NY Hair Transplant Surgery : Scalp Reductions

Additional Topics:

-	Limited role of scalp reductions
-	Use of Propecia/Rogaine
-	Transition from a hairpiece to hair transplants
-	Temple area transplantation
-	Trans-gender Transplantation
-	About Donor Scars

Links

60 Railroad Place Suite 102 Saratoga Springs, NY 12866
Phone: 518-581-1872 Toll Free: 1-800-281-9198
e-mail: saratogahair@spa.net

Scalp Reductions: When should they be done?

During the mid-1980’s these procedures were quite popular. The great advantage of a scalp reduction was seen to be that it removed a large amount of skin that then did not need to be transplanted. They have since dropped in popularity among hair surgeons for a number of reasons:

Stretchback: This has been found to occur following almost all scalp reductions to some extent. With certain types of scalps it is fairly minimal, but with many others it occurs to such an extent that the original gains of the reduction are completely lost, as the skin stretches back to almost the same position as in the beginning, thus resulting in a thinner scalp into which to have to transplant grafts. It is greatest in thin and hyper-elastic scalps, and happens the least in thick, loose scalps.

Creation of a scar: With each scalp reduction a scar is created. In the majority of cases these scars heal quite nicely and are indeed even hard to find several months later. But in some patients, this scar heals in such a way that it is wider than desired and can be difficult to hide, even with transplanting.

(to see enlarged view of transplant patients click the desired photo)
before surgery	6 weeks after one scalp reduction

Creation of abnormal directions of hair: If several reductions are performed, especially if scalp extenders are used to compound the gains, then the hair from each fringe is brought to the center and meets there, creating a "parting of the Red Sea" effect, which looks quite unnatural. This can be corrected in the rear with the Frechet "triple flap" correction procedure, but this involves a lot of surgery and carries a small amount of risk.

The fact that transplanting many small grafts enables the surgeon to cover a large area of bald skin: This is probably the biggest reason for the drop in the number of scalp reductions. During the 1980’s most hair transplantation was done using the large 4mm grafts, each of which contained 15-25 hairs. With the routine use of follicular unit grafts and small combination-FU’s using 1100-2000 per session, a large area of bald scalp can be filled in quite naturally without having to shrink it with scalp reductions.

(to see enlarged view of transplant patients click the desired photo)
Before surgery	After scalp reduction and three HT procedures. This density would not have been possible without the scalp reduction.

The techniques of scalp reduction are presently used in our practice mostly only in “corrective” cases, in which there are deformities that must be corrected by moving or removing an area of bald skin or hair that was transplanted into the wrong area. The second patient shown below (the one with gray hair) is probably the only type of patient in whom I would consider doing a scalp reduction today. It is ironically the patient with a relatively small bald crown, in whom almost total removal of the bald area is possible with the possibility then of creating a dense crown result. To give an idea of how rare these procedures are in our practice, we haven’t performed one since around 2000.