction is likely
to be most useful in
a patient who has a
large area of scalp
baldness and an
adequate supply of
good-quality donor
hair on the sides
and back of the
scalp. Another
consideration is the
rapidity of alopecia
progression and the
likelihood that
alopecia will
significantly
progress in the
future. These
factors will
influence the need
to consider future
hair transplantation
to keep pace with an
ever-expanding zone
of baldness. The
patient who
undergoes alopecia
reduction should be
willing and able to
have future alopecia
reduction and/or
hair transplantation
and/or correction of
surgical
complications as the
need arises.
3)
Tightness or laxity
of scalp skin-scalp
skin that has very
little laxity (the
ability to stretch)
may not be a good
foundation for
alopecia reduction.
The rationale for
alopecia reduction
is that bald scalp
can be surgically
removed and
hair-bearing scalp
skin stretched up to
cover the excised
area. A substantial
degree of scalp skin
laxity is required
to make the
procedure work well.
4)
The patient's
objectives-what do
you, the patient,
want hair
restoration to
accomplish? Your
objectives,
discussed thoroughly
with the physician
hair restoration
specialist, will be
a major factor in
determining if
alopecia reduction
is a good option for
you. For example,
alopecia reduction
may be a good option
for a patient who
wants to "pull up"
all available donor
hair to provide
dense coverage of
the scalp-given that
other factors such
as scalp laxity are
favorable to that
decision.
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2) Recovery
After scalp
reduction surgery,
you will have
prescriptions for
antibiotics to
prevent infection
and pain pills to
control discomfort.
Many patients do
fine with
acetaminophen
(Tylenol) after
surgery and do not
require stronger
medication.
After surgery, you
will wear a bandage
overnight. to
protect the flap,
minimize swelling,
and absorb drainage.
It is normal to see
a few drops of blood
on the gauze. If you
notice more than a
few drops, or if the
area of blood is
increasing, call
your doctor right
away. The dressing
may be removed in
one or two days, and
sutures come out
after 7 to 10 days.
After about a few
days, you will be
allowed to gently
wash your hair. At
this point, most
people return to
work, if they
haven't already.
After about 6 weeks,
you can proceed with
hair transplant
surgery, if that was
your ultimate plan.
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3) Alopecia
Reduction and Hair
Transplantation
Alopecia reduction
is often combined
with hair
transplantation.
Hair transplantation
may be combined with
alopecia reduction
to "fine tune" hair
restoration in
aesthetically
sensitive areas,
such as the frontal
hairline that is not
treated with
alopecia reduction.
Hair transplantation
may be necessary in
future years to keep
pace with continued
loss of hair. In
younger patients,
hair transplantation
may be done first to
restore the frontal
one-third of the
scalp, with alopecia
reduction reserved
for later years if
hair loss
progresses.
Alopecia reduction
surgery can be done
before, during or
after hair
transplantation, as
indicated by the
needs and wishes of
the patient and the
assessment of the
physician hair
restoration
specialist. The
timing of combined
alopecia reduction
and hair
transplantation can
be a critical
decision that
requires full
discussion and
understanding
between patient and
physician hair
restoration
specialist. The
decision must be
individualized to
the patient, based
upon considerations
that include the
patient's objectives
for hair
restoration, cost of
multiple procedures,
degree of likely
progression of hair
loss, and the
patient's age as a
factor in likely
progression of hair
loss over a longer
or shorter period of
time.
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4) Alopecia
Reduction Techniques
A number of alopecia
reduction techniques
have been developed.
No one technique is
adaptable to all
patients. Choice of
technique is based
upon considerations
that may include
degree of hair loss,
scalp laxity, amount
and quality of donor
hair, and whether
hair transplantation
is to be a
complementary
procedure. Alopecia
reduction technique
is largely a matter
of the pattern of
scalp incision-for
example, "Y"
pattern, "star"
pattern, "lateral
crescent" pattern,
etc. The choice of
technique and
rationale for the
choice should be
discussed by patient
and physician.
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5) Potential
Complications and
Side Effects
Careful planning and
expert surgical
skills are required
to achieve good
results in alopecia
reduction.
Complications are
uncommon but there
can be postoperative
complications such
as scarring at the
suture lines,
"stretch back" of
scalp skin at the
excised bald area,
and a central
midline scar called
a slot deformity.
Side effects of
alopecia reduction
surgery are
temporary
discomfort,
swelling, and
numbness in the
operated area.
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6) Results
Once the scalp is
reduced, you may
still require hair
transplants to cover
any remaining bald
areas. Scalp
reduction surgery
does not stop hair
loss, and you will
continue to lose
hair just as you
would have without
the surgery, but
usually the effects
of scalp reduction
surgery will last 5
to 10 years or more.
Skin is removed from
within the dotted
lines and the scalp
edges are pulled
upward and stitched
in
place.
Potential results
after one or two
scalp reductions.
Further reduction
procedures may be
done.
The bald area has
been reduced by
scalp reductions.
Hair grafts are
shown filling in the
remaining bald
areas.
An example of
styling, with the
completed result
after multiple scalp
reductions and hair
grafts.
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